Inspection on 09/01/06 for The Knole

This inspection was carried out on 9th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Knole 19/11/08

The Knole 12/11/07

The Knole 24/10/06

The Knole 26/09/05

The Knole 10/03/05

The Knole 06/09/04

The Knole 25/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Knole 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE Lead Inspector Mr Peter Still Unannounced Inspection 9th January 2006 13:45 The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Knole Address 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE 01242 526978 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) knole@langleyhousetrust.org The Langley House Trust Mr Malcolm James Gardiner Care Home 10 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (3), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (5) The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be over 30 years of age, of which five will be over 65 years of age at the time of registration All Persons accommodated will be male Date of last inspection 26th September 2005 Brief Description of the Service: The Knole is a care home operating within Christian principals that provides registered accommodation for up to ten males who have mental health needs. Two places are registered for learning disabilities and up to five for service users over 65 years of age. The home is a detached Victorian listed building situated in extensive grounds approximately one mile from the centre of Cheltenham. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours. 6 staff were on duty, including the manager with 8 residents and a further 5 people under Supporting People arrangements. There was 1 vacancy. 4 residents and 3 staff were spoken with specifically and other residents were observed and talked to briefly. Time was spent with the manager considering the actions he had taken since the last inspection and a tour of the building was made. Two additional people live off site and are provided with support when needed by the home staff. Significant buildings works were completed at the end of November to upgrade the whole property, which will provide residents with a very good environment to live in and will be easier for staff to provide support and manage the care to residents. What the service does well: What has improved since the last inspection? The extensive building works have been completed. Requirements from the last inspection have been addressed. The home now has a good office for staff to work from and the manager has his own small office too. All staff vacancies were filled by the end of the year. The provision of more comfortable places for residents to enjoy communally at the home and the inclusion of a training kitchen are likely to become valued facilities by residents. Access from the kitchen to the dining room was said to be working well. The drainage system, The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 6 which had caused problems to the building has now been rectified and damp was not evident in the cellar. There had been positive feedback from recent team meetings and as a consequence some procedures had changed and there had been positive learning points for staff and manager. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Sufficient pre admission information ensures the home can meet the needs of residents. EVIDENCE: The home ensures placing authorities provide documentation, which the home finds satisfactory in considering whether or not the needs of residents can be met and evidence concerning a recent person admitted, showed the home was able to complete a detailed assessment of needs. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 Care plans need review to ensure the information is collated in such a way that it can be easily referenced and risk assessments are provided. Residents were aware of their care plans and make decisions, with assistance, about their lives. EVIDENCE: Three residents said talked about their care plans, which they discuss with key workers. Key workers review care plans on a two weekly basis, using a dedicated form and including short and long-term goals. External agencies are involved when needed. Where residents have issues, the inspector was told these could be discussed at any time with staff or their key worker. Key information was recorded but was not organised in a way that was easy to reference, presenting a risk that a key point could be missed. Key worker forms were signed and up to date, but the main file for a resident recently admitted was not signed by the resident or key worker as indicated on the document and not held within the key worker/care plan file. A review of files must take place to ensure all information is where it should be and has been properly signed. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 10 Risk assessments had not been provided within files and should be kept in a section that is immediately identifiable. Staff need to have quick access to risk assessments and be able to see triggers and steps the resident and staff should take to reduce the risk. This would include guidance or instruction to staff on the way they are to respond. Developing this practice would also ensure a consistent approach from staff. The manager and another member of staff felt it would be helpful to review the current care planning arrangements to improve the way information is held, including risk assessments. Immediately following the inspection, the manager, who should be commended, submitted a risk assessment format to the Commission for comment. This showed a determination to act swiftly on issues identified. One resident file showed evidence of the resident making decisions on a significant matter with assistance from staff. One member of staff felt that further external input to support a resident would be helpful and that this may include training and guidance for the key worker and staff team on ways of working with people who have mental health needs and the specific issues staff identify in trying to support the care for residents. These points need to be raised within care planning so that agreement can be reached on steps to take, by whom and by when. The telephone for residents had been relocated to a more private place at the entrance of the home and a chair provided. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 17 Residents enjoy a range of activity away from the home and there are plans to re-establish more interests within the home in the near future. Residents were offered a healthy diet and the refurbished kitchen, with new training kitchen will support good food preparation and independence for residents. The extractor for the cooker must be installed urgently. EVIDENCE: Staff work hard to promote and find a wide range of activity and learning opportunities for residents within the local community. Some residents attend college and day centre, one resident plays the organ at a local church; the local gym is also used. The grounds at the home are extensive and large beds had been well prepared ready for propagating vegetables. Staff and residents had also been planting new shrubs. Within the home, the building works had only just been completed and there were plans to bring the art and crafts room back into use in the near future. The snooker room, which had water on the floor at the last inspection, had no indication of damp and had been redecorated. Residents said they did not use the snooker room, but hopefully will do so in the future, as staff work to encourage more activity within the home. The ground floor of the home had been reorganised within the refurbishment and there are now two lounges, which residents said they were The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 12 very happy with. The dining room was also used and a resident was working in the training/independence kitchen, pickling of a large number of eggs for the home. The menu was seen to provide a balanced diet and residents said they enjoyed the food. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 Most residents considered their emotional and health needs were being met. Training for staff concerning medication may be valuable. EVIDENCE: Four residents were spoken with and were positive about the way they can talk with staff, who listen to their needs and support them. One resident wanted to specifically talk with the inspector and said that he was not happy “picking up” on some unrest amongst staff. This was a reference to a previous period at the home and it may be that the steps the manger had been taking may have led to recent improvements but the point made by the resident should be a trigger for the manager, his senior staff team and all staff at the home to continue to consider ways of ensuring a fully cohesive and informed staff team. One member of staff said training for staff on specific areas of their work, including mental health was needed and previous requests for training had not been responded to. It may be helpful for the manager to approach the local pharmacy to see if they would be willing to provide some reinforcement training concerning practice in the control, dispensing and disposal of medication. The home has policy and procedures for medication and the system was not inspected on this occasion. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 14 The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Regular resident meetings and key worker support ensures residents were listened to. Training to ensure staff are up to date and confident with their responsibilities to protect residents from abuse must be provided. EVIDENCE: The manager has now recently established residents meetings twice a month, one being held on the day of inspection. The inspector was given the notes of the meeting for 19/12/05, which was comprehensive and well recorded. Four residents said staff and key workers do listen and address issues. Residents and staff had been given contact details of the Commission. A questionnaire for residents to complete was raised in minutes of the residents meeting but related to the building. In terms of a quality assurance audit, it would be important to broaden the remit of the questionnaire. One member of staff could not recall specific training concerning adult protection and “No Secrets”. Policy and procedure was available but regular reinforcement training was not being provided. The manager should seek suitable training for the staff team so they can confidently understand signs of abuse, the requirements around “No Secrets” and the steps staff must take if they have a concern or witness abuse of any kind. The manager said he would consider how this could be provided. One resident told the inspector that he had seen a member of staff being abrupt with a resident concerning a meal and that food had been prepared in the kitchen, whilst builders were working there and he felt it had constituted a health and safety risk. The inspector said it was important to raise concerns with staff. It may be helpful to talk to residents at a residents meeting about making complaints, and that staff would welcome feedback to promote change. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 16 The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 30 The providers have achieved significant improvements to the environment following extensive refurbishment to the whole home. Issues identified requiring action must be addressed swiftly, including windows requiring restrictors, which must meet health and Safety guidance. EVIDENCE: The providers should be praised for the significant improvements that have been made to the environment at the home. The exterior stone work had been cleaned and looks very good indeed; the drainage system, which was causing problems had been altered; a new boiler system had been provided; internally the home had been fully refurbished, providing more spaces for residents to enjoy and choice of who they wish to spend time with communally; The kitchen had been refurbished to a high standard and a new independence/training kitchen provides a valuable resource for residents. The home was clean, tidy and comfortable. Three residents said they were very happy with their new bedrooms and pleased with the results. Many bedrooms seen had been highly personalised by the residents, and the rooms were clearly “Home”. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 18 Two members of staff raised concern that some key outstanding issues regarding the building had not been dealt with even though they had been raised a number of times following the main completion of works at the home. The last regulation 26 visit report submitted to the Commission provided a thorough update on the situation and recorded that staff had found a number of additional issues, apart from the 117 identified by the architect on 07/12/05. This must be very frustrating for the residents, staff and the Trust. A requirement will be made for a list of key health and safety issues to be drawn up so that these can be attended to as a priority. Two members of staff were concerned that following completion of building works, the extractor hood for the cooker had not been installed. This must be addressed urgently since catering was being completed in house again. The fire alarm had also been frequently activated by smoke in the kitchen. If the 999 and evacuation procedures are not followed on every occasion there could be a risk of a real fire and so this is an urgent matter. A resident showed the manager a WC, which had the seat missing and another with the seat about to fall apart. Windows had been fitted with restrictors, which the manager felt complied with the standard. The inspector was concerned and agreed to seek advice and it was found that the restrictors do not comply with recent national health and safety guidance and a remedy will be required. The restrictors were attached by a chain and a detachable pin bar to the metal casement of the window. Health and safety guidance called “Falls from windows in health and social care”, says that windows more than 2 metres from the ground, which can be opened and are large enough for people to fall out should be restrained sufficiently to prevent such falls. Advises to restrict the opening to 100 mm; casement windows restricted by the fitting of a chain between the frame and opening light. Any restraining device and fixing should be strong enough to withstand damage and should require a tool to adjust or remove them. Any window alteration should be discussed with the local fire prevention office. Bedroom 8 was unoccupied and did not have a window restrictor. The room should not be used until a suitable restrictor is in place. As a thank you to the residents for the many months they have had to cope with the building works, the Trust decided to offer a splendid full day out to London, and details of this were seen in the residents meeting minutes dated 19/12/05. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 Residents are supported by a number of staff that had completed their NVQ level 3 training. The manager was continuing work on improving good staff moral. CRB checks must be available at the home for inspection. EVIDENCE: Staff vacancies were filled by the end of last year and the new staff were being inducted. Two members of staff hold NVQ level 4; 6 have completed Level 3 training and of these staff, 4 were awaiting their certificates. One member of staff had commenced the training. The manager and other staff considered that staff moral had improved and previous issues resolved. Two staff provided thoughtful and balanced views concerning issues, which need more time or consideration to ensure a fully positive atmosphere at the home and both staff felt they too had a role in promoting this. The manager will need to continue with his positive steps to ensure staff can talk through any points, which will improve the smooth running of the home and general contentment of staff. It was pleasing to hear that there had been positive feedback from recent staff supervision sessions. The third senior member of staff was positive towards the senior staff above him and of the general staff team. He was not able to say that he was fully aware of all management decisions since he does not attend the senior team meetings and that on occasions information comes from other staff. It was clear that he has an important role and wishes to promote a consistent line on the management of the home. The manager should consider seeking frank The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 20 discussions with this member of staff and find ways of ensuring he is kept in the loop of information so that he can be the positive force at the home he wishes to be in moving practice forward. A requirement will be repeated that the original CRB documents must be held at the home until inspected by the Commission. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The manager takes account of issues raised to ensure residents live in a home with a positive atmosphere. Residents feel their views and needs are taken into account. Some health and safety issues need addressing to protect residents. EVIDENCE: The manager works positively to create a good atmosphere within the home and to address issues of concern. The regulation 26 visits undertaken by the provider have been noted as very thorough and the points made would be valuable to the manager and staff at the home. The extensive building works have taken up a great deal of management and staff time over many months and staff were happy that they will be able to resume their full concentration on supporting residents. All but one requirement from the last inspection had been responded to and the provider was awaiting a response from the Commission regarding this, concerning CRB checks, which was the only remaining item. Outstanding works to the building The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 22 following completion at the end of November 2005 will need to be resolved and the health and safety items must be identified and addressed swiftly. The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Knole Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000016612.V272427.R01.S.doc Version 5.0 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA24 YA35 Regulation 13 (4) c 18 (1) c (i) 12 (5) & 21 19 Requirement Concerning the building, draw up list of health & safety issues and ensure their speedy resolution. Consult staff about training needs. Respond to repeated requests and provide a training plan. Continue to improve communication and openness between management and staff. Ensure CRB checks for all staff are at the Care Home so they can be inspected by the Commission (Previous timescale of 16/12/05 not met) Provided risk assessments for each resident. Review care planning file system to ensure documents are in the correct place and easy to reference, signed and dated. Timescale for action 31/03/06 28/04/06 3 4 YA38 YA34 31/05/06 31/03/06 5 6 YA6 YA6 15 15 28/04/06 28/04/06 The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Knole DS0000016612.V272427.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!