CARE HOMES FOR OLDER PEOPLE
The Knowle Care Home 5 - 7 Egerton Road Ashton Preston Lancashire PR2 1AJ Lead Inspector
Mrs Felicity Lacey Announced Inspection 18th October 2005 10:00 X10015.doc Version 1.40 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 Knowle Care Home DS0000062611.V252375.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 Older People. 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 Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Knowle Care Home Address 5 - 7 Egerton Road Ashton Preston Lancashire PR2 1AJ 01772 727485 01772 731670 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) The Knowle Care Home Ltd Mrs Susan Burns Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home may accommodate up to 23 persons in the category OP (older persons). 30th June 2005 Date of last inspection Brief Description of the Service: The Knowle is registered as a care home providing accommodation and personal care for up to 24 older persons of either sex aged 65 years and over. There are 21 service users presently accommodated. The home is situated in a residential area on the outskirts of Preston. The Knowle is a large Victorian property that is in keeping with the surrounding area and it has retained many of its original features. Service users accommodation is provided on ground and first floor and access is provided by a passenger lift. There are fourteen single and five double bedrooms, five of which have on-suite facilities. Communal areas comprise of two lounges, a dining room and a conservatory, these are situated on ground floor. There is a pleasant secluded garden at the rear of the home with ramped access. The Knowle is reasonably close to shops and local amenities, and has excellent transport links for the city centre. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection?
The manager and staff have improved infection control procedures. All staff have received training and are aware of the need to put procedures into practice at all times to prevent the spread of infection. There have been improvements to the exterior of the building and there has been refurbishment of some bedrooms. The bathrooms and toilets have been fitted with new blinds. Cleaning schedules have been introduced and monitored to ensure that all parts of the home are kept clean. The home has acted on recommendations from the Environmental Health Department to improve the health and safety measures at the home. Medication procedures have been improved. The way of recording visits of medical personnel has been improved but needs further refinements. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 6 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 Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 All prospective residents have their needs assessed prior to admission and this ensures that the home is able to meet the identified needs and provide appropriate support. EVIDENCE: The residents who have recently come to live at the home had been assessed prior to admission by the manager and her deputy. All prospective residents are visited prior to their decision to move to The Knowle. The pre admission assessment forms the basis of the residents care plan. Social work assessments are held on file. All prospective residents are encouraged to visit the home prior to moving there and have a 4 week trail period in which to decide whether the home suits their needs. The residents spoken with felt that they had been able to make an informed decision and that the home lived up to their expectations. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The residents spoken with were confident that the staff of the home have a good understanding of their care needs, and that this is demonstrated in the way in which support is offered. EVIDENCE: Care plans contained information that related to the physical care needs of residents and recreational interests. The care plans are currently reviewed regularly by the deputy manager of the home to ensure that they remain accurate. All residents have an allocated key worker who takes a particular interest in their welfare. Health needs are monitored and records show the frequent involvement of health professionals and the outcome of these visits. These records should be maintained individually to ensure that confidential information is not shared (see NMS 37). The residents spoken with felt their health needs were met at the home. The home has worked closely with local health professionals to continue to care for
The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 10 some residents who have experienced deterioration in their health needs. There are a number of residents who require regular visits from the district nurse and the advice given regarding their care is documented. All residents have access to specialist services as required, for example dental treatment, hearing and sight tests. Medication procedures have been improved there has been a new system of recording the receipt and ordering of medication to ensure accurate records of the medication at the home are available. The home has purchased a fridge for the storage of medication. The staff of the home have undergone training in medication administration and recording. The residents spoken with felt that the staff of the home were courteous and respectful. The GP who completed a questionnaire confirmed that all consultations take place in private. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents benefit from support in maintaining personal relationships. The choices and preferences of residents are respected. The gathering of information of the life experiences of residents would further ensure that the service offered is in line with their cultural and social expectations. EVIDENCE: The homes approach to providing recreational and social activities could be improved by highlighting the previous life experiences of the residents in the care plan, for example recording jobs held and significant events. By gathering information, with the consent of the resident, regarding life experiences before moving to the home staff will gain a valuable insight into the social and cultural needs of the individual. Residents were happy with the activities currently on offer, and these can be further improved by offering the opportunity for trips outside the home. Residents are able to receive visitors at any reasonable time. The staff at the home make visitors feel very welcome, this was confirmed by a visitor at the time of the inspection. The importance of keeping contact with family and friends is appreciated by the staff team, who assist residents to maintain regular contact by phone or letters. In some cases staff keep families and representatives informed of the progress of the resident through regular phone calls. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 12 Some service users retain control over their own finances in line with their preferences and other have an appointed agent. The policy of the home is to encourage independent administration of financial affairs. The residents considered the meals served at the home to be tasty and wholesome. Hot and cold drinks are readily available. Residents may choose where to have their meal, whether in the dining room or in their own bedrooms. Particular dietary requirements are followed as advised by the residents GP. Residents are assisted at meal times in line with their personal care plan. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a complaints procedure and service users are encouraged to make their concerns known, service users and their supporters are confident that any complaint they may have will be treated with importance. EVIDENCE: The home has a complaints procedure and this information is given to all residents or their representatives at the time of admission. The Commission for Social Care inspection received one complaint since the last inspection and this has been acted upon by the home and appropriate action taken to resolve the concerns raised. Residents spoken with during the inspection said that they raised anything they were not happy about with the care staff who sorted their concerns out. Concerns related largely to housekeeping matters, for example the temperature in a particular bedroom. A record is kept of concerns raised and the action taken to remedy them. An individual record of each complaint should be kept, to allow for confidential information to be stored correctly (see NMS 37). The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home and its grounds provide clean and comfortable surroundings with sufficient facilities for the needs of the service users. EVIDENCE: There have been improvements to the exterior of the home. Internally some carpets have been replaced and recommendations by the Environmental Health Department have been implemented to reduce identified hazards in the home. There is an open stairwell that is not used by residents but is accessible, and this should be risk assessed to ensure that it poses no danger to the safety of residents. The home has improved the systems of monitoring to ensure all parts of the home are kept clean and odour free. Toilets and bathrooms are checked every 2 hours to ensure they are kept clean. The downstairs shower room would benefit from decoration and the replacement of the broken edging to the shower tray. All bathrooms and toilets have been fitted with roller blinds. The residents spoken with were pleased with the standard of cleanliness at the home.
The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 Recruitment procedures must be followed and appropriate checks sought to protect residents welfare. Staff are being given training opportunities to ensure their practice is based on understanding and the values of good quality care. EVIDENCE: The home has a recruitment procedure which is being followed in the main. References and completed application forms were seen on file. However there was an instance where a member of staff had been employed prior to receipt of a satisfactory Criminal Record Bureau disclosure or a POVA First check. This issue was raised at the previous inspection and it remains important that all staff are employed only after the required checks have been completed. All staff are currently registered on National Vocational Qualification courses, through a variety of providers. Assessors frequently visit the home. The manager appreciates the need to ensure that all staff undertake training and a commitment to this effect is contained in the terms and conditions of employment. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,37,38 Staff are appropriately supervised and have a clear understanding of their role and duties. All aspects of health and safety are monitored and this provides a safe environment in which to live and work. EVIDENCE: The manager of the home is continuing to work towards completing her NVQ 4 award. She is supported in her management role by a deputy manager. Staff members receive regular formal supervision in which they discuss the day to day running of the home and their own personal practice. This is complemented by an annual appraisal system during which the staff member and the manager complete an assessment of the workers performance and identify areas for further development. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 17 The records stored and maintained at the home are kept secure. However, the format of recording should be such to allow residents to view their individual record and in line with the Data Protection Act 1998,the records of medical visits and complaints as detailed in previous sections must be maintained on an individual basis. The home has recently appointed a health and safety representative. The local Environmental Health Department have inspected the home and the recommendations made have been acted upon. The Pre Inspection questionnaire indicated the all routine health and safety checks have been carried out, with the exception of the renewal of the electrical wiring certificate which is due this month. Infection control has been highlighted over the past few months. Staff have received formal training and are aware of the measures in place. Gloves and aprons are available and the manager is ensuring that the procedures in place are followed by all staff. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 3 2 3 The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES 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 Standard OP29 Regulation 19 Requirement A new worker must only start work if a CRB disclosure has been applied for or a POVA First check obtained. This requirement was also made with immediate effect at the inspection of 19.10.04. The unguarded stairwell identified at this visit should be risk assessed and any identified measure to reduce risk put in place. Timescale for action 18/10/05 2 OP38 13 18/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP26 OP28 Good Practice Recommendations Social histories should be gathered to ensure service meets cultural and social expectations of residents. The shower tray in the downstairs bathroom should be repaired. 50 of staff should achieve an NVQ in Care by December
DS0000062611.V252375.R01.S.doc Version 5.0 Page 20 The Knowle Care Home 4 5 OP31 OP37 2005 The registered manager should achieve a NVQ level 4 in Care and Management by December 2005. All records should be maintained in accordance with the Data Protection Act 1998. The Knowle Care Home DS0000062611.V252375.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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