Inspection on 02/10/07 for The Knowle Care Home

This inspection was carried out on 2nd October 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Knowle Care Home 14/08/06

The Knowle Care Home 17/01/06

The Knowle Care Home 18/10/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Knowle Care Home 5 - 7 Egerton Road Ashton Preston Lancashire PR2 1AJ Lead Inspector Mrs Felicity Lacey Unannounced Inspection 10:00 2 October 2007 nd 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.V345094.R01.S.doc Version 5.2 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.V345094.R01.S.doc Version 5.2 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.V345094.R01.S.doc Version 5.2 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). 14th August 2006 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 23 older persons. There are 21 residents 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. Residents accommodation is provided on ground and first floor and access is provided by a passenger lift. There are fifteen single and four 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 fees at the home are £386 per week. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home. During the visit the inspector was able to speak to people who lived at The Knowle, staff, visitors and the manager. Case records and documentation kept at the home were looked at. A tour of the premises took place. As part of this inspection the manager provided written information about the running and administration of the home. Surveys were sent to a sample of residents, relatives and health and social care professionals. 11 surveys were returned. What the service does well: What has improved since the last inspection? The staff team have continued to add to their skills through regular training. Activities offered in the home have improved and there have been limited trips out. Regular meetings have been held with residents to help decide what The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 6 activities people would like, to discuss menus and to give people a chance to raise any concerns. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 8 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.V345094.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Pre-admission assessments are completed and this ensures that a decision to move in is based on an understanding of individual support needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents spoken with confirmed that in some cases they had the opportunity to visit the home before moving in, other people came from hospital and their relatives had been involved in planning the move. In all cases staff from the home had completed an assessment of need. Examination of case files showed that a pre admission assessment was completed and other relevant assessments from health and social care professionals were considered, this information ensured that the staff of the home are aware of the personal care needs of prospective residents and are able to meet these needs. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. The staff of the home meet the personal care needs of residents and work with other health professionals when required, this ensures that the welfare of residents is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents care plans identified the support needs and the level and type of assistance required. Care plans are agreed and signed by the resident or their representative. In some cases social histories have been compiled and this gives a good insight into the residents personal life experiences. There are separate care plans for night and day. Staff spoken with were aware of the care plans. Care plans are reviewed regularly and any changes noted. Care plans are supplemented with District Nursing care plans, these document the health care needs that are met by the District Nursing team. It is important that any change in the District Nurse plan is clearly recorded by the staff of the home in the residents care plan. In one case advice regarding pressure area The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 11 care and the frequency of turning a resident had not been accurately recorded on the care plan, which had been reviewed regularly. The member of staff who completes the reviews explained that the frequency with which the resident was turned was influenced by other factors, however even though staff may have personal knowledge of this the written care plan should give accurate and full advise to avoid confusion, and to provide a clear record of care given. Residents spoken with thought that their health needs were understood and confirmed that the staff acted on any request to contact health services. There was evidence on files seen of the involvement of a range of health professionals. Medication is administered by staff who are trained in safe practices. The records seen were completed accurately and provided an audit trail for medication received, administered and returned. Residents who wish to retain control of their own medication are able to do so in line with an individual risk assessment. Residents spoken with felt that their privacy and dignity was respected by staff at the home. Since the last inspection a concern was raised about the inappropriate use of a residents room for treatment, this issue has now been dealt with and all staff are aware of the need to ensure that residents bedrooms are their own private space and this must be respected at all times. The importance of privacy and dignity is stressed during induction and is given further consideration in National Vocational Qualification training. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. The interests of residents are reflected in the activities on offer at the home, visitors are made welcome and this ensures that residents can have an active social life in line with their own preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an increase of activities available within the home. Residents have been involved in deciding which activities they would like to be involved in. There are regular aromatherapy and beauty treatment sessions. Bingo remains popular. Sing-a-longs and music afternoons are enjoyed by some residents. Other residents enjoy spending time in their own rooms, some residents enjoy knitting and crocheting. Residents spoken with were satisfied with the activities offered in the home, however the lack of opportunity to go out and about was commented on by some residents. There has been an organised trip out which people enjoyed, however there are limited opportunities to go out in the local community. On occasion staff are able to accompany a resident to the local shops or for a walk around the block, but opportunities are very limited. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 13 Friends and relatives are made welcome at The Knowle. Visitors spoken with were very pleased with the standard of care at the home, they felt they were always made to feel welcome. Visitors are able to come at any time and may join in activities or share a meal. Residents can entertain visitors in the privacy of their own room or in one of the communal areas. Residents at the home manage their own financial affairs, or if they are not able to do are encouraged to appoint an agent to act on their behalf. Residents are able to bring their own possessions to the home and are encouraged to arrange their rooms as they choose. Residents were pleased with the quality and choice of food on offer at the home. There is choice at each mealtime. Some residents enjoy a cooked breakfast and others prefer cereal and toast. Meal times are flexible and the choice of the resident where to have their meal is respected. Residents spoken with confirmed that were asked about their preferences and could request particular favourites. Residents have been involved in planning the menu. Specialist cutlery and equipment has been purchased for some residents to help promote independence when eating. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. The complaints and safeguarding procedures are understood by staff and residents, this promotes the welfare of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place. There has been one complaint received by the Commission for Social Care Inspection which covered a range of issues regarding health care at the home. The complaint was investigated and responded to in line with the procedure. Where improvements were needed steps have been taken to ensure these have been made. The way in which complaint investigations are recorded was discussed as the response to this complaint contained some additional descriptive information, which did not appear to add to the outcome of the investigation. It is important that factual information is presented and any limits on a person capacity should be noted, however this should not detract from the importance of concerns raised and the approach to resolving matters. Staff spoken with understood how to respond to complaints. Residents who spoke with the inspector during the visit where clear about how they would approach any concerns, and were confident that the staff would do their best to resolve any issues. Two surveys from relatives indicated that they were not sure of how to make a complaint. Residents who completed surveys did not indicate that they knew how to make a complaint, however they knew who to The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 15 speak to if they were unhappy. It would be advisable to ensure that all residents and relatives are clear in how to raise a complaint or concern if they felt they needed to do so. The Knowle has an adult protection policy and whistle blowing procedures in place. Staff confirmed that they were aware of the procedure to follow is there was any case of suspected abuse. The National Vocational Qualification programme also provides awareness and understanding of adult protection and safeguarding issues. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26 Quality in this outcome area is adequate. The quality of decorations, furnishings and the fabric of the building needs to be improved to provide a pleasant environment in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Knowle has a number of communal rooms and a large conservatory. There is a pleasant garden area to the rear of the property. The home was very warm at the time of the visit. The decoration and carpeting of the home is in need of renewal. In the corridors on the ground floor the carpeting is stained and worn. A tour of bedrooms showed that the decoration, furniture and carpeting was in need of renewal. For example in one room the curtains were threadbare in places and handles were missing off the wardrobe. In another room walls were stained and the window frame was in need of urgent attention as it had rotted through The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 17 and bare wood was exposed. It is important that an audit of redecoration and refurbishment needs is completed. A plan to address how the improvement of the quality of the environment is to be achieved and a timescale for these improvements should be devised and implemented. The home was clean however in some rooms there were cobwebs high on the ceiling and it is important that these areas are regularly cleaned. The home has employed more domestic staff since the last inspection, and the manager has introduced monitoring checks to ensure that standards of cleanliness are maintained. There are infection control procedures in place and staff were observed using protective gloves and aprons. 10 staff have completed training in the prevention of infection and management of infection control and it is planned that the remaining staff will complete this course. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. Staff have access to regular training opportunities which means that residents benefit from being supported by competent staff. Staffing levels at the home have fluctuated and this should be monitored to ensure that the needs of residents are consistently met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has experienced a period of staff shortages and this created difficulties, however over the past months the staffing situation has stabilised. In the main the residents spoken with felt that there were enough staff on duty at most times, however there were times when staff were very pressured in the range of tasks they had to do and this impacted on the care received by residents. For example on the day of the visit to the home a staff member was off sick, this meant that one resident was not able to have a bath in the morning as she would have liked to, and also that a planned walk out with another resident was delayed. The impact of the duties required from some staff should be considered when determining the staffing levels required to meet the needs of the residents. Currently the Officer in Charge is undertaking tasks, which are essential in the day-to-day management of the home, for example liaising with health professionals and updating records and care plans. The manager is involved in The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 19 the administration of the home and overseeing plans affecting the future of the home. The responsible individual should monitor the level of delegation of management tasks and replacement staffing hours should be provided if needed to ensure there are adequate numbers of staff to meet the assessed needs of the residents at all times. The Knowle has exceeded the recommended ratio of staff with a National Vocational Qualification in Care at Level 2 or above. Those staff who have not yet achieved this qualification are enrolled on courses. The staff spoken with felt that training was encouraged and regular opportunities were given to update and add to their skills. Recent training addressed pressure area care, First Aid and Infection Control. Staff files showed that the recruitment procedure of the home was being followed. All employees complete an application form and have the required checks completed prior to employment. Staff spoken with confirmed that they had received an induction and were supported by the officer in charge and the registered manager in carrying out their duties. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. The management team of the home provide support and direction for staff, and regularly seek views of residents this provides an open and inclusive environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is experienced and supported in her role by the Officer in Charge, who is also experienced and competent in her role. The manager is continuing to work towards achieving her National Vocational Qualification at Level 4 in management and care. As The Knowle is owned by a company the manager is answerable to the Responsible Individual and has regular contact with him. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 21 The home has Investors in People Award, this provides recognition of a commitment to staff development and training. Currently the views of the people living at the home and other interested parties are not gathered in a formal way. Regular formal meetings are held with residents and there is frequent day-to-day contact between residents, relatives, visitors and staff. Thought should be given to a formal audit of views, this would ensure that stakeholders and involved professionals would have a formal way in which to express their view as to how the home operates, and would give an indication of any areas that need improvement. Copies of reports from visits made by the Responsible Individual about the conduct of the home, required by Regulation 26 of the Care Homes Regulations 2000, were not available at the time of the visit. A copy of the reports produced over the next 3 months should be sent to the Commission to enable improvements at the home to be monitored. The regulation 26 reports should demonstrate that the responsible individual is aware of the quality of care and the standards at the home, it is important that these visit take place and reports are made available to the Commission. The home does not hold responsibility for the control of any resident’s finances, all residents control their own finances or have a representative. The fee of the home includes most items and activities, there are some expenses that are charged, such a private chiropody. The Annual Self Assessment completed by the home indicates that some health and safety checks have been completed. At the time of the inspection the home did not have a current satisfactory electrical installation certificate in place, and this must be obtained without delay. The Environmental Health and Health and Safety Executive have visited since the last inspection. Recommendations have been made including that an asbestos assessment is carried out; this had not been completed at the time of the visit. Training is provided in health and safety topics. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 22 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 3 4 Standard OP24 OP19 OP24 OP27 Regulation 23(2)(b) 23(2)(b) 23(2)(d) 18(1)(a) Requirement The rotten window frame in ground floor bedroom must be replaced. All parts of the home must be kept in a good state of repair externally and internally. All parts of the home must be kept clean and reasonably decorated. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must establish and maintain a system for reviewing and improving the quality of care for service users. Visits must be conducted in line with regulation 26 and copies of these reports should be available to the Commission of Social Care Inspection. A valid satisfactory electrical installation certificate must be in place. DS0000062611.V345094.R01.S.doc Timescale for action 02/11/07 02/01/08 02/01/08 02/11/07 5 OP33 24, 26 02/11/07 6 OP38 23(2)(b) 02/11/07 The Knowle Care Home Version 5.2 Page 24 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 Refer to Standard OP31 OP38 Good Practice Recommendations The registered manager should achieve a NVQ level 4 in Care and Management. Recommended actions arising from the Health and Safety visit from the Environmental Health and Safety Department of the city council should be addressed. The Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Knowle Care Home DS0000062611.V345094.R01.S.doc Version 5.2 Page 26 - 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. 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