Inspection on 22/10/08 for The Knowles

This inspection was carried out on 22nd October 2008.

CSCI found this care home to be providing an Good service.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Knowles 17/05/10

The Knowles 29/10/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Knowles 6 Duggins Lane Tile Hill Coventry West Midlands CV4 9GN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The Knowles 6 Duggins Lane Tile Hill Coventry West Midlands CV4 9GN 02476460148 02476464386 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Knowles Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Knowles is a residential home for 38 older people. The Home is located in a quiet residential area of the Tile Hill village area of Coventry, situated close to and within easy reach of a small range of local shops, leisure centre, public house, bank, bus route and railway station. The home has recently been extended and refurbished to provide extra 10 bedrooms and an extra shower room and more toilets. The accommodation is spread over two floors and includes 36 single bedrooms, one double bedroom, two lounge areas, and one dining room, 12 toilets, one assisted bathroom, two accessible shower rooms and one bath. The home has parking to the front and grounds for recreation and seating to the front and side. People at the home pay for additional personal items, such as hairdressing, private chiropody, toiletries, newspapers, leisure costs. People are charged per hour where they need escorts to appointments that cannot be supported by relatives or advocates. Care Homes for Older People Page 4 of 33 Brief description of the care home Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and obtaining their views of the service provided. The following information in this report is the findings of an unannounced inspection visit that took place on Wednesday 22 October 2008. Thirty five people were living at The Knowles at the time of the visit. Three residents were case tracked, this involves finding out about their experience of living in the care home by meeting with them, or observing them, talking to them and their families (where possible). Looking at their care files and the environment in which they live. Staff training records are reviewed to ensure training is provided to meet residents needs. Care Homes for Older People Page 6 of 33 Documentation regarding staffing, health and safety, medication and complaints are also reviewed. During the inspection the manager was on duty along with the deputy, five care assistants and two housekeepers, a cook, maintenance person, administration assistant and laundry assistant. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff and residents. Other records looked at during this inspection included, care, staff recruitment, training, staff duty rotas, health and safety and medication records. Notification of incidents received by us from the Home and any other information received were also looked at. Annual Quality Assurance Assessment documentation was sent to the Home for completion and information recorded in this document was reviewed during the inspection process. Five feedback questionnaires were completed by residents, survey findings and comments made are included in the main body of this report. The inspector was introduced to some of the people that live at The Knowles and conversations were held with six people. Further information to identify the outcomes for residents was also gained through observation of residents and staff. What the care home does well: The manager and staff have an in-depth knowledge of the care needs of those that live at The Knowles. Care plans contain enough information about individual needs to give staff this knowledge. Documentation in care files was easy to read and in good order Staff were patient and helpful and the atmosphere at the Home was relaxed and friendly. Staff worked well as a team and said that they have the necessary training and equipment to enable them to do their jobs. Residents felt confident that if they had any concerns, staff would deal with them quickly and appropriately. Information on how to complain is freely available throughout the Home. The Home was clean and odour free. Bedrooms had been personalised and were comfortable. Residents had brought personal possessions such as ornaments, pictures and photographs. Recruitment procedures are robust and employment practices ensure that suitable staff work at the home. Quality assurance systems are good and incorporate a range of practices to seek residents views and to audit working practices. Regular satisfaction surveys take place and residents or visitors to the Home are able to put any suggestions into the suggestions box located near the entrance of the Home. Residents are also involved in the care planning process, which gives them a say in how their care is managed. The people that live at the home are supported to make choices about what they do with their day. They are able to decide when and where they eat their meals, which were well presented and nutritious. The manager is aware of the issues that require attention and is dedicated to meet the needs of those under her care and support staff in this process. All residents were appropriately dressed for the season and well cared for and those residents spoken with made positive comments about the care they received. Some of the positive comments made by residents during this inspection are detailed below:I am very happy here, I have my own toilet, a nice bright room, patio doors so that when the weather is nice I can sit outside my bedroom. I am so glad I am still able to live with my husband here and that we are both being looked after. the staff are lovely, I have no worries or concerns, its all OK here. the staff are all lovely, kind and friendly and give you help when needed. Care Homes for Older People Page 8 of 33 the management is good. What has improved since the last inspection? What they could do better: Documentary evidence should be available to demonstrate that all residents have been given a copy of the Service Users Guide. Amongst other things, this document gives them information about the Homes services and facilities that they are entitled to for their money. Residents should be involved in the care planning process and documentary evidence should be available to demonstrate this. Where possible residents should sign their care plans to show that they agree to the planned care that they will receive. Care plans should be updated as residents needs change. Some of the documentation referred to in care plans is no longer used as the residents needs have changed but the care plan had not been updated to reflect this. A more appropriate area should be sought for the storage of the hoists and seated weighing scales. These are currently kept in the large lounge and give a clinical not homely feel to the area. The manager should seek advice from an infection control specialist regarding the cleaning of commodes to ensure that the methods currently used in the Home are satisfactory. Although a large amount of training is provided to staff on a regular basis, records showed that not all staff have undertaken up to date training in mandatory areas such as moving and handling, food hygiene and first aid. The manager is aware of the staff Care Homes for Older People Page 9 of 33 who require this training and is in the process of arranging training courses. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission practices ensure that residents are assessed as being suitable to live at the Knowles and that staff have the information to be able to meet their identified needs. Evidence: The Home have developed an information booklet which gives information to residents about services, facilities and staffing at the Knowles. Details required in the Service Users Guide and Statement of Purpose are available in this book. Everyone is apparently given a copy upon admission. Some of the bedrooms seen did not have a copy. The manager confirmed that some relatives take them away to look at, so they are therefore not available in the residents bedroom. Two of the residents questioned did not know what the information book was. It was therefore difficult to confirm that these books have been given to residents upon admission. Care Homes for Older People Page 12 of 33 Evidence: Pre-admission assessments are undertaken by the manager and deputy manager. These assessments can be undertaken at the location of the residents choice. Standardised documentation is used to obtain as much information as possible about the potential resident. This enables the Home to decide whether they will be able to meet their needs and to prepare for their arrival. Those who are interested in moving into the Knowles are able to visit the Home for a day and talk to residents and staff, join in any activities and have a meal. Three people where chosen to case track. This involves looking at their care file, talking to them and to the staff who care for them. Looking at their bedroom and the communal areas which they use. Talking to their family if possible and looking at documentation relating to the care of the person. The care file of the resident most recently admitted to the Home was reviewed. Preadmission assessment documentation was available on file. This demonstrated that the manager and deputy undertook a pre-admission assessment three days before the resident moved into the Home. Initial plans of care giving staff information on how to meet this persons needs were developed on the day of admission to the Home. The documentation used for the pre-admission assessment asks for review of personal care, continence management, tissue viability, sleeping habits, social, medication, eating and drinking etc. Standard statements are recorded under each heading which relate to the type of assistance needed and the number of staff required to help. The Home Services section of the pre-admission assessment was blank. This relates to hairdressing, dental, optical and chiropody requirements. The manager said that the resident was not sure of what services were required at the time of the assessment. This should be recorded on the form to demonstrate that the questions have been asked. Following the assessment the Home write to the potential resident confirming that they are able to meet their identified needs and offering them a place at the Knowles. All three care files seen contained pre-admission assessment documentation. Details recorded were sufficient to enable initial plans of care to be developed, appropriate equipment to be made available and for staff to have enough information to be able to care for the resident. Five residents responded to our survey, all said that they received enough information about the Home before they moved in so they could decide it if was the right place for Care Homes for Older People Page 13 of 33 Evidence: them. Care Homes for Older People Page 14 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recording of residents health, personal and social care needs are good and give staff detailed guidance to enable them to meet the care needs of those that live at The Knowles. Improvements have been made to medication administration practices which are now robust. Residents are treated with respect and their rights to privacy and dignity are maintained. Evidence: Three residents were chosen for case tracking. This included reviewing their care files, talking to them and the staff who care for them, reviewing staff training records, health and safety and other records relating to their care. All three files contained a pre-admission assessment undertaken by the manager and deputy. These contained sufficient information to enable the Home to make a decision as to whether they would be able to meet their individual needs. It also enables them Care Homes for Older People Page 15 of 33 Evidence: to prepare for their arrival by obtaining appropriate equipment if needed. Pre-admission assessments were thorough and information obtained was used to form the initial plans of care upon admission to the Home. Care plans are developed on the day of admission or shortly after. Standardised care plan documentation is used which covers areas such as Personal hygiene, mobility, continence management, tissue viability, mental health, sleeping habits, social, medication, diet, Home services, financial, spiritual and communication. All care plans seen were detailed and gave staff sufficient information to be able to meet residents individual needs, preferences were also recorded i.e. times for getting up in the morning and going to bed, leisure interests, diet etc. Care plans had been reviewed on a monthly basis and there was evidence of care plans being updated following review. However one care plan recorded that the resident should have food and fluid monitored, there was no evidence of any up to date food and fluid monitoring charts. The manager confirmed that the care plan needed updating as the food and fluid intake is no longer monitored. Another care plan recorded that the residents bowel movements should be recorded. There was no evidence of a bowel movement monitoring sheet in the file. The manager confirmed that this is not completed as the person does not have problems with their bowels any longer. It was also recorded that staff are to check hourly throughout the night .... Daily records demonstrate that staff are checking on this person every two hours. The manager again confirmed that this care plan needed updating as checks are now required every two hours. Two of the files seen had not been signed by the resident or their representative to show their agreement to the care prescribed. One of the residents had only moved into the Home immediately before the inspection, however the other resident had been living at the Home for over a year. Handling assessments, tissue viability trigger tool and nutritional screening tool were available as well as individual risk assessments regarding access to the kitchen, falls and using a wheelchair, using the lifts/stairs. This shows that the Home are identifying the risks of accident/injury and are acting upon this to reduce the risk. One of the care files contained a life profile including information regarding significant dates, preferences, interests and hobbies and a brief life history. This is useful information to enable the Home to remember significant dates, to help plan activities and for staff to be able to hold conversations with the resident regarding topics of interest. Care Homes for Older People Page 16 of 33 Evidence: Daily records were completed per shift. These generally recorded times when there is any change in the residents health or wellbeing, for example times when the resident is not eating or feeling unwell. There was evidence in the care files that residents have access to external professionals as needed such as GP, dentist, optician, chiropodist, district nurse etc. All five residents who responded to our questionnaire confirmed that they always get the medical support that they need. Residents weight is being recorded on a regular basis. Records demonstrate that one residents weight was stable but the other resident was losing weight. It was noted that the resident had gained weight recently but there was no documentary evidence to demonstrate the action to take to address the overall weight loss. A bathing log is kept which records the times when residents have a bath or shower and times when they have refused. Records show that two of the residents being case tracked had a sufficient amount of baths in accordance with their care plan requirements. There were no records for the other resident who had recently moved into the Home. Four of the five people who responded to our questionnaire said that they always receive the care and support that they need, one person said that they usually receive it. All said that staff listen and act upon what they say. The medication storage, records and administration was reviewed for the three residents case tracked. A homely remedies sheet has been signed by the GP for each resident, a copy of this document is kept on their care file. This records the homely remedies such as paracetamol or simple cough linctus that they are able to take over and above their prescribed medication and the length of time they are able to take it before they seek medical guidance. Medication storage was reviewed and it was identified that all medication is stored securely. Key custody practices were satisfactory and medication awaiting return to the pharmacy was also stored appropriately. A medication quality assurance file has been set up by the manager. This includes a staff signature list with the signatures of those staff who administer medication. Copies of medication training certificates. Details of audits undertaken for each member of Care Homes for Older People Page 17 of 33 Evidence: staff regarding their record keeping and administration. Regular audits of medication received and administered are undertaken and records are kept. Staff have been enrolled on the distance learning course regarding the safe handling of medication, some staff already have this qualification. Copies of original prescriptions are kept for each resident on their care file. Medication received is checked against prescriptions and these are also checked against medication administration records. No residents are taking controlled medications currently. There is a controlled drugs register available and a controlled drugs cabinet for secure storage when needed. The Home has two medication trolleys, the practice of one staff member getting out the medication and signing records and another staff member giving the medication to the resident has now stopped. Two staff administer medication but they have their own drug trolley and administer and sign their own records. This is an improvement on medication administration practices previously used. Details of medication used by each resident with details of what they are used for are kept in the front of each care file. This enables staff to have a better understanding of the importance of the medication they are giving and the specific medical conditions they are used for. A count of medication was undertaken for the three residents who were case tracked. This highlighted one occasion staff had not signed medication administration record to show that they had given a tablet. All other records were checked and found to be correct. All residents seen were dressed appropriate for the time of year, nails were clean and hair was nicely brushed. Residents appeared at ease in their surroundings and those that could, wandered freely around the Home. Personal care was conducted in private and privacy and dignity was maintained on all occasions throughout this visit. Care Homes for Older People Page 18 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience in terms of meals and social and leisure activities meets the expectations of all residents. The service ensures that visitors are made welcome and residents benefit from visits from family and friends. Evidence: There were no activities taking place during the morning of the inspection. Some residents chatted amongst each other whilst others snoozed or looked around the room. The manager reported that activities take place on a daily basis, these often take place in the main lounge or dining room depending upon the activity. An activity diary is kept, this records the activity undertaken and the names of the residents who have joined in. The dairy records activities such as darts, nail care, chair exercises, cards, jigsaws taking place on a daily basis. In addition to the in-house activities provided by staff, external entertainers visit the Home on a regular basis. The Knowles Social Calendar details activities organised between October 2008 and September 2009. Events such as a Halloween, bonfire and Care Homes for Older People Page 19 of 33 Evidence: Christmas party have been arranged. External entertainers such as a Beatles tribute band, Fizzical Fun and Jumping Jacques are also arranged. Residents spoken to confirmed that there is always something going on in the Home and said that they enjoy the activities that take place. All five people who responded to our questionnaire said that there are always activities arranged by the Home that they can take part in. One resident further commented that day trips are good. Visitors were seen in the Home on the day of inspection. They were made welcome by staff and appeared to be at ease in the Home. There is a cupboard which has facilities for visitors to make themselves a drink if they wish. The Home has an open visiting policy and visitors are welcomed at any reasonable time. Residents were seen being encouraged to remain independent throughout the visit. Care plans record tasks that residents are able to do themselves and those which they require assistance or encouragement to complete. Two of the care plans seen had not been signed by the resident to demonstrate their involvement in the care planning process. This is vital to ensure that residents are given the opportunity to have their say about the care they receive and the way they receive it. Staff should record in care plans if residents are unable to sign their documentation. Staff were seen to offer residents a choice of drinks throughout the morning of the inspection. Residents were offered sherry, brandy, tea, coffee or squash in the morning. Those seated in the lounge appeared to enjoy their drinks, some had both alcoholic drinks and tea. Residents were offered a choice of the main lunchtime meal. Choices available were egg chips and beans or cheese and onion pasty. Bread and butter pudding was served for desert. Three of the five people who responded to our questionnaire said that they usually like the meals at the Home, the other two residents said that they always like the meals. The dining tables were appropriately laid for lunch and those seen appeared to be enjoying their lunch which was a sociable occasion. One resident chose to eat in the lounge and his wishes were accommodated. Staff tell residents at breakfast time the choice of meal available at lunch. There is always a choice of two meals for lunch and tea. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that their concerns will be listened to and acted upon. Systems are in place to protect residents from the risk of abuse and staff are trained to recognise and report suspicions of abuse so that residents are protected from harm. Evidence: The complaints policy is on display on the noticeboard and in other areas around the Home. A copy is also available in the information booklet which is given to residents upon admission. The Home have a log book to record concerns and complaints. They have not received any complaints since the last inspection but have received two concerns. Details of the concerns were recorded along with information regarding any investigation, outcome and action taken. Suggestions slips are sent out to residents and visitors to the Home attached to the seasonal newsletter. There is a suggestions box in the Home and people can put anonymous suggestions in if they wish. All five residents who responded to our questionnaire said that they knew how to make a complaint and knew who to speak to if they were not happy. Visitors spoken to during the inspection said that everything is OK, if I had any problems, I would speak Care Homes for Older People Page 21 of 33 Evidence: to staff and they would sort it out by the next time I visit Two residents said that they have no problems, but if they did the manager or staff would sort them. There have been no adult protection issues since the last inspection. Adult protection policies are up to date. A copy of the local social services policy and no secrets documents are also available for staff to review. Staff have undertaken protection of vulnerable adults training. Staff spoken to during the inspection were aware of the action to take if they witnessed an act of abuse and were aware of the policy regarding whistle blowing poor practice. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained Evidence: A tour of the premises took place, this included the lounges, dining room, laundry, kitchen, bathrooms and some bedrooms. The dining room was clean, furniture was in a good state of repair, dining chairs have wheels at the bottom to enable residents to move them easily to sit at the dining table. There are two lounges at this Home. A large lounge which has two televisions and a smaller lounge. At the last inspection of the Home the chairs were arranged across the middle of the large lounge, therefore making residents sit in two small groups. There was a television by each group of chairs. At that time each television was showing a different programme and it was difficult to hear or concentrate on either. However at this inspection, the seating remains the same but both televisions are now showing the same programme. The large lounge was clean and bright and residents appeared to be at ease in their surroundings. A hoist, standing hoist and seated scales were being stored in the main lounge which did not give a very homely feel. Care Homes for Older People Page 23 of 33 Evidence: The seating in the smaller lounge was arranged around the walls, this may make it difficult for staff to assist those with mobility difficulties. The room was bright as wall and ceiling lights were on. Residents in this lounge chatted amongst each other, watched the television and also appeared to be at ease in their surroundings. Gardens were reasonably well maintained and pleasant to look at. The laundry houses two washing and two tumble dryers. All were in good working order. The laundry was in use on the day of inspection, there was a small amount of items waiting to be dried and some to be returned to residents rooms. The laundry was clean and hygenic. Laundry processes were discussed and it was noted that soiled laundry is placed into a bag and sluice washed in accordance with the Homes infection control procedures. Bedrooms seen had been personalised with pictures and ornaments. Call alarms are available in each room and residents have a safe to enable them to lock away personal items if they wish. Rooms were clean and hygienic and comfortable. The vinyl flooring in one bedroom had bubbled and needed re-laying as it presented a trip hazard. All other carpets and flooring seen was in a good state of repair. Furnishings and fittings were satisfactory. The methods of cleaning commodes was discussed with the manager. It was noted that commodes are sprayed with disinfectant on a daily basis and then soaked in a bath once per week. The manager was advised to contact an infection control specialist to confirm that the methods currently used to clean commodes is acceptable. The shower room on the first floor and the assisted bathroom were nicely decorated, clean and bright and had a homely feel. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of staff are on duty to meet the needs of the people living in the home. Further training should be provided to make sure people are cared for by competent staff Evidence: Staffing levels were discussed with the manager. On the day of inspection, the manager, was on duty along with the deputy, five care staff, an administration assistance, two housekeepers, a cook, a laundry assistance and a maintenance person. There were thirty five people living at the Knowles and one person was in hospital. A copy of the duty rotas was taken for review. Duty rotas show that five care staff work between the hours of 7.30 am - 1.30pm, four carers between 1.30pm - 4pm, four carers between 4pm - 9pm and three between 9pm - 7.30am. Laundry cover is provided seven days per week between the hours of 9am - 1pm. Two domestic assistants work Monday - Friday between 9am - 1.30pm and one on a Saturday and Sunday. A cook and catering assistant are also on duty seven days per week. The manager and deputy manager cover the management of the Home over a seven day period. Staffing levels on the day of inspection appeared to be sufficient to meet the needs of those living at the Knowles. Care Homes for Older People Page 25 of 33 Evidence: Residents spoke positively about staff saying that they were kind and caring. Eighteen care staff are employed at the Knowles, nine of these staff have obtained their National Vocational Qualification in Care at level two. A further three staff are starting this training in November 2008. The personnel files of three staff employed since the last inspection were reviewed. Each file contained sufficient information to demonstrate that robust recruitment practices take place at the Home. Application forms, contracts of employment, two written references, criminal records bureau and protection of vulnerable adults checks were on file for each person seen. Induction training is conducted in line with Skills for Care requirements unless the staff member is employed with a National Vocational Qualification in Care. Copies of training certificates are also kept on file. These demonstrate that staff undertake a wide variety of training on a regular basis. From records seen it was evident that some updates in mandatory training are required. Five newly employed staff have not yet undertaken any moving and handling training, nine staff require updates in food hygiene training, four staff require first aid training and ten staff are booked to undertake infection control training. The manager is aware of the staff that require update training and is in the process of organising this. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Homes manager has set up systems to ensure that the quality of the service provided meets the needs and expectations of the Service users who live at the Home. The health, safety and welfare of residents and staff is promoted and protected. Evidence: There have been no changes to the management arrangements in place since the last inspection. The Registered Manager has obtained the National Vocational Qualification in Care at level three and is currently awaiting certification for the NVQ level four and Registered Managers Award. The manager has worked at the Knowles for two Years and has a wealth of knowledge about the care needs of the people who live at the Home. The quality assurance file demonstrates the methods used to determine whether the service provided meets the needs and expectations of those who live at the Knowles. Care Homes for Older People Page 27 of 33 Evidence: The file contains details of audits undertaken, satisfaction surveys with action plans and minutes of residents and staff meetings with action plans. The responses to satisfaction surveys sent to residents in January, May and August 2008 were available on file. A large majority of responses received were positive. Two residents commented in the survey specifically about activities that they did not like the activities. Two people responded to the catering survey that they did not like the tea time menu choices and one person was not happy with the food choices on the main lunchtime menu. All other responses were positive. Action plans following these surveys were available on file. Residents meeting minutes for February 2008 recorded that residents had requested that the same television programme be on both televisions in the main lounge. This was identified as an issue for action at the last inspection. It was noted during this inspection that both televisions had the same programme on. No residents attended the residents meeting scheduled for August 2008, the manager said that she went into each lounge and asked if anyone had anything to discuss. All apparently responded that they would go and see the manager individually if they had any issues that they wished to raise. Staff meetings are held on a regular basis. Minutes of the meetings held in May, July and October were available for review. It was evident from these minutes that staff have the opportunity to air their views during these meetings. Various audits are undertaken such as, room, accident, medication audits, monthly and six monthly care plan audits. Daily audits of daily reports, bath logs are also undertaken. The Homes Services Director also audits one care plan per month and talks to two residents per month as part of the Regulatory process. Quality assurance systems in place provide a good means of ensuring that the quality of service provided meets residents needs and expectations. The Home do not hold any personal allowance or other monies on behalf of residents. All items are paid for and relatives are either invoiced for amounts owing or some relatives have set up a standing order to pay for any expenditure. All residents have family members looking after their affairs, no resident requires the services of an advocate. Health and safety records and practices were reviewed to evidence whether the health and safety of staff and residents is given priority. Care Homes for Older People Page 28 of 33 Evidence: Fire records seen demonstrated that emergency lighting and fire doors are tested on a monthly basis. A log is kept of weekly fire point tests. Fire drills have been held in February, May and October 2008. An external company are called into the Home as needed to service all fire fighting equipment, service reports were available on file. All staff have undertaken fire safety training during 2008. A bacteriological analysis of water was undertaken in December 2007 and is undertaken on an annual basis. This is done to ensure that residents are not at risk of Legionnaires disease from the Homes water supply. The Landlords Gas Safety Certificate on file is dated June 2008, the next safety check is due in June 2009. This is undertaken to ensure that gas systems and appliances are safe to use. Records show that a routine service of the lift was undertaken in August 2008, hoist servicing records were available and a lift safety certificate was on file dated June 2008. Information received in the Homes Annual Quality Assurance Assessment records dates of other dates of servicing of equipment in use at the Home which were all up to date. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 All staff must have training in 14/07/2008 moving and handling, and this must be up dated every year to ensure that they remain up to date and knowledgeable. This ensures that the residents are safe when being assisted with mobilising. Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 Documentary evidence must 12/01/2009 be available to demonstrate that staff receive regular mandatory and service user focused training. Moving and handling and must be undertaken on a regular basis. This is to ensure that staff have the skills and knowledge to be able to provide care for residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Every resident should be given a copy of the Service Users Guide. Documentary or other evidence should be available to demonstrate this Following regular review of care plans any care needs that have changed should be updated on care plans. This gives staff the most up to date information to be able to meet identified needs. 2 7 Care Homes for Older People Page 31 of 33 3 7 Residents or their representatives should sign care plans to demonstrate their involvement in and agreement to prescribed care. Once weight loss has been identified details of any actions taken to address this should be recorded in a plan of care. The vinyl flooring in one bedroom seen which had raised and bubbled should be relayed flat to remove any trip hazard. A more suitable storage area should be sought for the hoist, seated scales etc currently stored in the large lounge. Storage of this equipment in this area does not give the lounge a homely feel. The Home should contact an infection control specialist to ensure that the methods used to clean commodes are the best use of facilities at the Home and meet infection control standards. 4 5 8 19 6 19 7 26 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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