Inspection on 29/10/07 for The Knowles

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Knowles 17/05/10

The Knowles 22/10/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Knowles 6 Duggins Lane Tile Hill Coventry West Midlands CV4 9GN Lead Inspector Deborah Shelton Key Unannounced Inspection 29th October 2007 09:45 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 Knowles DS0000069671.V348125.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 Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knowles Address 6 Duggins Lane Tile Hill Coventry West Midlands CV4 9GN 02476 460 148 02476 464 386 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) Knowles Care Home Ltd Mrs Claire Diana Murrin Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22 January 2007 Brief Description of the Service: 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 of the establishment and grounds for recreation and seating to the front and side of the home. The current fees (29/10/2007) range from £386 - £411 per week. The people at the home pay for additional personal items, such as hairdressing, private chiropody, toiletries, newspapers, leisure costs. People are charged £8.00 per hour where they need escorts to appointments that cannot be supported by relatives or advocates. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following are the findings of an unannounced inspection visit that took place on Monday 29 October 2007 between the hours of 09:30am and 6:30pm. The Home manager was on duty along with the Deputy Manager, four care assistants, an agency cook, a laundry assistant, gardener, maintenance person, domestic and an administration assistant. Thirty-seven people were living at The Knowles at the time of the visit. Three residents were ‘case tracked’, this involves finding out about the individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences. Looking at their care files, looking at their environment, and discussions with staff on duty. Reviewing staff training records to ensure training is provided to meet resident’s needs. The inspection process consisted of discussions with the manager, staff and residents. Records examined during this inspection included, complaints, care, staff recruitment, training, social activity records, staff duty rotas, health, safety and medication records. Notification of incidents received by us from the Home and any other information received were also examined. The inspection process enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. Annual Quality Assurance Assessment documentation was sent to the Home for completion and information recorded in this document was reviewed during the inspection process. Seven feedback questionnaires were completed by residents and two by relatives. 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 seven people. Further information to identify the outcomes for residents’ was also gained through observation of residents and staff and discussion with relatives. The inspector wishes to thank the manager and her staff for the hospitality on the day of inspection. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 6 What the service does well: Care plan documentation was easy to read, in good order and up to date. Sufficient details were recorded to enable staff to meet the health and personal care needs of residents. Risk assessments were up to date and there was evidence of action taken by staff following completion of risk assessments. The manager had an in depth knowledge of residents individual needs. The Home was clean and hygienic and in good decorative order. Staff were polite and friendly and residents appeared to have a good relationship with them. The atmosphere at the Home was relaxed and friendly on the day of the visit. Efforts are made to celebrate special occasions such as birthdays, Easter, Christmas etc. The manager was arranging a Halloween Party for residents, which they were looking forward to. 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. Suitable procedures are in place for vetting staff to ensure they are suitable to work at the home. Quality assurance systems in place mean that resident’s views are sought regarding the quality of the service provided. Although recently, those who live at the Home have apparently not been interested in attending formal meetings. Various other methods are in use for obtaining feedback such as satisfaction surveys, comments book and suggestion box. Residents are also involved in the care planning process, which gives them a say in how their care is managed. A majority of comments received throughout the inspection were positive, some of which are included in the main body of this report and others detailed below: “I love it here, staff are lovely and the food is good” “everything is clean and tidy always. My clothes are taken away and come back clean very quickly” “the food is good and there is plenty of it” “everything is good here, you can pretty much do as you like” “the food is good and the Home is clean” “I have no worries at all” The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: As mentioned above two of the requirements identified at the last inspection visit remain outstanding. The time taken to give out medication was identified as an issue. Medication rounds were taking too long, therefore some residents were not receiving their medication at the correct time. The manager has taken action to address this, however, alternative action should be taken. Currently two staff complete medication rounds. One staff member takes the medication from the blister pack and signs the medication administration record to demonstrate that the resident has taken their tablet. The other staff member gives out the tablet. The member of staff who signs the medication record to say that they have witnessed the resident taking the tablet does not always witness this. An alternative method of administering medication should be considered so that it is given out in a timely and safe manner. The manager was advised to devise an assessment tool to check that staff have fully understood the medication procedure to satisfy her that staff are clear about safe medication practices. An audit was developed which is undertaken on a weekly basis. However, issues such as staff taking tablets out The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 8 of blister packs out of date order and no record of the amount of medication received on the premises were identified during this inspection. Two bedrooms were identified at the January 2007 inspection as having an unpleasant odour. At the time the manager said that she would take action to address this matter. The manager confirmed that various methods had been tried to remove the odours, unfortunately these were unsuccessful. An order has now been placed to replace the carpet flooring with easy clean, non-slip, laminate flooring. This issue will remain until the odour has been removed. It has been identified at previous inspections that regular, varied activities take place at the Home. Feedback on the day of this inspection was not all positive. Some residents commented that there is nothing to do. Records did not demonstrate that regular, meaningful activities take place. Some residents appeared un-stimulated throughout most of the day during the inspection and there was limited staff interaction. The manager is hoping to address this issue when new staff have been recruited. It was noted that fresh vegetables are not used during food preparation. Apart from potatoes there were no fresh vegetables on the premises. Consideration should be given to resident’s personal taste and nutritional requirements regarding the use of frozen versus fresh vegetables. Some staff are in need of update training regarding moving and handling. The manager confirmed that staff are able to undertake this training in either December 07 or March 08. All staff should have regular updates in mandatory training areas. 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 summary of this inspection report can be made available in other formats on request. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 9 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 Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good This judgement has been made using available 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 has developed an “information book” which contains information from the Service User’s Guide, complaint’s policy and contract of residency. The manager confirmed that residents are given a copy of this document upon admission to the Home, these are kept in their bedroom unless their family take them away. It was noted that there have been no changes to this document apart from updating staff details etc since the last inspection. Evidence was available to demonstrate that each resident is given a copy of the information book. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 11 The care file of the most recently admitted resident was reviewed. This person was admitted to the Home in October 2007. A discussion was held with the manager regarding the pre-admission process but the resident did not wish to speak to the inspector on this occasion. The manager confirmed that it is either herself or the deputy who conduct pre-admission assessments. If they are in any doubt they re-visit the potential resident together and complete another assessment. Standardised documentation is used to gather information, this is in the form of a tick list with space for additional comments if necessary. Care plans are received from the Assessment and Care Management Team before the Home’s pre-admission assessment is undertaken. Once the information is gathered the resident is contacted by letter to confirm whether the Home would be able to meet their identified needs. People who are interested in moving into the Knowles are able to visit the Home before a decision is made. They are able to stay for a meal and chat to staff and residents. The pre-admission assessment documentation seen was completed the day before the resident moved into the Home. Documentation used in the assessment was not signed by the person recording the information. A majority of the information completed was comprehensive and gave staff sufficient information to enable them to meet identified needs. However some areas required further information for example “history of falls” yes – no further information was recorded i.e. when was the last fall? Where? possible cause?, injuries sustained? There were no details regarding optical, chiropody or dental arrangements and the section regarding “known allergies” was ticked yes but no detail of the allergy was recorded. The care plan completed upon admission to the Home had been updated with all missing information. The manager explained that it is sometimes difficult to get full and correct information from some potential residents. For example, this gentleman said that he had an allergy but could not recall what it was, upon speaking to his family they were unaware of any allergy. The manager was advised to record on pre-admission forms the information that she is given and to record when residents or carers are unsure. The manager should have recorded on the pre-admission form that the resident could not recall what he was allergic to. Care plans were developed on the day of admission to the Home and these were comprehensive and would give staff all of the information needed to meet this gentleman’s care needs. Seven residents responded to our feedback survey their comments regarding contracts of residency and information available about the Home before moving in are detailed below: - The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 12 Always Usually Sometimes Never 1 Have you received a contract Did you receive enough information about this Home before you moved in so you could decide if it was the right place for you. 6 Yes Comments 1 no response 2 7 yes The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The recording of resident’s 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. Some improvements are required to medication administration practices to protect residents from harm Residents are treated with respect and their rights to privacy and dignity are maintained. EVIDENCE: Three residents were case tracked on this occasion. This involved speaking to them, where possible, looking at their living accommodation, medication and care records. The care file of the resident most recently admitted to the Home was reviewed. This resident declined to speak to the inspector but was observed eating his evening meal and appeared at ease in his surroundings chatting to other residents at his table. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 14 Standardised documentation is used in the care planning process. Care plans were available regarding various aspects of personal and social care i.e. personal hygiene, medication, spiritual needs etc. Comprehensive information was recorded in care plans to assist staff in meeting this gentleman’s needs. Information recorded the type and level of assistance needed by staff, the number of staff required to help, tasks that the resident is able to perform unaided and tasks that he is to be encouraged to do. Maintaining a level of independence appeared to be encouraged in care plans which helps maintain residents well being. Risk assessments had been completed upon admission to the Home. These were very detailed. Each risk assessment is given a score and the appropriate action to take regarding each score grouping is recorded. Risk assessments were linked to care plans. Appropriate action was taken following the outcome of each risk assessment, i.e. weigh weekly. Daily entries are completed per shift. Some of the information recorded related to care plan goals such as personal hygiene and social activities, however night reports were brief i.e. “… appears to have slept well throughout the night”. There was no mention that staff were completing the two hourly checks as recorded in his care file. Some of the entries were repetitive and did not reflect the action that staff were taking to meet other care plan goals. A second care file was reviewed and the inspector spoke to this resident who confirmed that she is happy at the Home and stated that the food is good. The care file also contained comprehensive details to enable staff to meet identified care needs. There was documentary evidence to demonstrate that regular input is received from GP, District Nurse, optician and chiropodist as necessary. This resident has been living at the Knowles for fourteen months and there was evidence that care files are reviewed and updated on a regular basis. The manager confirmed that residents sit with staff at six monthly reviews where their care needs are discussed. If the resident is in agreement with the plan of care proposed they sign the care plan. This is then reviewed and updated on a monthly basis and the resident is then involved again at the next six monthly review. This care plan had been signed by the resident to demonstrate agreement to the care prescribed. Risk assessments were also in place that had been reviewed and updated. Daily entries were recorded per shift, however these were again repetitive and did not relate to care plan goals on all occasions. The last care file reviewed was for a resident who was observed in the lounge on the morning of the inspection and briefly spoke to the inspector. She said that she was happy to answer any questions and was very happy at the Home. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 15 This lady appeared at ease in her surroundings, chatting to other residents in the lounge, laughing, and joking. She commented that the food was excellent, the staff were lovely and everything was first class. Care plans in place were comprehensive and gave staff the information needed to meet this lady’s care needs. Risk assessments were in place, reviewed, updated and care plans were signed to demonstrate agreement to care prescribed. As with the other care files, daily entries were specific on some occasions but did not always relate to care plan goals and night entries were not specific regarding the level of staff intervention provided. The manager confirmed that a lot of work has taken place regarding care planning since the last inspection of the Home. This was evident as care plans were easy to read and understand and contained sufficient information to enable staff to meet resident’s identified care needs. There was also evidence on files that when problems have been identified following risk assessments, appropriate action has been taken to rectify the problem i.e. nutritional risk assessment requested weekly weight, weight loss identified, GP contacted and appropriate action taken. The medication records for the three residents being case tracked were reviewed. The medication administration records (MAR) for two of these residents were found to be correct and up to date. Medication is sent to the Home in blister packs. It was noted that staff are not routinely removing tablets from the blister in sequence. This may cause problems auditing medication if an error occurs. The third set of medication and records reviewed did not record the correct amount of medication received when the resident was admitted to the Home. There is therefore no way of auditing this medication to ensure that correct administration and record keeping takes place. A copy of the prescription is kept, this is checked against the MAR chart and medication received, there is a photograph of each resident on MAR charts and a staff signature list in the MAR folder. The temperature of the medication trolley storage room is monitored via a digital thermometer. These are all areas of good practice, the manager confirmed that a lot of work has taken place regarding medication practices and procedures. A weekly audit takes place by the manager and the findings are recorded in a diary for staff to review. It was noted at the last inspection that the medication round was taking a long time to complete. Two staff now undertake medication rounds with one staff issuing the medication and the other administering. The staff member signing the administration record must therefore rely on verbal confirmation from the The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 16 member of staff who administers the medication that the resident has taken it. The staff member is therefore signing for an action that she has not actually undertaken or witnessed. This method of administration is not considered safe practice. Controlled medication storage and record keeping was reviewed. Staff are recording administration of controlled medication on loose pages. These records must be kept in a bound book or register with numbered pages. The bound book should include the balance remaining for each product with a separate record page being maintained for each resident. Following the inspection written confirmation was received from the manager to confirm that a controlled drugs register has been purchased and is now in use. Residents were well dressed, some of the ladies commented that they had visited the hairdresser and were pleased with the results. One lady was pleased to show me her manicured nails and said that she enjoyed having her nails painted by staff. Residents appeared to be at ease in their surroundings and had a good relationship with staff. Personal care was completed in private and this was handled discreetly by staff. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The lifestyle experience in terms of meals and social/leisure activities does not meet the expectations of all residents. The service ensures that visitors are made welcome and the residents’ benefit from visits from family and friends. EVIDENCE: During the morning of the visit the inspector completed paperwork in lounge one. The television was playing but none of the residents appeared to be watching. Some residents appeared un-stimulated and were staring into space or snoozing whilst three were chatting amongst themselves. The inspector stayed in the lounge until lunchtime. During this period there was very little staff interaction with residents. Staff came into the lounge to give mid morning drinks and then to take residents to the toilet before lunch and took them to lunch. The inspector spent a large part of the afternoon in lounge two. This lounge is divided into two halves by chairs back to back across the middle of the room. At each end of the room two televisions were playing both showing different channels and both were very loud. It was difficult to hear either television properly due to the noise levels. A member of staff came into the lounge to The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 18 try to encourage residents to play skittles. The staff member was friendly and polite and tried to encourage residents to play. Each resident had approximately two throws of the ball before the staff member had to move to another area of the lounge to try to encourage other residents to join in. Feedback from residents regarding activities was mixed, some commented that there is always something going on and plenty to do, whilst others said that there is never anything going on and they couldn’t remember the last time that there were activities. One resident commented “somebody comes in to sing to us occasionally”. Other comments received on the day of inspection and in our feedback survey responses are detailed below. “there is nothing to do in the day” “I am not interested in the T.V. and there is nothing else going on in the day” “there is nothing going on at all” “there is something going on some days, not every day” “something happens once per week if you are lucky” “there are more activities now than when my mum first moved in” Always Usually Are there activities arranged by the Home that you can take part in? 5 2 Sometimes Never Comments I enjoyed our trip to the zoo Activity records demonstrate that some form of activity takes place at least twice per week, however sometimes these activities were watching a DVD or listening to music. There was limited evidence to demonstrate that meaningful, stimulating activities take place on a regular basis. There was no recent evidence to demonstrate that activities are discussed with residents. The manager confirmed that residents were quite happy with the two televisions on in the lounge and said that this was done at their request. However during the afternoon a majority of residents in one half of the lounge were not watching, or were seated in a position that made watching the television difficult and one resident commented that it was difficult to hear the television. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 19 The manager confirmed that due to staff shortages the amount of activities that takes place has reduced recently. However two new staff are due to commence their employment soon and activities will again take place more regularly. The manager was in the process of dressing the Home for a Halloween party on 31 October 07. Residents had visited Twycross zoo in September and apparently everyone enjoyed this outing. Visitors were seen on the premises during the inspection. Those spoken to said that staff always make them feel welcome and give them regular updates regarding the health of their loved one. Visitors confirmed that they are invited to join in residents meetings or parties. Residents are encouraged to maintain their independence as much as possible. Care plans detail tasks that residents are able to perform without assistance, they also record tasks that the resident is to be encouraged to undertake to maintain independence. Residents meetings take place, although nobody attended the meeting in August 07 and the manager reported a very low attendance at previous meetings. These meetings give residents the opportunity to voice their opinions about the running of the Home and daily life. Residents are involved in the care planning process and encouraged to give their views regarding their care needs and how these should be met. The inspector dined with residents on this occasion. The meal served was either pork casserole, mixed frozen vegetables and mashed potatoes or fish cakes, frozen vegetables and mashed potatoes. The two ladies who sat with the inspector enjoyed their meal both commented that the food is good and there is plenty of it. One lady said that there is usually too much for her to eat. Other comments received about the food varied, one resident said that the food was “edible but not as good as you would make yourself, there is a choice of two things but if you don’t like either then it’s no choice”, other residents said that “the food is excellent”. Our feedback survey results, detailed below show that a majority of those who responded like the meals at the Home. Always Usually Do you like the meals at the Home 6 1 Sometimes Never Comments During a tour of the kitchen area it was noted that apart from potatoes there were no other fresh vegetables. The manager confirmed that a majority of the The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 20 time frozen vegetables were served but they were considering using fresh vegetables at least three times per week in the future. The manager should ensure that residents are happy with the use of frozen vegetables as some people may have preferences regarding the taste of fresh or frozen vegetables. Nutritional value should also be taken into consideration. The kitchen was clean and hygienic. The cook was on sick leave and an agency cook had prepared the meal on the day of inspection. Fridge and freezer temperature records and kitchen cleaning records had not been updated since 21 October 2007. There was therefore no documentary evidence to demonstrate that foods are being stored at appropriate temperatures. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good This judgement has been made using available 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: A copy of the complaint procedure is on display in various places in the Home, this is also available in the “information book” which is given to all residents. The manager reported that she has a good relationship with residents and visitors and the Home receives very few complaints. The complaint logbook was reviewed and it was noted that not all complaints/concerns received had been logged. The manager reported that she is only logging complaints and not concerns. This is purely dependent upon the wording used by the person raising the issue with the Home. Some of the “concerns” raised were actually complaints that remained not logged. The manager confirmed that she is happy to start logging “concerns” either separately or on the “complaint” log and this would be done immediately. If only some of the information is logged it is difficult to get a full picture of issues raised and how the Home are addressing these issues. Residents and visitors spoken to said that they would be happy to speak to the manager or deputy regarding any concerns that they may have and felt sure The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 22 that they would deal with these quickly and appropriately. One resident said, “If I had any complaints I would speak to someone, the manager or anyone else always sorts it out very quickly. They are very good at that”. The Home have received four complaints/concerns since the last inspection visit. The manager must ensure that complaint records are up to date and contain all information relating to the complaint raised. There have been no adult protection issues at this Home since the last inspection. The manager confirmed that the adult protection policy has been reviewed but no recent changes made. A copy of “no secrets” is on display on the notice board and staff have undertaken protection of vulnerable adults training recently. Staff were seen moving and handling residents in an appropriate manner during the inspection, however it was noted that some staff require moving and handling update training, which is to be provided in either December 07 or March 08. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The standard of the environment within this Home is generally well maintained providing an attractive, hygienic and homely place to live therefore improving the quality of life for residents. EVIDENCE: A tour of the premises was undertaken. This included looking at the bedrooms of those residents being case tracked plus three others, bathrooms, kitchen, laundry and communal areas. The Home is in good decorative order and is pleasantly furnished. Fixtures and fittings are in a good state of repair. Two bedrooms were identified at the last inspection as having an unpleasant odour. The manager confirmed that every effort has been taken to remove the odour however this has been unsuccessful. Quotes have been obtained and the flooring in these rooms is being replaced with non-slip laminate flooring. This flooring is in place in corridors and in the dining room currently. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 24 Some of the bedrooms have patio doors that lead to the garden. One resident sitting in her room confirmed that she had the doors open most days to let some fresh air in, she also said that she likes to take a walk into the garden sometimes and really liked the fact that she is able to do this from her bedroom. The manager confirmed that risk assessments are in place and only those residents deemed safe would be given a key to the patio door as residents would be able to access the main road if they wandered out of the garden. Disposable gloves and aprons were available at the reception/carers station at the front of the Home and in the laundry. Staff were seen wearing disposable gloves and aprons appropriately throughout the visit. The laundry area was clean and hygienic and there was no backlog of items waiting to be laundered. The kitchen was also clean and hygienic although kitchen cleaning records were not up to date. The gardens were pleasant and residents commented on the good work of the gardener maintaining the gardens to such a high standard. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With the use of regular agency staff there are sufficient numbers of staff on duty to meet the needs of people living in the home. Recruitment procedures are robust and protect residents from risk of harm. EVIDENCE: A copy of the duty rotas for the week before, during and after the inspection visit were obtained for review. The manager confirmed that staffing levels are consistent on a daily basis, this is usually the manager, deputy manager, four care staff, laundry and housekeeper. A maintenance person attends the Home twice per week and a gardener once per fortnight. An administration assistant works for four days per week. On the day of inspection three of the four care staff were from an agency. The manager said that agency staff are used regularly at the moment but they always try to use the same agency staff. Comments made on the day of the visit and in our feedback surveys regarding staff are detailed below: “the Home use a lot of agency staff which can take away the personal nature of care” The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 26 “it takes a while for staff to get to know residents, especially if agency staff are used” “staff keep me updated all of the time with anything that I need to know” “some staff are nice, not all” Responses from the seven feedback surveys regarding staff are detailed below. Always Do you always receive the care and support you need. Do the staff listen and act on what you say 7 Usually Sometimes Never Comments All nice The girls are nice 7 yes Staff were friendly and kind to residents and appeared to have a good relationship with them. However, they did not have sufficient time to complete activities or just chat to residents in lounge one during the morning of the inspection. The level of staff interaction in the lounge was limited to only completing tasks i.e. serving drinks, toileting or taking residents to the dining room. Three staff personnel files were reviewed to evidence whether the recruitment procedures at the Home are robust and protect residents. All files seen contained appropriate documentation such as criminal records bureau and protection of vulnerable adults checks. Application forms and references. The file for the most recently employed staff member only contained one written reference and a note stating that a further reference had been requested but not received. The manager said that she is still trying to obtain a second reference for this staff member. A separate file is available for each staff member that contains copies of training certificates. The manager confirmed that two staff have been interviewed recently and will commence their employment at the Home once their criminal records bureau and protection of vulnerable adults checks have been received. Sixteen care staff are employed at the Knowles, eight of these staff have undertaken a national vocational qualification in care at level 2. This means that fifty percent of care staff have obtained this qualification. Undertaking regular training goes some way to ensuring that people living in the home are cared for by competent staff. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 27 The manager confirmed that staff undertake induction training which is a one day orientation programme which shows staff where policies and procedures are kept etc and further induction training which is in line with Skills for Care requirements. This can take up to six months to complete as documentation is very comprehensive. The manager confirmed that those staff undertaking induction training now have their records at home. Induction information was not reviewed in detail on this occasion. Individual records are available to record what training has been undertaken by each member of staff. Records demonstrate that staff undertake a wide range of training on a regular basis. However it was noted that not all staff have undertaken moving and handling training recently. The manager confirmed that training is available in December in their sister Home and staff are able to attend this, training is also arranged for March 2008. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 28 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home’s 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: The new manager is in the process of completing the Registered Managers Award and has 10 years experience of working with older people, including 5 years as a deputy manger at another home. Since the last inspection the manager has become registered with the Commission for Social Care Inspection. The manager has worked hard to introduce systems and improve upon existing systems in place. The manager works in a supernumerary The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 29 capacity but likes to spend some time each week working alongside staff providing “hands on care” to residents. Quality assurance systems in place were discussed. Residents and relatives meetings take place twice per year and minutes were available to demonstrate what issues were discussed. The manager confirmed that recently there has been a very low uptake for these meetings and nobody attended the meeting in August 2007. Dates of the meetings are advertised on notice boards and in the quarterly newsletter. Visitor’s satisfaction surveys are available in the entrance of the Home and the manager sends out surveys twice per year, however they rarely receive any responses. One survey was on file dated August 2006. A comments book is available in the manager’s office and visitors, staff or residents are able to make comments in this book but must ask the manager or the administrator for the book to record their comments. Visitors may feel uncomfortable asking for this book to record suggestions for improvements or grumbles. Leaving this book readily accessible to visitors may lead to more open and honest feedback. Suggestions slips are attached to the back of the quarterly newsletter and a suggestions box is available in the entrance of the Home. This is checked on a weekly basis but suggestions are rarely received. A general satisfaction survey was sent to residents in November 2006 and a catering satisfaction survey more recently, however this was not dated. The manager has not devised an action plan following the results of any surveys. It was noted that a majority of the comments received were positive. However documentary evidence of the action taken to address issues raised should be available. Regulation 26 visits are undertaken on a monthly basis and an action plan is available to demonstrate the action taken to address any issues identified. The Home does not hold funds on behalf of any residents. The manager confirmed that residents buy toiletries, chiropody, hairdressing etc from petty cash and family members are invoiced to request funds. Records are available to demonstrate this although these were not reviewed at this inspection. Records regarding fire, electrical wiring, hot water temperatures and legionella were reviewed to evidence whether the health and safety of staff and residents is maintained. Records were available to demonstrate that legionella tests were undertaken in November 2006. Fire points are tested on a weekly basis, emergency lighting and fire doors are tested monthly. A quarterly fire drill also takes place with those staff on duty. Records were available from an external company to demonstrate that fire-fighting equipment is serviced on a regular basis. An electrical test was undertaken in November 2006 the letter on file The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 30 reported faults have been identified which do not pose an electrical safety risk and all safety tests as required by IEE regulations have been met. The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 31 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? New Registration 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 OP9 Regulation 13 (2) Requirement The registered manager must make appropriate arrangements for the recording, storage and safe administration of medications. The concerns identified in this report regarding the recording and administration of medications must be addressed within a risk management framework. Take prompt action to eradicate odours in any bedrooms. (Outstanding since 22 January 2007) Documentary evidence must be available to demonstrate that staff receive regular mandatory and service user focussed training. Moving and handling and must be undertaken on a regular basis. Documentary evidence must be available to demonstrate that induction training in line with the Skills for Care Council is undertaken. Timescale for action 20/12/07 2 OP26 23(2)(d) 15/01/08 3 OP30 18(1) 15/01/08 The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 33 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 Refer to Standard OP7 Good Practice Recommendations Daily records should be linked to care plans and demonstrate the actions that staff are taking to deliver the prescribed care. Activities should be organised to suit individual needs of residents. Records must be maintained to demonstrate what activities have taken place and who has participated. The manager is recommended to increase the opportunities for people to get out more after consulting with them about the types of places they would like to visit. The use of frozen vegetables for each meal should be at the request of residents, the nutritional value of meals should not be compromised and documentary evidence should be available to demonstrate this. 2 OP12 3 OP12 4 OP15 The Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Knowles DS0000069671.V348125.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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