Inspection on 13/02/06 for The Knowls

This inspection was carried out on 13th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Knowls 14/11/07

The Knowls 22/08/06

The Knowls 17/10/05

The Knowls 02/02/05

The Knowls 27/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Knowls 86 Trull Road Taunton Somerset TA1 4QW Lead Inspector Ms Sue Hale Unannounced Inspection 13th February 2006 10:15:0 The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 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 Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Knowls Address 86 Trull Road Taunton Somerset TA1 4QW 01823 331712 01823 353691 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) Home First & Foremost Ltd Mrs Moira Phyllis Brunt Care Home 14 Category(ies) of Learning disability (14) registration, with number of places The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2005 Brief Description of the Service: The Knowls is a large semi-detached Victorian house situated close to Taunton town centre. The home is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation for up to fourteen people with learning disabilities. Two of the fourteen people live separately in an area of the house, known as Lomond House. Appropriate adaptations have been provided to meet service users’ needs. An Art Room is located in the grounds of the home. The gardens have been well maintained and are accessible to service users. The Registered Manager is Mrs Moira Brunt. The Registered Provider is Voyage Ltd. Voyage (formerly Home First and Foremost) achieved Investors in People status in December 2001. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced took place over the course of one day in February 2006. The inspector spoke to the manager and staff working in the home. Selected residents and staff files were checked and other records related to the running of the home. Fourteen residents were living at the home on the home at the time of the inspection. None of the residents at home on the day of the inspection were able to communicate their views of the home to the inspector. This report should be read in conjunction with the previous report of the 17th October 2005. What the service does well: What has improved since the last inspection? The pre admission document has been revised to meet the national minimum standards. The facilities in the staff sleep over room have been redecorated and improved as required in the previous report. The dining room tables have been replaced as required in the previous report. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 6 The manager now keeps a record of maintenance work that needs to be completed. The redecoration and refurbishment programme should be completed as soon as practical in the communal areas and residents private rooms to ensure the good standard of accommodation is maintained. The kitchen must be decorated to ensure it is clean and hygienic. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 & 5. Robust admission procedures are in place and all prospective residents would be able to spend time in the home and meet staff and existing residents before making a decision on residency. Standard 5 could not be assessed, as residents’ contracts were not kept on their personal file in the home. EVIDENCE: There have been no new admissions to the home since the previous inspection so this standard was evidenced by checking the admission and assessment polices and procedures and by discussion with staff. The home would undertake a pre admission assessment and would obtain information from the funding authority from the care management assessment and proposed care plan. An individual care and support plan would be developed with the resident and discussion with their families and /or representatives would take place. Prospective residents would be invited to meet the staff and current residents informally and to spend time within the home including an overnight stay to assess their suitability and ascertain the view existing residents. All admissions would be on a trial basis and be reviewed formally after a settling in period. The home does not accept emergency admissions. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 9 Standard 5 could not be assessed, as residents contracts were not kept in the home so were not available for inspection. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 & 10. The care and support plans are individual, well organised and regularly reviewed and updated. Records were stored securely and staff were aware of confidentially issues. EVIDENCE: The inspector viewed one care and support plan, which was detailed and comprehensive and gave clear information to staff. Each resident has a nominated key worker. Risk assessments were in place, detailed and up-todate and were reviewed as necessary to ensure the safety of residents. Residents were supported by staff to access all necessary medical and health care and copies of medical and health care assessments were on file. Reviews occur on a on a monthly basis with summaries kept that detail the outcomes for individuals. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 11 The home has a robust confidentiality policy and the manager and staff spoken to were familiar with it and confident in how it worked in day to day practice. Records are stored securely in the office. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 – 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17. The dining room tables were of good quality. EVIDENCE: The inspector noted that the dining room tables had been replaced since the previous inspection. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed and met at the previous inspection. EVIDENCE: The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. The home has a detailed complaints procedure that is available in appropriate formats for residents but requires amendment to meet the national minimum standards. EVIDENCE: No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. The complaints policy should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. This was recommended in the previous report but not addressed. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 28. Standard 29 is not currently applicable The shared space is adequately maintained but some areas of the home including residents’ rooms require maintenance and redecoration. On the day of the inspection some areas of the home needed cleaning and maintenance work including the kitchen. The staff facilities had improved and were of an acceptable standard. EVIDENCE: The manager stated that there were plans to start redecorating the home in April 2006. Whilst this was noted, it was evident that some areas of the home were showing signs of wear and tear and needed redecorating. Residents’ baths were enamel and three showed signs of ‘chipping’ that could present a risk of injury to the residents when bathing. One bath was due to be replaced the week following the inspection with others being replaced in the near future. This must be replaced as a matter of urgency. The kitchen was clean and tidy but required cleaning at a high level which staff was unable to reach, it also needed to be decorated. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 16 The staff sleep over room had been redecorated and the bathroom area refurbished. The staff toilet in the office was being refurbished on the day of the inspection. The flooring had been replaced as required in the previous report. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 36. The numbers of qualified staff are poor. The home provides formal and informal supervision and appraisal of staffs care practice. EVIDENCE: Five staff are qualified to NVQ level 2 or above, an increase of one since the previous inspection, which means that the percentage of qualified staff is only 17 per cent. A further ten members of staff are registered on NVQ courses. Significant efforts must be made to increase the number of qualified staff to ensure to ensure that the workforce of the home has the skills and experience to provide a good level of care. Records showed that staff received regular supervision with records kept of discussions and outcomes. Staff had access to appropriate training courses and received encouragement and support from the manager to do so. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42. Internal quality assurance systems are in place to audit and review the quality of service provided by the home. The health and welfare of residents is generally well promoted but could be improved. EVIDENCE: The organisation undertakes yearly internal quality audits in which the views of some stakeholders and relatives of residents are sought about the services the home and provides. The homes policies and procedures are reviewed and updated by the organisation centrally and distributed to the home. They were not dated. Fire Safety The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 19 The home had a fire emergency plan dated April 2004 but it was not fully completed and not specific to The Knowls. The fire risk assessment was dated April 2004. The fire alarms are checked weekly by staff and all staff new to the home meet with the manager to explain the homes fire procedures. Records were seen of up to date servicing of the fire alarm and fire extinguishers. Three staff had undertaken the organisations internal safety course. Electrical Safety The portable electrical appliances were all checked in August 2005 and the hard wiring certificate is valid until January 2009. Gas Safety Evidence was seen of servicing of gas equipment in July 2005. Health and Safety All windows have restrictors fitted to ensure the safety of residents. The home has COSHH policies and procedures and risk assessments for safe working practices. Moving and Handling There are no current residents that use hoists or other moving and handling equipment, however, due to the complex needs of the residents staff should all be trained in moving and handling and currently 14 staff have not undertaken up to date certified training. First Aid The majority of the staff has current first aid certificates and there are 2 first aid boxes in the home. Food Hygiene The majority of the staff has undertaken food hygiene training. Infection Control Infection control policies and procedures are covered to some degree in the homes induction. The manager and deputy manager have undertaken specific training via distance learning and the home has a policy dated March 2004. Accident Book The home has an accident book that complies with the Data Protection Act 1998. It did not always record if any treatment was given and was not signed by the manager. The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X 2 X X 2 X The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23 (2)(c) Requirement The registered person must replace all the baths that are in poor condition. (Previous timescale not met) Timescale for action 31/03/06 2 YA24 23 (2)(b) The registered person must 31/03/06 ensure that all areas of the home are decorated to an adequate standard. (Previous timescale not met) The registered person must make regular arrangements to clean areas of the home that staff cannot reasonable reach. (Previous timescale not met) The registered person must ensure that at least 50 of staff is qualified to NVQ level 2 or above. The fire emergency plan must be completed and specific to the home. 28/02/06 3 YA30 16 (2)(j) 4 YA32 18 (1)(a) 31/03/06 5 YA42 12 (1)(a) 31/03/06 The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA5 YA22 Good Practice Recommendations A copy of the residents’ contracts should be kept on their personal file in the home and available for inspection. The complaints policy should be revised to make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. All policies and procedures should be dated and evidence of review noted. The fire risk assessment should be reviewed to ensure that it is up to date. All staff should undertake training in moving and handling. The accident book should record if any treatment was given and should be overseen and signed by the manager. 3. 4. 5. 6. YA39 YA42 YA42 YA42 The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Knowls DS0000039960.V283628.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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