Inspection on 17/10/05 for The Knowls

This inspection was carried out on 17th October 2005.

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 found no outstanding requirements from the previous inspection report, but made 9 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 13/02/06

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 17th October 2005 08:35:0 The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 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.V258670.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V258670.R01.S.doc Version 5.0 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.V258670.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 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.V258670.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of one day in October 2005. The inspector met several of the residents and talked to two residents. The inspector viewed some parts of the home, checked all records relating to three individual residents, including care and support plans, and the accident book. Selected staff files were examined. The inspector spoke to the manager and three members of staff in private. As a result of this inspection seven requirements and three recommendations were made. What the service does well: What has improved since the last inspection? Some areas of the home had been decorated since the last inspection. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 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.V258670.R01.S.doc Version 5.0 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. The home does not ensure that a robust pre-admission assessment is conducted and recorded prior to new residents being admitted to the home. EVIDENCE: Since the last inspection the home has admitted one resident. The resident had previously lived in another home within the company before returning to live in the community. There was no written evidence to confirm that a formal assessment had been completed to ensure that the home could meet this person’s needs. The home must conduct a detailed assessment prior to any resident moving to the home, regardless of the company knowing the resident. This was discussed with the manager at the time of the inspection. A written pre admission assessment must be undertaken and kept on the individual’s personal file. The resident had not been able to visit the home before moving in as they were living some distance from the home. The manager said that she and a senior manager had visited the resident in their home to meet them and their family prior to the resident moving in. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 9 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, 7, 8, 9. Residents are encouraged to make decisions about their lives and are supported to be involved in the day-to-day routine as far as they are able. The home uses alternative methods of communication to offer choice and aid decision-making. The staff team and culture within the home support residents to take risks while promoting an independent lifestyle. Risk assessments are conducted and reviewed when needed. The care and support plans are individual, well organised and regularly reviewed and updated. The home kept good records in relation to the management of service users finances. EVIDENCE: The inspector viewed three care and support plans, all of which were detailed and comprehensive and gave clear information to staff. Each resident had a nominated key worker. Risk assessments were in place, detailed and up-toThe Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 10 date 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 monthly basis with summaries kept that detail the outcomes for individuals. At the time of the inspection it was noted that residents were being offered choices in aspects of daily living. Staff use varying methods of communication suited to individual resident’s needs. The inspector spoke to three staff at the time of the inspection who were able to demonstrate how residents are offered choices in all aspects of daily living. The inspector viewed and discussed the arrangements for the management of service user finances. The inspector viewed the finance documentation of three residents selected for ‘case tracking’, all records were found to be correct and kept in an appropriate manner. Daily records are kept of all transactions with receipts kept and the manager audits these records regularly as part of the home’s procedure to safeguard residents’ monies. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 11 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): 11, 12, 13, 14, 15, 16, 17. The home has a planned menu that is healthy and with choices available. The home encourages and supports residents to access the local community and partake in a variety of leisure, recreational and social activities. The home encourages family and friends to visit the home and residents’ rights are respected and promoted. EVIDENCE: It was evident from residents’ files checked, that they are offered choices in leisure, social and recreational activities. Activities are based on individual choice and need and records are kept of activities undertaken. At the time of the inspection one resident was using the art room. Activities available included going for a walk, music therapy, art and craftwork and trips out in the homes vehicle. The home pays for each resident to have a holiday with individuals making a small contribution towards the cost. Some residents had recently been to Cornwall and others to Euro Disney for their holidays. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 12 Residents who were unable to leave the home for an extended period were offered appropriate day trips. The home operates a regularly changing menu that takes seasonal changes into account to ensure a varied diet is provided. Wherever possible residents are involved in menu planning and can request an alternative meal if so wished. The dining room is spacious, however, the dining tables are worn and shabby through wear and tear and should be made good or replaced. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 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): 18, 19, 20. The home ensures that residents have access to all appropriate health care professionals. Residents’ benefit from a good gender balance in the staff team. EVIDENCE: The majority of residents are currently male. The staff team of 30, including the manager, includes 14 men which allows residents a choice of a member of staff of the same gender for personal care and leisure activities. The care and support plans viewed contained records of visits made to health care professionals. These included visits to the GP, dentist, chiropodist and optician. All staff had received training in moving and handling and residents’ individual needs are identified in their care plans. The inspector viewed risk assessments in relation to moving and handling. These had been reviewed and up dated as necessary to give clear information to staff. The inspector observed that residents were supported by staff to choose their own daily routines as far as practicable. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 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, 23. The home has a detailed complaints procedure that is available in appropriate formats for residents. Robust systems are in place to protect residents from abuse. EVIDENCE: The home has a clear complaints policy and procedure, which is also available in an accessible format. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. The policy should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. The manager and staff spoken to were clear about the procedure to follow if a complaint was received. All prospective staff has a POVA check and an enhanced CRB clearance before being employed to work at the home. The home has a detailed adult protection and whistle blowing policy and procedure and the majority of staff spoken to were familiar with the policies and what to do if an allegation of abuse was made. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 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, 25, 26, 27, 28, 30. The interior and exterior of the home is accessible and designed to meet the needs of the residents living at the home. The home offers a generally good standard of furnishings, fittings and decoration. 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. Staff facilities would benefit from maintenance and redecoration. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 16 EVIDENCE: All bedrooms are of single occupancy and offer en suite facilities for residents’ comfort and privacy. They are generally well decorated and furnished and contain personal possessions including family photographs, pictures, ornaments, television, hi-fi and DVD players. Some areas of the home needed maintenance work such as the replacement of light bulbs; the manager was advised to use a book to record maintenance issues. On the day of the inspection most areas of the home were clean, hygienic and tidy but still retained a very homely atmosphere. Cobwebs were apparent in some areas of the home at a level staff were unable to reach. A variety of shared space is available in the home to ensure privacy for residents if they wished to spend time alone or with visitors in private. It was evident that the home has always been decorated and furnished to a good standard but 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. These must be replaced as a matter of urgency. Staff facilities include a sleep over room and ensuite toilet/shower room. The shower facilities were in a poor condition and needed maintenance or replacement of the shower tray. The wall showed evidence of damp and needed maintenance work and decorating to bring it to an acceptable standard. The staff toilet in the office smelt of urine due to its recent use by a resident who needed ground floor accommodation and the wooden floor should be removed and replaced. The kitchen was clean and tidy but required cleaning at a high level which staff were unable to reach, it also needed to be decorated. Care staff also undertake domestic duties as part of their role and no additional ancillary staff are employed. A cleaning schedule is maintained. The laundry is sited away from the kitchen. There are two washing machines and a dryer. Hand washing facilities are provided for staff in the laundry. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 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): 31, 32, 33, 34, 35. On the day of the inspection the home appeared appropriately staffed to meet the needs of the residents. Voyage has a robust recruitment process that protects residents from the risk of abuse and harm. Voyage has a comprehensive training programme but progress in giving care staff access and support to obtaining an NVQ qualification is poor. EVIDENCE: The inspector viewed the recruitment files of two recently appointed staff members. The files contained the required documentation. Voyage has a dedicated training department and the manager is notified of forthcoming courses and able to nominate staff as required for their professional development. All staff had completed basic training such as first aid, moving and handling, food hygiene and fire safety. Newly appointed staff undertake the Learning Disability Award Framework training. Four staff are qualified to NVQ level 2 or above, which means that the percentage of qualified staff is only 14 . Significant efforts must be made to increase the number of qualified staff to ensure that the workforce of the home has the skills and experience to provide a good level of care. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 18 The manager and staff spoken to said that Voyage has a commitment to providing staff training and that foundation training was readily available. Staff spoken to felt very supported by the manager, they were paid to attend staff meetings and felt that they were able to contribute to the meetings. The gender make up of the staff team means that residents are able to choose to have a choice of the gender of the member of staff available for personal and social care. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 19 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): 37, 38, 40, 41, 43. The manager is competent and experienced to run the home and shows direction and leadership. Residents’ benefit from living in a well run home. Voyage has a clear management structure and comprehensive policies and procedures. All policies and procedures are available in the home. EVIDENCE: The manager is Mrs Moira Brunt who has several years experience of working with and managing a home for residents with a learning disability. Mrs Brunt is near to completing the Registered Managers Award. The inspector spoke in private to some care staff who all commented that Ms Brunt is approachable, a good listener and supportive. All records sampled were well presented and maintained and held in a secure and confidential manner. Voyage has comprehensive policies and procedures that have been recently reviewed to give up to date guidance and advice for the manager and staff. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 20 Monies held on behalf of residents were kept individually and securely with adequate systems set up to ensure that residents’ funds were safeguarded. The home’s insurance and registration certificate were displayed in the office. Staff spoken to described the manager as supportive and always available to offer advice and guidance. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 2 X 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Knowls Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 X 3 DS0000039960.V258670.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement The home must ensure that a detailed pre admission assessment is undertaken to ensure that the home can meet the needs of prospective residents. The Registered Person must make good or replace the dining room tables. The Registered Person must provide suitable facilities for staff. The Registered Person must replace all the baths that are chipped. The Registered Person must ensure that all areas of the home are decorated to an adequate standard. The Registered Person must ensure that the staff flooring is replaced to remove the offensive odours. The Registered Person must make regular arrangements to clean areas of the home that staff cannot reasonable reach. Timescale for action 30/11/05 2 3 4 5 YA17 YA30YA28 YA27YA24 YA24 23 (2)(c) 23 (3) 23 (2)(c) 23 (2)(b) 31/12/05 31/12/05 30/11/05 31/01/06 6 YA30 16 (2) k 30/11/05 7 YA30 16 (2)(j) 30/11/05 The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA22 YA24 YA32 Good Practice Recommendations 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. It is recommended that a maintenance book be used to log maintenance issues identified by staff. The registered person should ensure that at least 50 of staff are qualified to NVQ level 2 or above by 31/12/05. The Knowls DS0000039960.V258670.R01.S.doc Version 5.0 Page 24 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.V258670.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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