Inspection on 22/08/06 for The Knowls

This inspection was carried out on 22nd August 2006.

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 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 4 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 13/02/06

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 Loli Ruiz Unannounced Inspection 22nd August 2006 9:40 The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 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.V306005.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 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.V306005.R01.S.doc Version 5.2 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 (Mrs Brunt left the home 31/03/06. Mrs Sarah Fry is the new manager) Care Home 14 Category(ies) of Learning disability (14) registration, with number of places The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13/02/06 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. 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 Mrs Moira Brunt left her employment at the end of March 2006 and Mrs Sarah Fry, registered manager of another home of the same company, has taken over the management of the home since. The Registered Provider is Voyage Ltd. Mrs Fry is applying to register for this service. Voyage (formerly Home First and Foremost) achieved Investors in People status in December 2001. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the course of one day on 22nd August 2006. The new manager, Mrs Sarah Fry, new deputy and staff on duty were available and assisted during the inspection. Thirteen of the fourteen beds were occupied at the time of the inspection. Two service users were away on holiday with their families. The inspector had brief contact with seven service users who would have found it difficult to express their views to an unfamiliar person. The inspector spoke with a parent, in the home at the time. Selected care and staff files were checked and other records related to the running of the home also inspected. The inspector toured the home with a staff member and observed practice at different times of the day. This report should be read together with that of the previous inspection of February 2006. Requirements and recommendations unmet by the previous management have been carried over and they should be considered in that context. What the service does well: There had been no admissions to the home since the last inspection but past history suggests that the home would follow corporate robust admission procedures and provide the transition work needed to make new admissions to the home successful. The care and support plans are individual, well organised and regularly reviewed and updated, staff are familiar with the residents care needs and how these should be met. Parents are provided with copies of the care and support review notes. Records were stored securely. Staff continue to be well supported both formally and informally by the supervisory team and care practices are reviewed to ensure that the standard of care provided at the home is good. Service users were supported in a relaxed and friendly manner that brought about a calm and pleasant environment. The new management of the home has begun to work towards meeting the requirements and recommendations made after the last inspection of the home to the previous management. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V306005.R01.S.doc Version 5.2 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.V306005.R01.S.doc Version 5.2 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, 5 Service users needs and preferences are assessed by the referring local authority in cooperation with the management of the service. Admission documents are kept in the company’s head office outside the area and there is no local documentary evidence that standards relating to the admission process are met. EVIDENCE: Service user records inspected evidenced that the needs and preferences of service users had been assessed and documented. There was also evidence of the continuing involvement of service users’ social workers. There were no details of the statement of purpose or contract provided in service users files. Contracts continue to be stored in the head office in Henleyon-Thames and unavailable for inspection. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 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, The care and support plans are individual, well organised and regularly reviewed and updated. However, consultation with service users (their advocates) is not made explicit. The format is at present being reviewed aiming at reflecting a person centred approach. Service users are assisted in making decisions about matters that affect them, are given responsibilities explicitly based on trust and assisted to take risks within a framework of support. EVIDENCE: The inspector discussed three care and support plans with key workers who explained their involvement and role. Care, risks and support needs are comprehensively detailed and there is a behaviour management plan for each person. Monthly summaries are prepared and inform reviews. The involvement and agreement of service users and relatives in the care and support plans was not obvious as their signature was not included as it should be. The manager is working with senior staff to review the format used for care and support plans to make a person centred approach more explicit. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 10 There was evidence in the care notes of access to social and health care services and the manager plans to engage a behaviour specialist to assist the home best manage complex behaviours. Discussions with staff and observation of practice on the day evidenced that service users are consulted in all activities of daily living, that staff are sensitive to each individual’s needs and preferences and actively assist and encourage daily living skills, both in the home and while accessing services in the community. Examples were encouraging socially acceptable forms of communication and behaviour, trusting service users with new equipment based on previous success, consulting them about their meals, about daily activities, providing freedom of movement with the necessary support and also in the manner in which service users responded and engaged with staff. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 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): 12, 13, 14, 15, 16,17 Service users are given opportunities for appropriate social and leisure activities and to access community facilities and services. Service users are assisted with maintaining contact with relatives and friends. Service users are treated with respect, their rights and responsibilities recognised and included in the manner of support provided. A varied menu is prepared in consultation with service users and minority needs are catered for. Staff should use protective clothing when serving food and drink. EVIDENCE: Service users are assisted to attend a monthly social event organised with other homes, in Bridgewater. Service users access leisure facilities such as swimming, walks and have frequent short trips to local facilities and further away for half or whole day trips. Staff were pleased that individual behaviour improvements meant that some service users were now accessing venues that had been unsuccessful The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 12 before such as the cinema. On the day of the inspection, a small group of service users had gone out to lunch, later a key worker said they had gone to Exmouth- reported to have had a happy time. Service users were going out for tea in the afternoon and possibly a walk. Other service users were having 1:1 sessions in the art room. One had prepared a card for a relative. Two service users were in their bedrooms with staff closely available, a service user was tidying the bedroom with staff and another encouraged to assist with the lunch meal preparations. Activities were displayed on a board in the kitchen. Two service users were at home for a few days holiday and one of them returned with parents during the day. The inspector received positive feedback from a parent about the home, the staff, life style and opportunities provided by the home for their relative. Comments such as: “ We are so lucky” “ staff are very good, though there have been staff changes, new faces that people with autism do not appreciate” “ But Sara (manager) and Amy (deputy) were here before so that is good“ I would never need to right a letter, I can come and tell them about anything I may be unhappy about and they always respond well” “my (relative) is much better now ” “ I get copies of review notes sent”. The majority of service users are said to have close relations with relatives and visit them. Service users have one week paid holiday per year and they are asked to contribute if the holidays chosen are abroad or they take more than one holiday. Holidays have been booked for a week in Barnstaple and staff are booking another holiday in Cornwall. Observation of practice showed mutually respectful relations between staff and service users. Staff’s expressed their trust in service users and were rewarded by positive outcomes that they then acknowledged and built on. Monthly summaries note improved behaviours during the last few months. There was a relaxed atmosphere in the home throughout the day. A varied menu is prepared taking into consideration service users needs and preferences. Specialist suppliers are used to cater for health, cultural and religious diets. The meal observed was served in good portions, an unhurried manner with enough staff assisting. Staff were observed not using the protective clothing available to prepare and serve food and drink as they should to prevent the risk of contamination. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 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, Staff work to meet the service user’s psychological and support needs with improved outcomes. Social and health care specialists are engaged with meeting service users needs. The medication storage, recording and administration was appropriately carried out by trained staff, with some adjustments needed in connection with accessibility of the medication policy. EVIDENCE: Care and support records evidence that staff have a good knowledge of each service user needs and preferences and also evidence plans made to meet individual needs. Staff were observed checking out with service users that they agreed with whatever they were doing and staff also described how they assisted service users to choose appropriate options when out of the home. Good outcomes were reflected in relaxed and apparently contented service users. Where necessary the home works with other professionals. There were recent records of visits to dentist, chiropody and opticians by the individuals whose records were inspected. A CPN was visiting a service user on the day and records evidenced the continuing input of social workers. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 14 The GP was reviewing medication aiming with staff at reducing or discontinuing medication where not longer needed. The medication storage, recording and administration was found generally well managed. The medication policy should be personalised for the home and signed by the manager, be within easy reach so that those involved with medication can refer to it. A summarised version and a list of trained signatories should be included with the MAR-sheets. Staff involved with medication have completed a long distance medicines course assisted by a trainer from a local college. There is a new corporate tool for assessing and recording staff competencies in this area that the manager is about to introduce. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 15 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 generally works to protect service users best interests and evidence showed that this is achieved, however it has work to do to inform advocates and other stakeholders how they can formally complain. EVIDENCE: There have been no complaints since the new manager took over responsibility for the home and a relative indicated that raising any issues with staff or the management was not a problem and issues were easily resolved. The complaints policy, however, was not displayed as it should be in a location easily accessible by visitors. The inspector was not able to check if all contact details were included in it as recommended by the last inspection. The service users cash was not inspected during this visit but staff were observed checking with a senior staff balances as they re turned from trips out. Service users have individual accounts. Good behaviour management programmes were part of the care and support plans seen, with primary and secondary strategies detailed to manage risks. Staff had received training in appropriately managing behaviour and aimed not to have to use physical intervention (PI). They described how they protected people when faced with self-injurious behaviours, for example placing a pillow between a person and a hard object (i.e. wall) to lessen a blow. The manager confirmed that, although approved holding techniques form part of the training, they have rarely a need to use. She agreed to ensure that the PI policy is reviewed with the staff and to check that the provider has insurance to cover staff for engaging in physical interventions that they may have to use to protect service users. The manager plans to engage the The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 16 services of a behaviour specialist that the company employs. Behaviours in the home were improving as described in the monthly summaries and evidenced by a relaxed and happy atmosphere in the home. The manager would use the corporate policy for the protection of service users. She plans to review and personalise all policies. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 17 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 home is generally homely, safe and comfortable with a number of areas remaining in need of redecoration and upgrading. Some bedrooms are attractive and nicely personalised with personal equipment reflecting the preferences of the persons living in them. They all have en-suite facilities. Bedrooms and shared spaces that needed it, were being redecorated. Areas identified in the last inspection as in need of cleaning remained so. EVIDENCE: The inspector visited most areas in the two houses included the well tended gardens. Some areas of the building, shared and private, were attractive and well maintained. Signs of wear and tear in parts of the building remain obvious although redecoration of a large living room was taking place and two bedrooms were due to be redecorated next. A chipped bath had been replaced and two others were due to be replaced next. An absent basin was due to be installed in a bedroom. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 18 Two private WCs had unacceptable odours possibly due to old floor finishes not responding well to cleaning. The manager has worked out a new cleaning schedule but it is also possible that spillages are not cleaned as soon as they happen- resulting in smells in these areas. As in the last inspection, the kitchen was clean and tidy but required cleaning at a high level which staff was unable to reach, it also needed re-decorating. The staff toilet by the office had no water coming out of the hot tap. The flooring had been replaced as required in the previous report. Two bedroom doors had keys as the persons living in them were able to use keys. One was out and liked to lock the door. Other doors had key-pads. There was evidence that service users could access their bedrooms whenever they wanted. All service users are mobile and do not require mobility equipment. Equipment for sensory stimulation was observed in some areas. The home provides equipment and materials for the control of infection. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 19 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): 31,32,34,35,36 The home has an experienced staff team achieving good outcomes for service users, however staff numbers are reduced due to two vacant posts. The level of NVQ qualified staff has increased since the last inspection but the home remains below the 50 required. Appropriate recruitment and vetting procedures are carried out and new staff receive appropriate induction training and are supported to enable them to perform their roles effectively. The training chart has been improved. EVIDENCE: The manager is supported by an experienced deputy and supervisory staff. Areas of managerial responsibility are shared by the senior team, some of whom had received training in supervisory roles. Staff knew who was responsible for each area and there is a core of staff who have been in the home for a number of years and know the service users well. The new manager and deputy have worked in the home before with the same service users. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 20 The home had the equivalent of two full-time vacancies at the time and was functioning short of one staff from the ideal minimum, as identified by the manager. She made this shortfall up by working with the staff team in practical supporting tasks as necessary. She had some applicants and hoped to have recruited suitable staff soon to bring day numbers to a minimum of 8 and ideally 9. There are 3 wake staff and a sleep-in person at nights. Since the last inspection the levels of NVQ qualified staff have risen to 20 and a further 4 staff are working towards NVQ qualifications, bringing the level, once they qualify to 33 . The manager is an NVQ assessor and a second assessor is now available to the home and so she was confident that the 50 minimum would be achieved soon. The home needs a further 5 qualified staff to reach the target. Staff receive good induction and specialist training to equip them in their roles, such as LDAF, NVCI, communication techniques such as II and TC and for specific purposes such as rectal administration. Since Mrs Fry has taken over the home, the training matrix is now dated for training done (before there was just a tick) providing evidence of training done. The files of two new staff were inspected and evidenced appropriate recruitment, identity checks and vetting procedures as well as central and inhouse induction. A new staff member seen evidenced having worked a trial day and to receiving essential LADAF input and health and safety training. One of them had NVQ III. Files also evidenced contracts with terms and conditions of employment and formal supervision provided. Staff indicated that they were well supported by management and by the team. They liked working in the home and were proud of good outcomes achieved. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 21 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, 39,40, 42 Service users benefit from a registered manager who is qualified, experienced and has a positive and open approach to lead the home’s team. Internal quality assurance systems are in place to audit and review the quality of service provided by the home. The new manager has the task of formally personalising the corporate policies and procedures so that they are fully relevant to the home, familiar to the staff team and meet all legal requirements. There remain some areas of health and safety that do not meet requirements and could jeopardise the health and safety of service users and staff. EVIDENCE: The new manager is registered with CSCI for managing her previous home, which catered for service users with similar needs. She is due to apply for registration for the Knowls. Mrs Fry has completed the registered Manager’s The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 22 Award, is working towards NVQ IV and is a NVQ assessor. She is also working towards a NVQ verifier’s qualification. She has substantial experience and an open, positive and inclusive approach to her role. The organisation undertakes yearly internal quality audits in which the views of some stakeholders and advocates are sought about the services the home provides. The homes policies and procedures are reviewed and updated by the organisation centrally and distributed to the home. Mrs Fry must personalise these policies, sign and date them and ensure that staff are familiar with them. Requirements made by the last inspection to the previous manager, concerning the fire emergency procedures have been further recommended by the fire officer during a recent visit to the home. The inspector found that safety checks and maintenance had been appropriately carried out but found that a significant number of staff had not received fire instruction as required. All service users are fully mobile and equipment is not required for this purpose. Since the last inspection all staff have received general safe handling training. All staff had received basic First Aid training but the home also needs to provide an Appointed Person. All staff had undertaken food hygiene training but staff had not received the necessary infection control input and some practices were noted in the kitchen that did not comply with basic infection control principles. Accidents are recorded appropriately and the manager analyses all accidents and incidents in the home. The home has a valid wiring certificate but the portable equipment certificate was not inspected this time. The gas certificate due July 2006 was also not inspected. A company has a contract to check the water quality in the home and staff also perform checks to ensure that the mixing valves do not fail. All taps were said to be run on a daily basis. However the hot water tap of the staff WC by the office provided no water at all. The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 23 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 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 N/A 30 2 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 2 X 2 X The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? 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. YA22 22 The complaints policy must be up-to-date, include all necessary 22/09/06 contacts and be clearly available. (Unmet from previous inspection) All areas of the home that 30/11/06 needed must be refurbished and brought to a good standard. Please provide improvement plan for date given. The manager must make arrangements to maintain all areas of the home in a clean and hygienic condition, free from odours, and to this end, agree with the provider when old impervious floor finishes need replacing. (Timescales given to previous manager, regarding cleaning and decorating the kitchen ceiling and high walls had not been met) 22/09/06 Standard Regulation Requirement Timescale for action 2. YA24 23 (2)(b) 3. YA30 16 (2)(d) The Knowls DS0000039960.V306005.R01.S.doc Version 5.2 Page 25 4. YA42 12 (1) The manager must make arrangements to: * Comply with the fire officer’s recommendations. *Provide fire instruction to staff members whose instruction is out of date within 1 week of inspection. (The manager has informed the inspector that staff received fire instruction within a few days after the inspection) * Provide staff with training in Infection Control and Appointed Persons. 30/09/06 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 YA5 Good Practice Recommendations A copy of the residents’ contracts should be kept on their personal file in the home and available for inspection. (Unmet, recommended to the previous manager) Service users involvement should be made explicit by the inclusion of their (or their advocates) signature in care and support plans. Staff should use protective clothing when preparing and serving food and drink to diminish the risk of food contamination. A list of staff’s (involved with medication) signatures should be included with the MAR-sheets. Work to bring NVQ trained staff levels to NMS or 50 , should continue. DS0000039960.V306005.R01.S.doc Version 5.2 Page 26 2. YA8 3. YA17 4. YA20 5. YA32 The Knowls 6. 7. YA33 YA40 Efforts should continue to cover all staff vacancies. All policies and procedures should be personalised for the home, dated, signed by the manager and reviewed annually. To include the medication, complaints, whistle blowing, health and safety, statement of purpose and fire policies. (Unmet, recommended to the previous manager) 8. YA42 Hot water should be restored to one of the staff’s WCs at the earliest opportunity. 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