CARE HOMES FOR OLDER PEOPLE
Thomas Knight Care Home 1 Beaconsfield Street Blyth Northumberland NE24 2DP Lead Inspector
Jim Lamb Key Unannounced Inspection 16th June 2008 9:30 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 Thomas Knight Care Home DS0000060989.V366585.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. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Thomas Knight Care Home Address 1 Beaconsfield Street Blyth Northumberland NE24 2DP 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) 01670 546576 01670 546823 no email Mr Sewa Singh Gill Mrs Carol Ann Spence Care Home 54 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (17), Physical disability (1) Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th May 2007 Brief Description of the Service: Thomas Knight was opened in 2005, it is situated in the centre of Blyth. The home is close to local shops and amenities. The accommodation is located on three floors and all rooms are single with en-suite facilities. The ground floor of the home accommodates residents with general nursing needs. The second floor accommodates residents with nursing and mental health needs. There are sitting areas and a dining room on each floor. A passenger lift connects all floors. There are small gardens to the front and side of the home. The garden at the front is not suitable for use by those residents with any degree of confusion as it leads directly onto the main road. The fees for the home range from £365.46 to £450.19 per week. Further information can be found in the statement of purpose for the home and previous inspection reports. These are available in Thomas Knight. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes.
How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 16.06.08. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well:
People feel that they will be able to live the life they choose in the home. This is because the assessment is person centred and shows an understanding and respect for diversity, including gender (and gender identity), age, sexual orientation, race, religion or belief, and disability. People feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect and autonomy over their chosen way of life. The staff team on duty at the time of the inspection were friendly and helpful.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 6 The needs and wishes of each person who lives at the home have been assessed. This means that staff know about the needs of each person and what care and support they require. The staff team at the home value the differing needs of the people who live there and make sure that they are aware of each person’s preferences. They treat the people as individuals and support them to live the life they choose as much as possible. This means they know that their opinions are valued. Staff make a lot of effort to enable the people who live at the home to experience a variety of activities so they have more choice. This helps build their self-esteem and confidence. The home employs a full time activities coordinator. Staff work hard to enable the people who live at the home to use local services so they are part of the community. One service user said, “With help from the staff, I continue to visit my local pub several times a week”. Another said, “I continue to attend church every Sunday”. The staff are supervised and trained so they know how to provide the people who live at the home with good care. All of the people who live at the home have plans of care and risk assessments. This is so staff have the information they need to support each person and keep them safe. The home has procedures for staff for the administration and recording of medication. This is to make sure the people who live at the home receive the medication they need at the correct times. The home has procedures for dealing with complaints and for protecting the people who live there from abuse. This means that the people who live at the home feel safe, know they can talk to the staff and that what they say is taken seriously. What has improved since the last inspection?
The manager and staff have worked hard to improve standards within the home. The service has recently received a falls prevention certificate presented by Fishnets, part of Newcastle college. Capacity assessments have been implemented and these assist staff to promote individual’s choice and independence. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 7 Very positive comments have been received from both service users and their relatives. Five service users’ surveys and eight relatives surveys were received. Comments from service users included: “ I had plenty of time to settle in, and I considered it my home very quickly. The staff are very good”. “I am quite settled and am happy living here”. “I enjoy the entertainment, and enjoy singing, listening to music and watching television”. “Some days I refuse to take my medication. The nursing staff try, try and try again to get me to take my medication, but if I am being particularly stubborn, I will continue to refuse it”. “The staff are very helpful indeed”. Comments from relatives included: “I visit my wife daily, I have never seen anything to cause me to question the care that she receives. The staff carry out their duties in a professional manner, they are hard working and most of all caring”. “I have found the staff and the manager very supportive. Overall they are very caring and cheerful, even the cleaners will have a word as they do their work”. “It puts the resident first in everything. Also the home knows every residents individual needs, and tries its best to improve things and try other methods to see what is best for the residents”. “Care staff have shown a high standard of skills in every respect. Inexperienced staff are always under strict supervision until they reach the required standards”. “ All staff from the manager, to the secretary, to carers, kitchen and domestic staff care about the residents. Everyone makes an effort to help, even exceeding their respective roles in the home. My mother feels happy and comfortable in her home from home.” What they could do better:
Decorating the corridors will create a more pleasant and brighter environment for service users. Decorating the kitchen will improve hygiene and provide a pleasant working environment for staff.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 8 The lip ramps on the shower trays pose a health and safety risk to both service users and staff. These should be replaced with a safe alternative. Providing refreshment-making facilities on each floor will promote the nutritional needs of the service users, and increase their choice and independence. 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. Thomas Knight Care Home DS0000060989.V366585.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 Thomas Knight Care Home DS0000060989.V366585.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): 1 2 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are properly assessed and are provided with enough information about the service to enable them to make a choice about where they want to live. EVIDENCE: The care records for four service users were examined. These showed that the home makes sure that a full assessment of a new service users needs is carried out by the person’s social worker before they come into the home. The manager also carries out her own assessment, to be doubly sure that the home can meet all of the new person’s needs. More detailed assessments are carried out once the new service user has come into the home. These include assessments of risk; of nutritional needs; of social needs; of moving and handling needs, capacity assessment and of behavioural needs. A dependency rating scale is also completed.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 11 As a result of all these levels of assessment, the manager can clearly demonstrate that all her service users are in a home that can give them the care that they need. All are provided with a contract explaining the home’s terms and conditions, and fees. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 12 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): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of the service users are met and there is good multi disciplinary working taking place. The promotion of health care is taken seriously, and service users have their personal needs met in the way that they prefer. EVIDENCE: There are comprehensive assessments in the service users’ care plans. There is also a comprehensive risk assessment of service users. There are advocacy arrangements, as well as family input to represent service users. Care plans are drawn up with service users and their relatives. Plans are amended and reviewed on a regular basis.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 13 There are systems in place that will ensure that the placement and the service users plans are reviewed annually. These involve the care managers and the service users representatives. The service users confirmed that their privacy and dignity are respected at all times. Service users’ care records showed that they have access to external health care services. G.Ps visit when necessary. Service users are referred for specialist health care if appropriate. All service users receive regular health care checks. The service has recently introduced mental health capacity assessments. These have proved to be very beneficial for service users with varying degrees of dementia, and they assist staff to promote individual choice and independence. Staff who have completed relevant training administer medication. A sample of medication records was examined. These include photographs for identification purposes. Clear directions were recorded and each dose of medication was signed for, or a code entered to verify the reason not given. The Controlled Drugs register was appropriately recorded. Two service users said, “Medication is supplied correctly and at the right times”. Privacy and dignity issues are built into the home’s policies and procedures and staff training. All personal care and medical examination/treatment is carried out in private. The dispensing pharmacist offers good support and advice. Service users’ said that they are able to make decisions for themselves, and that they are happy with all aspects of the care that they receive. One relative said, “This place is great, the staff take excellent care of my wife, I have no concerns at all” Another relative said “I visit my relative every day, and I am always consulted about the care that she receives, the staff team here are very good”. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 14 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): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are offered a good quality lifestyle, which includes social contact, activities and choice. EVIDENCE: Each service user has a social skills assessment carried out, this is partly based on the activities of daily living. This is reviewed and updated on a regular basis. All service users and their relatives participate in this process. Service users are supported and encouraged to be in control of their own lives, to enjoy their own interests and hobbies. There are daily activities available, and entertainers frequently visit the home. The home has a full time activities co-ordinator, and she had good knowledge of the service users social interests. All service users are supported to maintain very close links with their families. They can choose who they want to see and when.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 15 The home’s menus are based on the known likes and dislikes of the service users. At least two hot meals are provided each day. The menus cover a six-week cycle and they are varied and well balanced. Several service users require a soft diet and these were attractively presented. Others need assistance to eat, and this was carried out in a sensitive and dignified way. All those spoken to said that the meals were very good and that they were always offered a choice. A random inspection took place earlier this year, and there was a requirement made to provide refreshment-making facilities on each floor of the home. This has not yet happened. Religious service, which is open to all denominations, is held in the home every fortnight. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 16 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): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good, clear, user-friendly complaint and protection system. Service users are safe and their views are listened to and acted upon. EVIDENCE: There is a complaints procedure. The procedure is written in a way that ensures service users fully understand its contents. Four service users said that they had been given copies of the procedure and that staff listened to their complaints and always dealt with them fairly. The home keeps a record of complaints. The home has a Whistle Blowing policy, the Local Authorities Vulnerable Adults procedures, and a copy of the Department of Health’s document, “NO SECRETS”. Staff are aware of these procedures and have easy access to them. Safeguarding adults training is ongoing for all staff. There have been two safeguarding referrals made since the last inspection visit. Both were appropriately investigated and resolved.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 17 Service users can deposit cash for safe keeping in the home’s safe and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded and had two signatures for each entry. There was plenty of evidence of personal spending. Receipts are obtained for purchases and numbered to cross-reference to the transaction. Weekly checks of balances and cash are carried out. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 18 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): 19 20 21 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, and clean environment for those living there. Some areas need to be improved. EVIDENCE: The home was generally clean. Some areas could be better maintained. The walls and woodwork in all the corridors are grubby and chipped, the kitchen walls and ceiling are also grubby and potentially unhygienic. The shower trays in all the bathrooms have a ramped lip to enable easy access, however all of these lips are loose, broken, unsafe and pose a health and safety risk to service users and staff. The grounds were tidy and safe, and accessible.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 19 The home has a no smoking policy. There is a small seating and patio area; this area is used for service users that smoke. The home has an appropriate amount of sitting, recreational and dining space. Service users can see visitors in private in their own rooms. Furnishings and fittings were domestic in design and in a satisfactory condition. Lighting was bright and domestic in design. All doors have privacy locks and room sizes meet the minimum required. There is space on either side of beds when necessary, to enable access for carers and specialist equipment. Service users’ bedrooms have opening windows and restrictors are in place where needed. All exit doors are alarmed, and the lift also has a security pass fitted. There was emergency lighting throughout the home. Water is stored at over 60°C. Valves at water outlets ensure water is provided close to 43°C to prevent scalding. The home was clean and free from offensive odours. The laundry facilities are well organised. The washing machines have the specified programme to meet disinfection standards. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 20 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): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised and who offer consistency of care within the home. EVIDENCE: Staff levels on the day of the inspection met the agreed level. The required numbers of staff were on duty: Top floor - 1 qualified RMN and 4 care staff until 3pm, and 3 between 3pm and 8pm. Middle floor - 3 care staff across the day. Ground floor - 1 qualified RGN and 3 care staff. Night staff: 2 qualified staff and 4 care staff. All staff are over 18 years of age and those left in charge were at least 21. The training needs of the staff are identified in supervision and appraisal sessions.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 21 The home’s training programme meets the National Training Organisation requirements for the first six months. Staff have also undertaken equality and diversity training. Staff receive at least three days paid training each year. The service has a rigorous staff recruitement and selection process to ensure that all appropriate checks and references are in place prior to employment. Two staff files were checked and both contained appropriate checks and references. The service has a good staff training and development programme in place. All statutory training was up to date and over 50 of the staff team has completed NVQ level 2/3. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 22 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): 31 33 35 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. Some areas need to be improved to promote service users’ best interests. EVIDENCE: The manager has the appropriate qualifications, experience and skills necessary to manage the service. Staff were clear about their responsibilities. Service users are told when inspections take place and there are copies of reports available for relatives and others to see.
Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 23 The finance records for service users are appropriately maintained. A quality system is in place to monitor the quality of the service provided. This involves gaining feedback from service users, relatives and professionals involved with the home. There are monthly audits of care records and health and safety checks. To-date the results of the service users’ survey outcomes have not been published and made available to all prospective service users. The home does not have an annual development plan that reflects the aims, objectives and outcomes for service users. There is a health and safety policy and a range of associated procedures. Staff receive training in health and safety and safe working practices (fire safety, moving and handling, first aid, food hygiene, and infection control). Staff training needs are identified in supervision sessions. Servicing and maintenance agreements are in place for facilities and equipment. All fire safety checks and tests are not all conducted at the required frequency and recorded. For example, the monthly checks for emergency lights and fire extinguishers had not been checked for the last two months. Water storage tanks, gas and electrics are checked annually. Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 24 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 3 3 3 3 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 3 X 2 Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 25 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 OP19 Regulation 23(2)(a) 16(2)(h) Requirement Consideration must be given to the provision of refreshment making facilities on each floor of the home. This is to ensure the nutritional needs of service users are fully promoted, as well increasing their choice and control in this area. The corridors on each floor must be decorated, using colour schemes suitable for each client group. The kitchen must be decorated and this will promote hygiene in this area. A more effective quality assurance system must be implemented, to include an annual development plan, and prospective service users must be made aware of the results of the service user surveys. The shower tray lip ramps must be replaced with a safe alternative. Timescale for action 31/10/08 2. OP19 23 (d) 01/09/08 3. 4. OP19 OP33 16 (j) 23 (d) 24(1) (a) (b) 01/09/08 01/09/08 5. OP21 13 (4) (a)(c) 01/10/08 Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Thomas Knight Care Home DS0000060989.V366585.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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
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