Inspection on 16/05/06 for Thomas Knight Care Home

This inspection was carried out on 16th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Thomas Knight Care Home 16/06/08

Thomas Knight Care Home 17/05/07

Thomas Knight Care Home 29/08/06

Thomas Knight Care Home 27/01/06

Thomas Knight Care Home 12/09/05

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Thomas Knight Care Home 1 Beaconsfield Street Blyth Northumberland NE24 2DN Lead Inspector Janet Thompson Key Unannounced Inspection 16th May 2006 09:30 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 DS0000060989.V289690.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. DS0000060989.V289690.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Thomas Knight Care Home Address 1 Beaconsfield Street Blyth Northumberland NE24 2DN 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 Mr Sewa Singh Gill 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) DS0000060989.V289690.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: Thomas Knight is a newly built care home 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. The middle floor is currently unoccupied. There are sitting areas and a dining room on each floor. A passenger lift connects all floors, the lift is of a type not usually found in care homes and its approval is still under discussion with the fire department. The gardens are located to the front and side of the home. They are very small. 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 £355.97 to £376.31 per week. DS0000060989.V289690.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home opened in 2005. During that year two main inspections and several monitoring inspections were carried out. This was due to serious concerns about the running of the home at that time. There were several changes of manager in 2005/2006 and the home was without a manager or deputy manager for a number of months. At the time of this inspection there was a new acting manager who had been in post for four weeks and had made some positive improvements. This inspection was unannounced. Information about the home was requested before the inspection. Resident questionnaires were also distributed. Due to the very recent appointment of the manager the information was not received until after the inspection. One resident questionnaire has been received which comments positively on all areas of the home except for social activities. During the inspection a range of records were examined and time was spent with service users and staff. Following the visit to the home there was an outbreak of diarrhoea and therefore the Environmental Health Officer and Infection Control nurse from the Health Protection Agency visited. Their feedback has been taken into account in this report. The home has three floors. The middle floor of the home is not yet opened. Residents are accommodated on the ground and second floors. What the service does well: The residents said they were happy at Thomas Knight. Four residents were spoken to and they all said that the staff were kind and helpful. Staff appeared to have a good rapport with residents. Residents looked clean and tidy. The atmosphere on the Dementia unit in particular was calm and relaxed. One resident had different cultural and religious needs as well as complex care needs. Staff were trying hard to meet all of his needs. DS0000060989.V289690.R01.S.doc Version 5.1 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. DS0000060989.V289690.R01.S.doc Version 5.1 Page 7 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 DS0000060989.V289690.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users did not have the information they need to make an informed choice about where to live. All residents have their needs assessed before moving into the home. Intermediate care is not provided at Thomas Knight. EVIDENCE: The home’s statement of purpose was not up to date and was poorly presented with inadequate print. There was no information on accommodation, available services, and the number of beds, fees or categories of care. This was highlighted at the first inspection of the home and the Proprietor has not taken any action to address it. Enforcement action may be taken if this requirement is not met within the new time scale. DS0000060989.V289690.R01.S.doc Version 5.1 Page 9 Three care plans of residents newly admitted to the home were examined. They all contained adequate pre-admission information. The information included the different ethnic and cultural needs of one resident. The staff nurse on duty confirmed that the manager visits every resident before admission even when the admission is an “emergency”. The manager confirmed that he would not admit anyone to the home without a preadmission visit. The residents recently admitted were unable to comment or remember their pre-admission period. DS0000060989.V289690.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’ needs are set out in a plan of care. Resident’s health needs appeared to be met. The medication procedures in the home are not adequate in protecting residents. Resident’s felt they are treated with respect and have privacy. EVIDENCE: Four plans of care were examined as part of case tracking. These included one resident with diverse cultural and religious needs, one new resident, one very dependent resident and one fairly independent resident. The care plans reflected the differing needs of the residents. All aspects of care were identified. Care plans were clear and easy to read. All assessments and plans had been reviewed monthly. The staff nurse in charge was able to discuss the care of the residents in detail. These accounts corresponded with what was written. Residents or their representatives had signed some care DS0000060989.V289690.R01.S.doc Version 5.1 Page 11 plans but not all. The staff nurse confirmed that this was an ongoing exercise and he was attempting to approach relatives to get all plans signed. Resident’s health needs were clearly recorded in care plans. This included visits from health professionals. Resident’s spoken to confirmed that they could see the doctor when they liked. One resident described the care given to her during a recent illness as “second to none”. All medication administration records were examined. These showed that several medications had not been signed for as given. The manager has carried out an audit of the controlled drugs but not yet for other medication. Two resident’s spoken to confirmed that they were treated well in the home and they felt that staff treated them respectfully. Staff were observed speaking to residents in a friendly way that was also respectful. Privacy is assisted through the use of single bedroom accommodation. DS0000060989.V289690.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s lifestyles do not meet their social needs. Resident’s are not assisted to maintain community links or to exercise choice and control. Food provision was adequate. EVIDENCE: There has not been an activities co-ordinator in the home for a number of months. Residents did not appear to have much to do and were largely unoccupied during the inspection. Resident’s told the inspector that they were bored, tired of doing the same things or did not think there was anything to do. Resident’s social preferences and abilities had been assessed as part of care planning but no action taken. Mr Gill, the Proprietor met with CSCI in 2005 and gave an undertaking to reassess the provision of activities in the home. So far this has not been done. DS0000060989.V289690.R01.S.doc Version 5.1 Page 13 Families and friends do visit resident’s in the home, however there does not seem to be any effort made to ensure that residents maintain community links when they do not have family to support them. Residents are not consulted through meetings or surveys regarding the running of the home. The manager is planning resident meetings but has not had time to do this yet. The Cook appeared to understand the needs of residents and had a list of special diets, including soft diets. The kitchen was stocked with fresh fruit and vegetables. The soft diets were ready for blending and the inspector noted that they were blended separately and served as individual flavours. Residents spoken to said they like the food and if they don’t want something they are offered an alternative. A choice of main meal is given. The Environmental Health Officer is concerned that the Cook does not have Intermediate Food Hygiene training despite informing the Proprietors that this was required some months ago. This is being monitored by the Environmental Health Officer. DS0000060989.V289690.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be listened to. Residents are not fully protected from abuse. EVIDENCE: There have been three complaints and one incident requiring use of the vulnerable adults procedures. Three residents spoken to said they would complain if they needed to and they all thought that their complaint would be taken seriously. One resident named a staff member that he would complain to, the remaining two residents were not sure who to complain to. The lack of a consistent manager in the past year has resulted in a variation in the standard of complaint management and some confusion as to the leadership of the home. This standard can not be fully met until residents and staff are made clear of the proper procedure for making a complaint. Adult Protection procedures are available in the home. Some staff have received training in the subject but not all. The manager has identified those staff who require training and has booked a course commencing in a few weeks. DS0000060989.V289690.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were safe. The home was clean, however not all hygiene standards are being met. EVIDENCE: All of the public areas, bathrooms and toilets were examined. Some of the bedrooms were examined. The home is newly built therefore does not yet require redecoration. Resident’s bedrooms were clean, tidy and well personalised. Four residents were spoken to, they said the home was clean enough and they were complimentary about the levels of hygiene. External grounds are limited. On the day of inspection they were tidy and free from rubbish. All bathrooms and toilets were clean and tidy. DS0000060989.V289690.R01.S.doc Version 5.1 Page 16 Several requirements have been made in the past year regarding the cleanliness of the premises and state of repair. These have been met. There were no obvious trip hazards. Fire exits were clear. Hazardous substances were locked away. There were no offensive odours in the building. The laundry, though busy, was well organised and clean. The laundry assistant said she had received training specific to her role and was confident that she understood the importance of hygiene. Following this inspection there was an outbreak of diarrhoea in the home and the Environmental Health Officer and Infection Control Nurse visited. They found that there were some areas not fully clean and that the relief laundry worker was working in a different way from the main laundry worker. Waste was not collected often enough. Clinical and domestic waste was not in a secure external bin. These professionals are producing a report in which they will make requirements of the home. This would indicate that standards are not yet consistently good, though they have improved. A requirement is outstanding regarding the supervision of staff. A new requirement has been made regarding audit of the premises, staff communication, education and staff meetings. DS0000060989.V289690.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the numbers of staff. Residents are protected by recruitment procedures. Staff do not all have up to date statutory training to enable them safely to do their jobs and therefore residents may not be in safe hands all of the time. EVIDENCE: There were sufficient numbers of staff on duty. The staffing for the home is: 1 Registered nurse on each floor at all times. 3 Care staff on each floor through the day. 2 Care staff on each floor at night. 37.5 of care staff have been trained in NVQ2 or above. The standard to reach is 50 . The manager had identified that some staff did not have appropriate pre employment checks, which he has now done. Four staff files were examined and contained all required information. All files showed that employment history had been checked. References have been obtained. Criminal records checks have been carried out. The manager has used an interview form when interviewing staff, which is good practice. DS0000060989.V289690.R01.S.doc Version 5.1 Page 18 A staff training plan was asked for at the last inspection. This has been produced but was not up to date. Since this inspection the manager has highlighted where the shortfalls in statutory training are and planned accordingly. Several staff require training updates. DS0000060989.V289690.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is not yet a registered manager in the home. The home is not run in the best interests of residents. Resident’s financial interests are safeguarded. Staff are not appropriately supervised. The health and safety of residents and staff is not protected. EVIDENCE: The manager has been at the home for four weeks in an “acting manager” capacity. He is not yet registered with CSCI. However in this time he has made some positive changes and identified areas for improvement. There has been good progress made in the last four weeks. There was no evidence to suggest that the home is run in the best interests of resident’s as they are not formally consulted in any way. The manager has already identified that resident meetings need to be restarted. Residents DS0000060989.V289690.R01.S.doc Version 5.1 Page 20 should be consulted as part of an ongoing quality assurance audit. There is no quality assurance system in the home. Finance records for all residents were examined. Monies are held individually and receipts kept for amounts spent. Three amounts were checked and found to be correct. The manager has started to formally supervise staff but not all staff have received a supervision. Staff are not up to date with statutory training relating to the health and safety of themselves and residents. The Environmental Health Officer has identified some matters needing attention in food hygiene. DS0000060989.V289690.R01.S.doc Version 5.1 Page 21 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 2 DS0000060989.V289690.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The Statement of purpose must be reviewed to ensure that all required information is included. (OUTSTANDING FROM 2005) All medication must be signed for as it is administered. A medication audit must be carried out on a regular basis. 3. OP12 16(2)(n) Improve the provision of social activities. (OUTSTANDING FROM JANUARY 2006) 01/09/06 Timescale for action 01/08/06 2. OP9 13(2) 01/08/06 4. OP15 16(2)(j)(i) Provide the Cook with Intermediate food hygiene training. 18 01/07/06 5 OP30 Provide a training plan that takes 01/07/06 account of assessed training needs of all staff. (OUTSTANDING 2005) The acting manager to submit an application form to be the registered manager. 01/07/06 6.. OP31 8 DS0000060989.V289690.R01.S.doc Version 5.1 Page 23 7. OP36 18(2) All staff to receive formal two monthly staff supervision. (OUTSTANDING 2005) Demonstrate how community contacts are maintained for those residents who do not have family. Provide staff with training in the management of complaints. Issue residents with the complaints procedure. Train care staff in Adult Protection Procedures. Ensure that staff are clear regarding their role and responsibilities. Instigate staff meetings. Perform an audit of the premises on a regular basis. 01/07/06 8. OP13 16(2)(m) 01/08/06 9. OP16 18, 22 01/08/06 10. OP18 18, 13(6) 01/09/06 11. OP26 23, 18 01/07/06 12. OP33 24 Introduce an effective quality assurance system that takes account of resident’s views. Carry out a health and safety audit in the home. Ensure that staff are up to date with statutory training. Provide an action plan to address the requirements of the Environmental Health Officer. 01/07/06 13. OP38 16(2)(j) (k) 01/07/06 DS0000060989.V289690.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP14 OP28 Good Practice Recommendations Instigate a programme of consultation with residents. 50 of the home’s staff should be qualified to NVQ level 2. DS0000060989.V289690.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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