Inspection on 27/01/06 for Thomas Knight Care Home

This inspection was carried out on 27th January 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 16/05/06

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 Unannounced Inspection 27 January 2006 10:00 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.V276182.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. Thomas Knight Care Home DS0000060989.V276182.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 - over 65 years of age (36), Old age, registration, with number not falling within any other category (17), of places Physical disability (1) Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2005 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 ensuite 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. 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. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection of the home since it opened in 2005. This inspection was unannounced and took place through the week. The home has had several monitoring inspections carried out following the last inspection. This was due to serious concerns being raised at that time. The home still does not have any continuity of a manager. At the time of this inspection the new acting manager had been in post for one week. The environmental health officer was asked to accompany the inspector to assess standards in the kitchen. This was due to concerns raised in a complaint about standards. What the service does well: What has improved since the last inspection? There were twenty requirements made at the last inspection. A good number of these have been met. Some have been partly met. Those things that have changed are: Residents are now receiving baths more frequently than once weekly if they desire or there is a need. Medication is better stored and staff have received training in the management of medicines. Staff have received adult protection training. Windows have been secured, emergency exits cleared, the payphone now works and a hairdressing sink has been lowered to enable it to be used. Emergency lights are working and hot water outlets are being monitored. Attention to hygiene is better. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 6 Equipment has now been provided for staff to be able to perform their role adequately. Moving and handling techniques have been reviewed and accidents monitored. Generally the home was cleaner and more hygienic. The acting manager, though only in post one week, has identified several areas requiring further improvement and started to prioritise these. 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. Thomas Knight Care Home DS0000060989.V276182.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 Thomas Knight Care Home DS0000060989.V276182.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 and 2 Prospective service users did not have the information they need to make an informed choice about where to live. Service users do not have adequate statements of terms and conditions or contracts for care. 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. The terms and conditions document bore no resemblance to the documents that were actually being issued to residents. The document being used did not meet requirements in that it was not up to date and failed to specify: : The room number to be occupied : Overall care and services covered by the fees : Fees payable : Additional services to be paid for Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 9 : Rights and obligations The acting manager reported that the registered persons are working on these documents. Thomas Knight Care Home DS0000060989.V276182.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 and 10 Care plans do not adequately identify all resident’s needs. Residents did appear to be treated with respect. EVIDENCE: Four care plans were examined. There was some improvement in the care planning since the last inspection, however some new documents used were repetitious. There did appear to be some confusion as to what should be recorded in each section. Resident’s weights were not properly recorded. One care plan stated that the resident should be weighed weekly. This had not been done. Resident’s social needs were very poorly addressed. Some plans did not show any social information at all. Staff were observed to speak to residents respectfully. Residents appeared relaxed with staff and happy in the home. The acting manager had identified ways in which residents could be better consulted in the home. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 11 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. Resident’s social needs are not met. Residents are encouraged to maintain contact with friends and family. Residents are helped to exercise choice in their lives. Residents diet is not adequate. EVIDENCE: The activities co-ordinator also works as the administrator. Due to the problems experienced in the management of the home she has prioritised the administrative part of her role. Social activities were said to be provided but there was no evidence of that in care plans. Residents did not appear to have much to do and were largely unoccupied through the visit. Resident’s social preferences and abilities had not been assessed as part of care planning. This is essential for building the basis of the activities programme. The inspector, CSCI manager Jan Collis and the Proprietor Mr Gill have met, at this meeting Mr Gill gave an undertaking to reassess the provision of activities in the home. This has not, so far been done. There were families visiting the home at the time of inspection. They appeared relaxed and at ease. One staff member was assisting a resident to change her clothes in preparation for her daughters visit. Staff were heard offering residents choices. Relatives/residents meetings do take place. The acting Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 12 manager has identified these as something she wishes to be involved in and improve on, which is good. A temporary Cook was working in the kitchen. He did not have a care-based background and was struggling to cope. He did not display any knowledge of special diets and the acting manager had to explain what constituted a diabetic diet. The environmental health officer was involved in the inspection. She raised concerns about the cleanliness of the kitchen and the promotion of food hygiene. The situation was made worse by the fact that the kitchen assistant was on long term sick. This meant that the Cook was dealing with all of the ordering, cleaning and cooking. Crockery was not returned to the floors in time for coffee rounds and one floor had run out of cups whilst another had a surplus. Lunch was late and when it arrived was not of a good standard. The acting manager sent some items back to the kitchen. The menu was not adhered to. The supper looked unappetising and was not home made. The inspector issued an immediate requirement for the provision of a kitchen assistant and review of catering arrangements. Prior to the writing of this report another Cook had been appointed and standards in the kitchen improved. The environmental health officer will be carrying out monitoring visits to confirm this. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 13 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): These standards were not addressed at this inspection. EVIDENCE: These were not addressed in full except to note that most staff have now received training in adult protection and the acting manager has some expertise in this subject. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 14 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): 26 The home was cleaner but not fully hygienic. EVIDENCE: The premises have improved since the last inspection. Staff now have access to trolleys to transport clean linen and a carpet-cleaning machine has been provided. Bathrooms were generally cleaner than before except one on the ground floor. The clinical waste bin in here was almost full and smelt very strong. The contents were not double bagged. The bath and toilet were dirty. There were some shampoos and lotions left in there. There were still some bins in the home that were hand operated. All bins should be operated by a foot pedal. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 15 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 and 30 Resident’s needs are not met by numbers of staff. Residents are not protected by recruitment practice. Staff are not fully trained to do their job. EVIDENCE: The staffing requirement for Thomas Knight is: 1 First level registered nurse at all times on both floors. Three care assistants throughout the day on both floors. One care assistant at night on the ground floor Two care assistants at night on the second floor. The ground floor night staffing arrangements are under review, the inspector advises that two carers are provided on this floor. It was noted that the staffing for the second floor has been reduced on occasion at night. This should not happen any reduction in staffing should be discussed with CSCI. Staff recruitment procedures have much improved. There are now files for each staff member showing the correct recruitment information. The acting manager has already reviewed these and identified that 4 staff did not have contracts of employment and 5 did not have a suitable CRB check. She has already taken steps to remedy this. This standard now shows minor instead of major shortfalls. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 16 Staff have now received training in Dementia care, Medications, Infection Control and Adult Protection. The acting manager has booked 13 staff on TOPPPS training courses. There now needs to be a training plan identifying statutory and vocational training needs for all staff. This standard now shows minor instead of major shortfalls. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 17 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. 35 and 36 The home does not have a registered manager. Resident’s financial interests are safeguarded. Staff are not formally supervised. EVIDENCE: At the last inspection an acting manager, who had taken over a few days previously, managed the home. She has since left. A temporary acting manager now manages the home. She has been in the home for one week. The inspector is very concerned of the effect the lack of a consistent manager has on the home and will be conducting a series of monitoring visits until this situation is resolved. At the last inspection there were not audits of residents financial accounts. These have now been done on a regular basis. Staff have not yet received any formal supervision. This is essential for assessing the progress of staff and the maintenance of standards. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 18 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 2 2 X X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 1 X x Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 19 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. OP1 4 The Statement of purpose must be reviewed to ensure that all details within it are correct. (OUTSTANDING 2005) Residents should be issued with a contract that covers all areas identified by this standard. The terms and conditions of residency must be reviewed to ensure that they are accurate and up to date. (OUTSTANDING 2005) Care plans must be reviewed to ensure that all aspects of physical, mental and social needs are addressed. There must be clear action plans for each assessment. Timescale for action 01/04/06 2. OP2 456 01/04/06 3. OP7 15 01/03/06 4. 5. OP12 OP15 Residents or their representative must sign their agreement to care plans and risk assessments. (OUTSTANDING 2005) 16(2)(n) Improve the provision of social activities. 16(2)(j)(i) Ensure that a cook and kitchen assistant are on duty over each main mealtime. DS0000060989.V276182.R01.S.doc 01/03/06 01/03/06 Thomas Knight Care Home Version 5.1 Page 20 Monitor the standards of hygiene and food provision in the kitchen. 6. OP26 13(3)(4) Provide industrial type bins that are foot operated. Ensure that all bathrooms are cleaned immediately after use. (OUTSTANDING 2005) Provide two care staff on every night shift on the second floor. (OUTSTANDING 2005) Provide staff with terms and conditions of employment as well as contracts. (OUTSTANDING 2005) Provide a training plan that takes account of assessed training needs of all staff. (OUTSTANDING 2005) Provide a permanent registered manager. Commence a programme of formal staff supervision. (OUTSTANDING 2005) 01/03/06 7. 8. OP27 OP29 8 8 01/03/06 01/03/06 9. OP30 18 01/04/06 10. 11. OP31 OP36 8 18(2) 01/04/06 01/03/06 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. 2. Refer to Standard OP27 OP28 Good Practice Recommendations Provide one nurse and two care staff to each floor throughout the night. 50 of the home’s staff should be qualified to NVQ level 2 by end of 2005. Thomas Knight Care Home DS0000060989.V276182.R01.S.doc Version 5.1 Page 21 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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