Care Home: Knights Luxury Retirement Home

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What the care home does well The routines of the home are flexible and aim to allow residents their freedom and independence by enabling them to retain as much control over their lives as possible, thus promoting equality and diversity. Visiting arrangements are in place to suit the needs of individual residents. The health care needs of people living at the home are well met meaning that residents have confidence that the staff team would arrange for medical assistance quickly if they were unwell. The home is well managed, with good training provided for staff. Over 50% of the care staff team are now qualified. This means that people are supported by staff who have had their work practice assessed and are deemed to be competent workers. There is a good system to introduce people to the home, with up to date written information provided and needs assessment done, so they know their needs can be met at the home. People spoken with living at the home told us that they like the staff and got on well with them. One person described the staff team as, "Always smiling, they have the patience of Job and nothing is too much trouble for them. I am really happy here". Another person said that staff were generally "very kind and helpful". What has improved since the last inspection? Since the last key inspection, significant improvements have been. The way medication is managed is now better organised and all staff with responsibility for the administration and recording of medication have received recent refresher training. This helps to keep people safe and makes sure that staff are competent to handle medication safely. All people living at the home now have an individual, detailed, written plan of care. This written information guides staff so that people are supported to do as much as possible for themselves while ensuring that all staff provide the right amount of support and assistance when required. Staff training has been given high priority. An up to date staff training matrix was available. This showed that all staff have received recent adult protection training and health and safety training including manual handling, fire safety, food hygiene, first aid and infection control. This again helps to keep people living at the home safe. Recruitment practices at the home have been strengthened. People are now only allowed to take up their employment at the home when all the required references and clearances have been received and deemed to be satisfactory. This helps to make sure that only suitable people are employed at The Knights care home to support and assist vulnerable people. What the care home could do better: Whilst medication is more safely managed at the home, a recommendation has been made so that staff have clear guidance under what circumstances medication to betaken `as required` should be given. This would make sure that there was clear evidence of consistency of use and that staff were only giving this medication under the agreed protocol. The management team at the home are planning to review the menus and catering arrangements. It has been recommended that this exercise is completed in consultation with residents, so that they can have their say about the variety and choice of the meals served. The only bedroom that has not been provided with a radiator guard should be provided with one as soon as the bedroom becomes vacant and before another resident occupies that bedroom. This would help to prevent the risk of accidental scalding. Bedrooms that have not been provided with an appropriate lock should be automatically provided with one as soon as that bedroom becomes vacant. This would help to ensure privacy for the occupant. It is important that the improvements noted at this inspection are maintained. The service now needs to build up a sustained track record of delivering good performance and managing improvement. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Knights Luxury Retirement Home 365/367 Clifton Drive North St Annes On Sea Lancashire FY8 2PA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 1 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Knights Luxury Retirement Home 365/367 Clifton Drive North St Annes On Sea Lancashire FY8 2PA 01253720421 01253782037 knights@arc-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aegis Residential Care Homes Ltd care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 31 Date of last inspection Brief description of the care home The Knights Retirement Home is owned by Pearlcare but operates under the previous company name of Aegis Residential Care Homes Limited. The home is registered to accommodate up to 31 older people who do not require nursing care. The home is a non-smoking establishment that is clearly identified in the written information provided to residents and prospective residents. The Knights Retirement Home is a detached property located on a main thoroughfare of St Annes and conveniently situated in close proximity to the main shopping centre, community facilities and resources and the promenade. Communal areas of the home are very comfortably furnished and allow for activities to be undertaken in one area while providing a quiet area for those who do not wish to participate. The majority of residents are accommodated in single bedroom Care Homes for Older People Page 4 of 33 Brief description of the care home en-suite accommodation, except for individuals who have made a positive choice to share twin accommodation. There is a passenger lift to access all areas of the internal environment and a ramped access to the front of the building. Although the home does not provide garden areas, there is a public park in close proximity that residents can access with ease and a patio area to the front of the property that is provided with seating to enable people living at the home to sit out in the summer months. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. This unannounced key inspection site visit took place during the course of a mid week day and spanned a period of approximately ten hours. Twenty three of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the requirements and recommendations made at the last key inspection. We spoke with the homes manager, the deputy manager the activities organiser and two members of the care staff team. Some discussion also took place with the clinical manager and the regional manager. Care Homes for Older People Page 6 of 33 In addition, two residents who were at home were also individually spoken with and brief discussion took place with several other residents in the lounge area of the home. Information was also gained from two residents, two relatives and four members of staff who completed and returned a Care Quality Commission (CQC) survey prior to the site visit taking place. This all helped to form an opinion as to whether The Knights care home was meeting the needs and expectations of the people who live there. At the time of the site visit, twenty three people were living at the home. Every year the manager is asked to provide us with written information about the quality of the service they provide. They are also asked to make an assessment of the quality of the service. This information, in part, has been used to focus our inspection activity and is included in this report. During the course of the site visit, a number of documents and records were examined and a tour of the building took place including communal areas of the home, toilets and bathrooms, some bedroom accommodation and the kitchen area. There is a passenger lift in place to assist those residents who cannot manage the stairs. Details of current fees and what is included in the fees is available from the home. The last key inspection at The Knights care home took place on 22nd July 2008. What the care home does well: What has improved since the last inspection? What they could do better: Whilst medication is more safely managed at the home, a recommendation has been made so that staff have clear guidance under what circumstances medication to be Care Homes for Older People Page 8 of 33 taken as required should be given. This would make sure that there was clear evidence of consistency of use and that staff were only giving this medication under the agreed protocol. The management team at the home are planning to review the menus and catering arrangements. It has been recommended that this exercise is completed in consultation with residents, so that they can have their say about the variety and choice of the meals served. The only bedroom that has not been provided with a radiator guard should be provided with one as soon as the bedroom becomes vacant and before another resident occupies that bedroom. This would help to prevent the risk of accidental scalding. Bedrooms that have not been provided with an appropriate lock should be automatically provided with one as soon as that bedroom becomes vacant. This would help to ensure privacy for the occupant. It is important that the improvements noted at this inspection are maintained. The service now needs to build up a sustained track record of delivering good performance and managing improvement. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home receive sufficient information to help them make a decision and staff receive enough information to understand the persons needs and requirements. Evidence: Since the last inspection, the homes Statement of Purpose and Service User Guide have been reviewed and and updated. These two booklets, that tell residents, prospective residents and other interested people about the home are now up to date and detailed. The Knights care home is a none smoking home and this is clearly identified in the booklets so that people can make a positive choice about moving into the home. People are only admitted to The Knights care home if their health, personal and social care needs could be met. The manager or the deputy manager carry out an Care Homes for Older People Page 11 of 33 Evidence: assessment of people considering moving into the home. This is completed in order to determine if the level of care and support required could be provided at the home. Both the manager and deputy manager are experienced in undertaking pre admission assessments. The prospective resident is visited in their own home or in some cases, in hospital. This provides an opportunity for the prospective resident to find out more about the home and for the manager to undertake a formal assessment of current strengths and needs. This information, along with any other relevant assessments conducted by other agencys such as health assessments, are taken into account. This collated information, along with any further information provided by family or other advocates, provides the basis of the initial plan of care. Wherever possible, people are also actively encouraged to visit the home and meet staff and other residents as part of the assessment and introductory process. The files viewed showed that good pre assessment information is gathered and that relatives are involved in this process where possible. Information includes health and social care needs and highlights any areas of risk. This enables the manager to make an informed decision as to whether the individual needs and requirements of a prospective new resident could be met at The Knights care home. Once the assessment process is complete and the manager has made a decision, the prospective resident is provided with written information confirming the outcome of the pre admission assessment. One resident spoken with confirmed that she had been provided with detailed written information about the home and that a full pre admission assessment had taken place. The Knights care home does not provide intermediate care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of well being and confidence that any health issue would be dealt with. Evidence: Each person has a written plan of care and three of these were viewed. The detailed record and subsequent guidance to staff regarding the individual support required for each resident, and how this was to be achieved, has also been considerably improved. There was some evidence of good person centred care been promoted in the care plans seen. For example, although all elements of the goal, action and evaluation sections of the care plan were completed in sufficient detail to ensure that staff had clear direction, one of the care plans evidenced included information that this particular resident enjoyed milky coffee with one sugar and a chocolate biscuit at 11:00am. For another person the care plan said that this resident was self caring with regard to personal care, but then went on to add that the carer needs to prepare toiletries, towels and the bath water before the resident had a bath. This sort of detail Care Homes for Older People Page 13 of 33 Evidence: helps to ensure that a consistent service is provided and that the individual residents wants and expectations are met. Another lady described the care and support provided as, Faultless, excellent, the place is like a five star hotel. Care plans also included social interests and religious needs and requirements and how these were to be maintained. This is good practice and shows that all needs and requirements are equally considered and strategies put into place to address each area of a residents chosen daily life style. One resident individually spoken with said that she had been involved with developing her plan of care, was happy with the content and that staff supported her in the way described on the care plan. Risk assessments are also in place and address potential risks. Specific individual risk assessments are determined by the requirements of each resident but can include, nutrition, mobility, manual handling, sleep, using the lift, leaving the building, bathing/showering, sleep, vision, teeth and self medication. Each risk assessment concludes with a plan and guidance for staff as to how to minimise the risk and this is regularly reviewed. Residents and where appropriate their relatives, had been given opportunity to be involved in the care planning process, so that they could have some say into the care provided. If no changes are required to the care plan, a designated senior carer speaks individually with the resident to see if they feel that anything needs changing. If changes to the care plan are required, this is normally fully discussed with the resident before any changes are made so as to make sure that the resident is in agreement to the proposed amendments. There was clear evidence that all care plans are reviewed on at least a monthly basis or more frequently if needed. For the more dependent resident, the entire care plan is rewritten each month. This means that staff always have clear, up to date information in order to provided a high quality, consistent service. Two members of the care staff team individually spoken with, confirmed that they felt sufficient written information was provided to ensure a good quality of care, that was supplemented by good verbal information sharing. Although care planning has improved, the company are aware that the system used to record care needs at The Knights could be be improved. We were informed that the home is to pilot new documentation for both pre admission assessments and care planning. This was viewed. It is proposed that the new documentation would be very comprehensive, not only covering areas such health, social and personal care needs but also important issues such as a pen picture of each resident, life events, social links, and pets. Each area of need would have a different care plan and be presented in a way that was easy to read and easy for staff to find relevant information. Care Homes for Older People Page 14 of 33 Evidence: Records are kept of each persons weight, with any significant changes being responded to. Good records are kept of any health care visits such as by Doctors or District Nurses. This means that any health care issues can be monitored and tracked. Residents spoken with all stated that their health care needs were being met. This was also confirmed by residents that completed a Care Quality Commission (CQC) survey. As part of the visit, we checked how medicines were being handled. We checked a sample of medicines stocks, medicines records and care plans. Overall we found substantial improvement in the handling of medicines that help protect the health and wellbeing of people who live in the home. There is now a good system in place to make sure that medication is administered safely and as prescribed. All staff with responsibility for the administration and recording of medication have received appropriate training. The medication administration records of three people were viewed. These had been completed correctly and had a photograph of the person attached, this is good practice and helps prevent mistakes being made. Following a risk assessment, people are able to look after their own medication either totally or in part if this is deemed to be safe. One resident individually spoken with was self administering their own prescribed medication. A locked facility is provided in this persons individual bedroom accommodation for the safe storage of personal items such as medication. Medicines stock was seen to be well organised, records were clearly presented and spare stock was stored securely. Records of medicines received into the home, given to people and disposed of were signed and up to date. We saw regular recorded checks that were carried out weekly and monthly to make sure staff were giving and recording medicines correctly. When any mistakes were found action was taken immediately to help prevent them happening again. Hand written entries on the drug administration record were seen to be signed, dated and countersigned by a second person. This is good practice so as to ensure that the hand written entry is correct for the protection of residents. Although the management of medication in the home has significantly improved, the system could be further strengthened by developing individual protocols for each persons when required medication. This would advise staff under what circumstances it would be appropriate to give this medication to ensure consistency of use. Residents spoken with felt that their privacy and dignity was respected and that staff were sensitive and mindful of residents feelings, with one resident saying that privacy and dignity was, Taken care of very well and that she usually had the same carer when she needed assistance with personal care. Another resident spoken with said Care Homes for Older People Page 15 of 33 Evidence: that not only did carers make sure that her privacy and dignity was well maintained, but that she also felt respected by staff. A carer also gave a good account of how she respected residents privacy and dignity when assistance with personal care was required. All staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training, and supervision arrangements. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in activities that suit their lifestyle and maintain their interests. Evidence: People living at The Knights care home are offered a wide choice of activities that is suited to their wishes and lifestyle. Prior to admission and also following admission, staff try hard to obtain as much information as possible about the social, cultural and leisure needs of people living at the home. This means that staff have the information they need to make sure that the care and support provided is right for that person. Peoples spiritual needs are also recorded so they can be given opportunity and any help they need to continue to follow their faith. There is a large notice board in the reception area of the home that gives a lot of information about the weekly activities taking place, forthcoming events, details of church services, details of the door to door library service provided by the local authority that is accessed by the home and an account of visits that residents have recently enjoyed. On the day of the site visit, this included a trip to Bowness and a visit to Ashton Gardens. In addition, each resident is provided with a monthly list of Care Homes for Older People Page 17 of 33 Evidence: activities in their individual bedroom so they can plan what they would like to do each day. Discussion with the activity organiser confirmed that activities were designed to accommodate the known interests of people living at the home as well as providing some new interests. Currently the activity programme includes, a chess club, bingo, scrabble and other board games, quizzes, armchair exercises, Tia Chi and a monthly film club. Sing alongs, with a song book and CD for residents to guess the name of the song and craft activities also take place and armchair line dancing is to commence in August. A red nose day took place with staff and some residents deciding to wear their pyjamas all day, a friends and family buffet has been held along with a coffee morning to raise money for the McMillan nurses. In addition, there is a church service held monthly at the home and residents are also escorted to church services of their choice. Details of this was seen on the care plan of one resident. For one resident, the talking book service from the blind society has been secured. There is also a reminiscence board with pictures, articles and memorabilia of the period. It is understood that this promotes a lot of discussion, memories and interest. Residents are asked what they would like to see on the reminiscence wall and generally this is changed each month. A hairdresser visits each week and care staff will also spend one to one time with residents who prefer not to become involved with organised activities. Specific interests of individual residents are also taken into account. For one recently admitted resident who enjoys birds, the handyman is making a bird table to go outside her bedroom window. This lady will now talk about a variety of different birds that nest in the surrounding area. It is very important for this person that this particular interest is maintained with the support of staff, this ladys key worker always makes sure that there is an adequate supply of bird seed. For another resident a ramp is being built to make sure that her motorised scooter can be housed safely. The equipment enables this resident to go out alone in the local community, visit friends and maintain her independence. People spoken with were very pleased with the activities provided. However one resident said that she was not particularly interested in joining in with the activity programme, she enjoyed spending time in her own bedroom reading, including a daily paper, doing crosswords or watching television and confirmed that her wishes were always respected. People are encouraged to maintain contact with family, so that they can continue to be part of family life. As seen, visitors are made welcome at any time of the residents choice with a drink being offered and staff giving them a warm welcome. Residents Care Homes for Older People Page 18 of 33 Evidence: can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. There appeared to be a good, comfortable relationship between friends and relatives with one resident saying, My friends visit me here, they are always made very welcome. People are supported to make decisions about their day-to day lives, such as when to go to bed, when to get up and how to spend their time. Advocacy information is available. Some people are able to manage their own financial affairs and for others a relative or other advocate takes on this responsibility. Individuals are supported to look after all or certain elements of their medication. People are able to bring their own important possessions into the home and so personalise their individual bedrooms. The people spoken with said that they were happy with the meals provided. The main meal of the day is now at lunchtime, a resident spoken with said she had now got used to this and stated that the chef was helpful, that there was a monthly menu rota but if none of the choices were acceptable there were numerous options including a different hot meal or what ever you fancy on the day . Another resident described the meals served as Excellent and confirmed that a wide choice of foods were offered. Each day every resident is asked individually what their menu choice is for each meal. Fresh fruit was seen to be freely available in communal areas of the home for residents to help themselves to and one person explained that the District Nurse had suggested that she ate kiwi fruit each day. This had been provided and is now enjoyed each day. Drinks and snacks are provided throughout the day or on request, with cakes being served in the afternoon of the site visit. As seen, some people prefer to eat some of their meals or all of their meals in their bedroom rather than the dining room and this is supported. Although people spoken with during the course of the site visit said they enjoyed the meals served, there were some comments on the CQC surveys that were less positive. One resident told us in answer to the question, what could the home do better said, More variety of meals. Another resident told us ,I am happy at the home but I feel the food could be improved. A member of staff also commented that the service could be improved by Varying the menu. These comments were discussed with the homes manager. It is understood that the management team were aware of some issues relating to meals and mealtimes and are currently taking steps to address the comments raised. Specialist diets in respect of medical, religious or cultural requirements can be provided if required. Menus are periodically changed to reflect the seasons and residents can influence menu planning through regular resident forum agenda items. Care Homes for Older People Page 19 of 33 Evidence: Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints policy and adult protection policy in place. This, along with staff training helps to protect residents. Evidence: The Knights Care Home has the corporate complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the homes manager prior to the site visit taking place, a record of complaints is kept that includes details of any action/investigation taken. Since the last key inspection one complaint was received by the home. This complaint was of a serious nature and resulted in a multi agency safeguarding investigation. The company fully co-operated in the matter and took the necessary steps to protect people living at the home. The matter is now almost concluded. However because of the recent investigation, the complaint record and method of investigation was elsewhere and not available on this occasion. The complaint procedure is incorporated in the homes Statement of Purpose and Service User Guide a copy of which is given to each newly admitted resident. A copy of the complaint procedure is also given to each residents next of kin. Residents spoken with were very clear that if they did have any concerns they would speak with the Care Homes for Older People Page 21 of 33 Evidence: manager or another member of staff. Residents spoken with also told us that if they did have a complaint they felt that their concerns would be taken very seriously and acted upon. This was supported by comments made on the CQC surveys completed by residents and relatives. However nobody spoken with, at the time of the site visit, expressed any complaints. There were however, many complements. During the visit, it was clear that people living at the home had formed good relationships with staff, meaning that any minor issues could be raised and dealt with informally as part of day to day life at the home. Information within the Annual Quality Assurance Assessment (AQAA) completed by the homes manager stated that staff have been trained to deal with things quickly, so as to not leave issues unresolved so that clients did not hold the view that nothing was being done. It was also stated that the home needs to ensure that they are able to be proactive in managing issues at an early stage, rather than reacting to complaints when they become more serious. This aim appeared to be succeeding. A member of staff spoken with was clear about what she should do if a complaint was made to her including making sure that the management team were quickly made aware of the concern. The Knights care home continues to have a variety of policies and procedures in place for the protection of residents. This includes the corporate adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received recent training regarding protection and abuse. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Opportunity is also provided for this topic to be discussion during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home is excellent and provides residents with an attractive, homely and well-maintained place to live. Evidence: The Knights care home is a detached property, situated close to the local shopping centre and other community facilities, including a local park. Accommodation is provided on the ground, first and second floor of the building. There is a passenger lift for ease of access to the upper floors. Although the home does not have a garden, there is a large raised patio area to the front of the home that is provided with seating and plants that residents and their visitors can enjoy in the summer months. There is also a ramped access for those who have restricted mobility and a car parking area. The home is welcoming, comfortable, well maintained and provides excellent accommodation. The majority of bedroom accommodation is for single occupancy and all bedrooms are provided with an en-suite facility. Shared bedrooms are only occupied by married couples or people that have made a positive decision to share. On the ground floor there are two lounges and a large dining room, giving a variety of places to sit. Communal areas of the home are bright, welcoming and airy. Pictures and ornaments give a homely touch and there are photographs displayed of residents and staff enjoying social events. Care Homes for Older People Page 23 of 33 Evidence: To ensure safety, now all radiators in resident accommodation, with the exception of one, are guarded and there are thermostatic devices on all hot water outlets in resident accommodation to prevent the risk of accidental scalding. The management team are aware that once the bedroom without the radiator guard becomes vacant, there is an expectation that a well fitting and secure radiator guard or a radiator that has a guaranteed low surface temperature, will be fitted before a new occupant occupies that bedroom. A lockable facility is provided for the safe storage of personal items and the majority of bedroom doors are fitted with a lock to ensure privacy. It is understood that residents were asked if they wished to have a lock on their bedroom door, some refused. Again there is an expectation that bedroom doors currently without an appropriate lock will automatically be provided with one, once the bedroom becomes vacant and prior to a new occupant using the bedroom. If an instance occurs that a resident is deemed to be unsafe to hold a key to their bedroom accommodation, a risk assessment should be in place that is regularly reviewed. Aids to independent living, including grab rails, hoists and assisted baths are provided to meet the needs of residents accommodated. Residents spoken with were very pleased with the accommodation provided, One person described the communal areas of the home as, Excellent and that her bedroom was, Beautiful. This same person went on to say that her bedroom was cleaned every day including the en-suite bathroom and toilet. However a comment on a CQC survey was made by a relative said that, Staff not always available in the reception area if residents or visitors need to speak with someone. This was discussed with the manager. There is apparently, a bell in the reception area in order to alert staff, residents and visitors are to be reminded of this. As at previous inspections, The Knights care home remains clean, hygienic and very well maintained with a variety of policies and procedures to advise staff in the control of infection. Laundry facilities are in a designated area of the home and situated away from resident accommodation and food preparation areas. The laundry is well equipped to meet the needs of the home. Information in the AQAA confirmed that all members of the care staff team have received recent infection control training. This important training ensures that people working at the home are aware of good infection control measures in order to protect residents. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that live at the home are supported by well trained staff who have gone through a thorough recruitment process, so their needs are met and they are safe from possible harm or poor practice. Evidence: Staffing levels at The Knights care home are determined by the assessed needs of residents accommodated. Additional staff are on duty during busy periods of the day and all night staff have waking watch responsibility. During the night time period there is also a person on call who could be contacted to provide additional cover in the event of an emergency. Along with the activity co-coordinator and handyman, there are sufficient ancillary staff employed to ensure standards in respect of domestic tasks and catering are maintained. Two residents spoken with, one of whom spends a lot of time in her bedroom said that staff came quickly when the call bell was pressed and that, Staff respond well to the call bell. Care staff spoken with also felt that there was always enough staff on duty to fulfil residents assessed needs and requirements. One person said, Everybody (staff) want to do it well, its more of a family type atmosphere here, good relationship and rapport with residents. Another carer wrote on a CQC survey that, I believe The Knights offers a very friendly atmosphere, the staff have a good relationship with management which comes across Care Homes for Older People Page 25 of 33 Evidence: in the running of the home. Ensure good care is delivered at all times. A relative passed comment, Generally if my father has any requests regarding his room, care or meals, they are usually responded to very well. He finds some members of staff more reliable than others, but all staff are very approachable. Since the last inspection, staff training and development has been given high priority. National Vocational Qualification (NVQ) training is promoted, with more than 50 of the care staff team having achieved Level 2 of this award. An additional, four members of staff have achieved a more advanced Level 3 of this award. Two recently appointed staff are waiting for a commencement date to undertake the level 2 qualification. Once these people have completed this award, all but two members of staff will have achieved this qualification. In addition the administrator and domestic staff have successfully completed an NVQ qualification in relevant subjects. NVQ training is a nationally recognised qualification for staff and shows that the majority of staff at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. Good additional training is also provided that is valued by staff. Further training in specialised areas is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff. This helps to ensure that a good, individualised service is promoted by a well trained staff team. Recent training for all care staff has included a range of mandatory health and safety training, parts of which have also been provided to ancillary staff at the home. Although currently only two members of the staff team have received malnutrition care and assistance with eating training, a nutrition and diet course has been arrange for all staff, that will take place in August 2009. Other recent training, most of which is work book based, distance learning courses, has included, health and safety, COSHH, dementia care, diabetes, promoting continence and equality and diversity. A number of staff are currently undertaking a palliative care course. The work books for this were viewed. The training course is detailed and informative. Staff spoke positively about this course and what they had learned from it that they were already putting into practice. From information in the AQAA and discussion with the homes manager, it is understood that any newly appointed members of the care staff team are routinely provided with nationally recognised Skills for Care induction training. Any new ancillary members of staff are provided with appropriate elements of the induction training programme. This makes sure that all newly appointed staff have the basic skills and understanding to ensure that they are competent to provided an appropriate level of care and support. Care Homes for Older People Page 26 of 33 Evidence: All training is now up to date and each member of staff has an individual training file that includes copies of their training certificates. The staff training matrix not only details the training already undertaken but also highlights further training requirements and when refresher training in due. The Knights care home has a structured recruitment policy and procedure in place for the employment of new staff. The staff files of three members of staff were viewed, two of which were of staff that had been recently appointed. Records included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people that have been deemed unsuitable to work with vulnerable people. This robust system helps to ensure that only suitable people are employed that have the personal qualities to work with vulnerable people. The management team recognises the importance of recruiting staff that have the qualities that people like such as being friendly, good communicators and caring. One resident spoken with said that recent staff appointments had been better since the new manager had come into post. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed with systems, policies and procedures in place to ensure the health and safety of people living there are promoted and protected. Evidence: Since the last key inspection, a new manager has been appointed. The new manager is well qualified and experienced in managing a care home for older people and has undertaken a range of relevant training that has included, a business excellence diploma, a diploma in performance coaching and the registered managers award. This is a qualification that all managers of care homes are expected to achieve to ensure they have the skills to manage the care home in the best interests of the residents. The homes manager continues to attend a variety of courses to make sure that her knowledge is up to date in order to advise and guide staff appropriately. Staff and residents spoke highly of the manager. One resident told us that, Things are a lot better than last year, **** (manager) is very good at getting things sorted out. A member of staff said , I enjoy working here, definite improvements, supportive Care Homes for Older People Page 28 of 33 Evidence: manager who is also receptive to suggestions. The manager is in the process of submitting an application to be registered with the Care Quality Commission. There are clear lines of accountability within the home and external management. An area manager from the organisation visits the home on at least a monthly basis to audit records and to speak with resident and staff. This helps the area manager to make a judgement as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting residents needs, is considered important. Various quality assurance systems are in place including, surveys for residents and their family which recently have been provided every five or six months, however now that the home is achieving higher standards, this is likely to revert back to annual surveys. The surveys are evaluated and the regional manager provides feedback on where improvements need to be made. An action plan is then developed with outcomes monitored. Information regarding the outcome of the surveys are provided in the reception area of the home for anybody to access. Regular residents forums take place and a suggestion box is located in a communal area of the home. These give residents opportunity to air their views and opinions with other people or more privately by way of the suggestion box. Senior staff meetings take place every four weeks and a full team meeting takes place on a two monthly basis. Staff also have access to information via a staff communication book and an information board in the staff room. Staff are encouraged to offer ideas and suggestions so that improvements can be made for the benefit of the residents. The home has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Residents also enjoy frequent daily dialogue with members of staff. This helps residents to say what they think about any aspect of their life at the home, at a time of their choice without waiting, so that any matters could be immediately addressed. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home do retain monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate signed and countersigned records of any financial transactions undertaken and secure facilities to store monies held. Residents Care Homes for Older People Page 29 of 33 Evidence: monies held in safe keeping are further protected by random, external, financial audits, the most recent one being completed in May 2009. There is now clear evidence that formal one to one staff supervision is taking place on a regular basis. This was confirmed by the supervision notes seen and through discussion with the two members of staff individually spoken with. This means that staff have opportunity to meet privately with their supervisor in order to discuss work practices and training needs as well as any other issues relating to working at the home. All staff also receive daily informal supervision as part of the management role. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. Good environmental risk assessments were in place regarding the physical environment of the home and in respect of individual residents. The staff training matrix also confirmed that staff receive mandatory health and safety training including, fire safety training, first aid training, manual handling training, food hygiene and infection control training. Since the last inspection further health and safety training has been provided to make sure that staff are aware of the importance of maintaining the health and safety of residents and their responsibility in this matter. Refresher training is also provided on a planned basis to ensure that staff have regular up to date information to act on. All these checks, along side the training that staff receive, help to protect people living at the home, staff and visitors. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Individual protocols should be introduced for when required medication is prescribed. This would advise staff of under what circumstances the medication should be given to ensure consistency of use. The planned review of menus and catering arrangements should take place in consultation with residents. This would help to promote people living at the home to have their say about the meals served and the variety and choice offered. Once a bedroom without an appropriate door lock becomes vacant, a door lock should be automatically fitted before a new resident takes up occupancy of the bedroom. This would ensure privacy for the new occupant. Likewise, once the bedroom becomes vacant that is without a radiator guard, this should be routinely provided to help prevent the risk of accidental injury. 2 15 3 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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