Care Home: Knightsbridge Lodge

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What the care home does well People tell us that they are very happy at the home and content with most aspects of their care. The service also provide good access to health care professionals if it is needed. The service provides are very well kept home for people to live in and also provide outside grounds that people clearly appreciate and have the freedom to use. Staff are recruited well and the training being provided for them has improved. What the care home could do better: The service need to make sure that the pre admission assessment is clearly defined as a process that takes place before each admission. Although there is plenty of evidence to suggest that people are treated as individuals the staff need to make sure they are exploring all aspects of people`s equality and diversity needs and meeting these. Random inspection report Care homes for older people Name: Address: Knightsbridge Lodge Knightsbridge Lodge Knightsbridge Green Cheltenham Glos GL51 9TA one star adequate service 18/08/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janice Patrick1 Date: 1 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Knightsbridge Lodge Knightsbridge Lodge Knightsbridge Green Cheltenham Glos GL51 9TA 01242680168 Telephone number: Fax number: Email address: Provider web address: Knightsbridge.lodge@btinternet.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Carol Ann Coates Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr David Easdown,Mrs Ann Dorothy Easdown care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 22 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Knightsbridge Lodge is situated adjacent to the main Tewkesbury Road near the hamlet of Knightsbridge. The home is conveniently positioned about six miles between Care Homes for Older People Page 2 of 10 1 8 0 8 2 0 0 9 Brief description of the care home Gloucester and Cheltenham. The house was originally a Victorian Toll House and has been sympathetically extended to provide accommodation for 22 older people. Bedrooms are positioned on the ground and first floor; a shaft lift provides access to the first floor. All bedrooms have wash hand basins and three rooms have en-suite facilities. All the rooms are single occupancy. Well-equipped bathrooms are provided on each floor with a shower room on the ground floor. Toilets are provided within close proximity of all bedrooms and communal areas. On the ground floor there are two lounges and one dining room. The attractive gardens are well maintained and fully accessible to all people who live in the home. The provider supplies information about the home, including the Commissions most recent report to anyone who has expressed an interest. The details are maintained in a file, which is displayed in the front hall of the home. Current fees range from three hundred and forty six pounds and sixty pence to five hundred and thirty four pounds. Hairdressing, chiropody and any personal purchases are charged extra; the individual prices are available on request. Care Homes for Older People Page 3 of 10 What we found: Before we visited the service we considered all the information we had gathered since the last key inspection which was carried out on 18th August 2009. We revisited the last key inspection report and the outstanding requirements. We read the registered providers improvement plan, which told us how these would be met and by when. We reviewed the notifications the service have sent to us since August 2009. These inform us of any deaths and occurrences that effect service users. We considered the most recent information sent to us by the service called the annual quality assurance assessment, (AQAA). This document is completed by the registered manager/provider and tells us what the service considers it is doing well, how they evidence this, what improvements have been made and any plans for the next 12 months. We forwarded questionnaires to seek the views of those who use the service and from those who work there. We received eight back from people who use the service and four from members of staff. One inspector then visited the service for a period of four hours and spoke to some of the people who live there and staff. We inspected a selection of care records, staff recruitment records and medicine records. We also walked around the building and noted its general condition and infection control arrangements. The two care records we (the Care Quality Commission) inspected did not clearly indicate that a comprehensive pre admission assessment had been completed prior to the persons admission. However, on talking to the member of staff who had carried these out, she confirmed that she had visited both people in hospital, carried out an assessment of their needs and recorded these. We recommended that a specific pre admission assessment form should be used making it easier for the service to demonstrate that this required process is taking place. We were told that this would be organised straight away so we have not made a specific recommendation regarding this. Following admission people are helped to settle in and the type of support they require, their preferences and health needs are explored in more detail with them. If this is not possible then close relatives or close representative will be encouraged to get involved on their behalf. We spoke to one person who told us that she did not feel that her spiritual and religious needs were being met. This persons activities regarding this, prior to her admission, had been identified and correctly recorded but not given any further consideration. Although staff told us that the person had not raised their feelings on this with them, it does tell us that staff need to be more aware of peoples diversity needs and feel confident to explore them further. The registered provider agreed with this as she had been aware of another situation that had come to their attention, but explained that staff probably do need some support and training, which the service will organise and provide. Since the last key inspection the service has been developing the process of how it captures the required information, relating to peoples care and how it records this. We read the contents of both care files and there was a definite improvement in how the care/support was identified, how the instructions for staff are written and in the ongoing process of monitoring and evaluation. Although there are always improvements that can Care Homes for Older People Page 4 of 10 be made, the previous requirement made in relation to adequate and appropriate care planning has been met. We inspected how specific risks are assessed and managed. Both people had assessments carried out for their nutritional risk, pressure sore risk, falls risk and mobility. In one case however, the pressure sore risk assessment required a more up to date review as the persons capabilities had altered. The same persons current potential to fall, when walking outside, needed addressing within a written assessment. Although staff told us that they are aware of when the person leaves the building, they also confirmed that they are not always aware of her return. This person does not wear an alarm pendent when outside so some sort of arrangement needs to be in place to reduce the potential risk of her falling outside and staff not being aware of this. Another persons ability to get agitated and disturb at night and then get injured, has reduced. The current arrangements to keep this person safe were discussed. On the whole the service were able to demonstrate that they were more aware of the need to formally assess and record what they are doing to reduce various risks, but they must be sure they are recording any evaluation they make regarding these. The previous requirement made in relation to this however has been met. During our visit one person was momentarily disorientated whilst looking for the toilet. Staff were observed dealing with this in a supportive and respectful manner. We checked all stocks and records of controlled medicines, which at the time of this inspection were correct. The registered provider told us that the medicine records are audited by the head of care once a month. We saw records that gave staff guidance on how medicines that are prescribed on an as required basis should be used. These were primarily for pain relief medication. One particular medication prescribed on an as required basis really needed clear guidance for staff to follow but a care plan could not be found. We were told that it had been written so we asked for this to either be found or re-written and placed alongside the persons medication record. We have not repeated the requirement made previously for medicines prescribed on an as required basis to have associated care plans because we could generally see that this had been carried out. The omission of this care plan did lead us on to discussing the services general arrangements for auditing. The person who has applied to be the registered manager of the service needs to take some advice on this so that he can be confident that the care records are as they need to be. We spoke to another person who had recently moved in to the service and they were very happy with the care and attention they were receiving. We also heard staff naturally giving people opportunities to make decisions and choices as they were conversing with them. We received eight questionnaires back from people who use the service and all implied that they were happy with the care and services they were receiving. One person did make a comment about only being able to have one bath once a week when really they would like two. Others spoke of very prompt medical care and friendly staff. Another felt the food could be served more quickly in the dining room. We inspected the recruitment files of two new staff members. Both staff had started work after receipt of appropriate checks through the Independent Safeguarding Authority (ISA) Care Homes for Older People Page 5 of 10 and after receipt of a clearance by the Criminal Records Bureau (CRB). References for both people had been requested and received. In one persons case this had involved the registered provider speaking to additional people who had also provided necessary information. The registered provider was able to show us notes she had made when exploring the staffs employment history, there were no gaps. As part of the recruitment of one person certain risks needed to be assessed and we were shown notes that had been made whilst the registered provider had been working through this process. This had not resulted in a formal risk assessment being documented but the process had clearly taken place. This shows that the recruitment practice is being carried out in a robust manner and is considering the vulnerability of the people using the service. Both staff had completed a medical declaration and contracts were in each file. There was evidence of induction training taking place or having been completed. The four questionnaires returned by staff confirmed that the good practices above took place during their employment and that staff felt supported. Three out of four staff felt there should be more staff on duty. There was no evidence at the time of this inspection that peoples needs were not being met so the previous requirement made in relation to this has been met. We walked around the building and observed that the same good decorative order had been maintained since our last inspection. The environment was clean and fresh and the usual high standard of presentation was observed. The chairs had been replaced in the dining room and various areas had been redecorated. The service have reviewed their fire evacuation procedures and individual evacuation plans are in place. We also saw a current fire risk assessment. Staff have received up dated fire training but on walking around the home we saw one corridor door, clearly labelled as a fire door, wedged open. The manager investigated this whilst we were on the premises and told us that staff had explained that they need to get wheelchairs through the door. This maybe so but an alternative arrangement must be found that does not compromise the other good fire safety arrangements that have been put in place. We are also concerned that staff maybe missing the point of the fire training contents if they are happy to keep a wooden wedge under a fire door. The management have subsequently confirmed that an alternative door opener has been identified and will be fitted. The service have always had cleaning schedules in place and arrangements to help maintain good infection control. We witnessed a training session taking place by the newly trained dementia link worker. This persons role is to support staff and therefore help improve the care and approach by staff towards people who suffer from certain degrees of dementia or forgetfulness. So far staff have spoken about why some people may present with certain behaviours and how best to manage these. This training session was taking place in one of the lounges. The manager explained that the people present had been asked if they would like to sit in the other lounge whilst this was taking place, but they had wished to remain. Several were asleep. During this visit we did not observe any activities taking place. This we were told was due to the training session but that normally there is an activities program in place. We saw a program of activities on the notice board and the returned questionnaires confirm that Care Homes for Older People Page 6 of 10 there are activities held that they feel they can join. At the time of this inspection one person told us that she joins in various discussions and group activities, which she enjoys. We observed a gazebo in the well maintained garden with chairs underneath where people can obviously sit. What the care home does well: What they could do better: 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 2. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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