Care Home: Knyveton Hall

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What the care home does well Residents have their needs assessed prior to being offered a place at the home to ensure that these needs can be met at the home. Each resident has a care plan that has been developed from the assesments carried out when a person is admitted to the home. These were up to date and residents or relatives had been invoved in their development. Residents` health needs are met and staff respect residents` right to be treated with respect and dignity. Medication is generally administered in line with good practice. The home provides a range of activities to meet residents` social and recreational needs. Visitors are made welcome and there are no restrictions on visiting. The home provides a good standard of food. The home has a well publicised complaints procedure and all the staff of the home have been trained in adult protection. Knyveton Hall provides a `homely` and comfortable environment for residents. The home has good levels of staffing and staff are employed in accordace with the Regulations. Staff receive core mandatory training and can go on to more specialised training. The home is well managed and run in the interests of residents. What has improved since the last inspection? There has been an improvement in the way medication is administered in the home. The Registered Manager has now completed the Registered Manager`s award. There has been an improvement in the servicing and testing of equipment within the home. What the care home could do better: Photographs of residents should be taken and put at the front of a person`s care plan as soon as possible after admission to the home. The home needs to ensure that it has the facility of a controlled drugs cabinet that meets new Regulations. Photographs should be placed at the front of each resident`s medication administration records to assist new staff in identifying residents should they have to administer medication. A Maximum/minimum thermometer should be used in the small fridge used for storing some medications to ensure that they arestored within the correct temperature range. Some areas of the home are in need of re-decoration whilst the laundry room is in need of refurbishment. The majority of radiators in the home are uncovered and a plan should be put in place for them to be covered to protect residents from the risk of burns. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Knyveton Hall 34 Knyveton Road East Cliff Bournemouth Dorset BH1 3QR     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: Martin Bayne     Date: 1 5 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 28 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 28 Information about the care home Name of care home: Address: Knyveton Hall 34 Knyveton Road East Cliff Bournemouth Dorset BH1 3QR 01202557671 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) : Alan Coggins Limited care home 39 Number of places (if applicable): Under 65 Over 65 39 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Knyveton Hall is situated between Bournemouth and Boscombe close to Boscombe town centre and a short drive from the sea front. Bournemouth town is approximately two miles away from the home. There is parking at the front of the premises, street parking is also available. Knyveton Hall is a family run care home for older people who need the support of residential care. Services include personal care, meals, laundry, domestic services and recreational activities. Knyveton Hall is registered to accommodate up to a maximum of 39 older people (aged 65 and over), both male and female. The proprietors are Alan and Elaine Coggins who live on the premises. The home is run by Mrs Coggins, she is supported by her sister who is the deputy manager and a care manager. Knyveton Hall is run as a Limited Company, Alan Coggins Limited. The home is arranged over four floors containing 35 single rooms and 2 shared rooms, all floors Care Homes for Older People Page 4 of 28 Brief description of the care home can be accessed by a passenger lift. Communal areas include three lounges, two on the ground floor and one in the basement and a dining room. The basement lounge gives direct access to the level back garden. Care Homes for Older People Page 5 of 28 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: We, the Commission, carried out a key inspection of Knyveton Hall Residential Home between 9:15am and 4:45pm on 15th June 2009. The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons and to follow-up on the two requirments and six recommendations made at the last key inspection in June 2007. We were assisted throughout the inspection by the Registered Manager, Mrs Coggins and also by the Head of Care and the homes Administrator. During the inspection we spoke with twelve of the residents and with six members of staff. Throughout the Care Homes for Older People Page 6 of 28 inspection we used the personal care files of four residents to track the records and paperwork that the home is required to maintain under the Care Homes Regulations 2001. Additional information that helped form the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document completed by the home. The fees for the home range from 256 - 466 pounds per week. Information about additional charges are detailed within the homes Terms and Conditions of Residence. What the care home does well: What has improved since the last inspection? What they could do better: Photographs of residents should be taken and put at the front of a persons care plan as soon as possible after admission to the home. The home needs to ensure that it has the facility of a controlled drugs cabinet that meets new Regulations. Photographs should be placed at the front of each residents medication administration records to assist new staff in identifying residents should they have to administer medication. A Maximum/minimum thermometer should be used in the small fridge used for storing some medications to ensure that they are Care Homes for Older People Page 8 of 28 stored within the correct temperature range. Some areas of the home are in need of re-decoration whilst the laundry room is in need of refurbishment. The majority of radiators in the home are uncovered and a plan should be put in place for them to be covered to protect residents from the risk of burns. 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 28 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 28 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. Residents benefit from having their needs assessed before being offered a place at the home and by being fully informed of the services provided by the home. Evidence: At the time of the inspection there were 38 residents living at the home with one of these residents being in hosptial. About two thirds of the residents had been placed through care management arrangements and the other third privately funded. We were told that when a referral is received relatives are invited to visit the home. If a person is referred through care management arrangements, a copy of the care management assessment is requested. Should relatives then wish to proceed with the referral, the Registered Mangager, the head of care or the homes administrator will visit the person referred and carry out a pre-admission assessment of need. If it is decided that the home can meet the persons needs, they are invited to visit the home Care Homes for Older People Page 11 of 28 Evidence: and spend time having meal or joining in the homes daliy routines. We were told that relatives or the propspective resident are always given a copy of the homes Service User Guide so that they are fully informed of the services provided at the home. We looked at the personal files for the four residents we tracked through the inspection. We found that for each person a pre-admission assessment had been carried out to ensure that the home is able to meet the needs of the people it admits for residential care. Care Homes for Older People Page 12 of 28 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. Residents health needs are met through up to date care planning and they benefit from being treated with respect and dignity. Some additional recording will ensure best practice concerning medication administration. Evidence: Care plans are kept in a locked cabinet in the quiet lounge so that staff have good access to these records. We looked at the care plans for the four residents we tracked through the inspection. The residents chosen had all been admitted to the home since the time of the last inspection. There were no photographs of the person concerned at the front of their care plan, as there should be but we saw that photographs were at the front of other residents files who had been in the home for a longer period. We recommend that photographs are taken and put at the front of care plans as soon as possible so that new staff can easily identify to whom the care plan refers and also photgraphs can be useful in the event of a person going missing from the home. We saw that the care plans had been developed from various assessments, such as general assessment of need, health assessments, moving and handling assessments, Care Homes for Older People Page 13 of 28 Evidence: skin care assessments and the MUST tool (Malnutition Universal Screening Tool). The care plans were up to date and being regularly reviewed. In some cases we saw that relatives or residents had signed their care plans, indicating that they were fully involved in this process. The care plans provided sufficent information for a new member of staff to support the person concerned. We also saw that risk assessments had been completed to ensure that care is provided in as safe a way as possible. Within the care plans and daily recording we saw that health needs of residents were being appropriately referred to health professionals. Each resident is registered with a GP and other health care needs such as chiropody, dentistry and eye care needs were being attended to. We spoke with one resident who told us that they were having a leg wound treated by the district nurses and that this had been arranged speedily. During the inspection we spoke with about a third of the residents living at the home and we received good feedback from all the people spoken with. We were told that there was a good staff team who treated residents with respect and dignity. Throughout the inspection we observed that there were good relationships between residents and staff. One resident told us she ranked the home as achieving ten out of ten. Another person commented, I am not just saying this lightly, but it is very good here. We looked at how medication is administered in the home. The home has a medication trolley that is kept locked and chained to the wall when not in use. There is also a controlled medication storage area, however this does not meet new regulations and the home is required to have a controlled drugs cabinet that meets these new standards. At the time of the inspection there were no residents who had been prescribed controlled drugs. We saw that the home had a controlled drugs register. Within the medication trolley we saw that medicines were being stored correctly. The home also has a small fridge where medication requiring refrigereation are stored. Records of the temperature of the fridge were being recorded, however we recommend that the home purchase a maximum/minimum thermometer for the fridge so as to ensure that medications are stored within the correct temperature range throughout the day. We looked at the medication administration records for all of the residents. We saw good practice of any known allergies being recorded of residents on their medication records and hand entries being checked and signed by a second person. We recommend however that photographs are attached to the front of a persons medication records to ensure that medication is administered to the right person. We also recommend that a record is kept at the front of the medication records of the staff who have been trained to administer medication with a sample of Care Homes for Older People Page 14 of 28 Evidence: the their signature. We saw that mediction records were being competed correctly with no gaps within the records. Care Homes for Older People Page 15 of 28 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. Residents benefit from activites being provided regularly and through there being sufficent staff to meet residents social and recreational needs. Visitors are welcome and a good standard of food is provided. Evidence: We saw that the home seeks information about each residents life history so that staff are better informed on how to care for people. This includes an assesment of their interests and hobbies. A range of communal activities are provided such as bingo, arts and carfts, exercise classes, walks and excursions away from the home and the occasional visiting entertainer. The home has good levels of staffing so there are plenty of staff available not only to meet personal care needs but also to be available to spend time with residents. During the inspection we saw that was a lot of interaction between staff nd residents. The residents we spoke with told us that they were happy with the levels of activities provided. We saw that peoples religeous and spiritual needs were assessed and met. One resident told us that they were taken out to attend a Methodist Service each week, whilst the returned AQAA informed that the needs of two Jewish people were being Care Homes for Older People Page 16 of 28 Evidence: met. Residents are able maintain contact with friends and relatives and there are no restrictions on visiting. All of the residents we spoke with told us that the food was of a good standard. We saw that peoples dietary needs, likes and dislikes were recorded as part of the admission assessment and each person has an assessment carried out of their dietary needs. We saw that residents weights were being regularly recorded and monitored. The home employs a cook who is provided with an up to date list of peoples dietary needs. Care Homes for Older People Page 17 of 28 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. Residents benefit from a well publicised complaints procedure and through the staff being trained in adult protection. Evidence: We were informed that each resident and their relative had been issued with a copy of the homes complaints procedure. Since the last key inspection the management has received one complaint and this had been investigated and responded to. The complaints procedure has been recently updated to inform Social Services funded residents of how to contact the Council. The procedure also informs of the address of CQC. We saw that all of the staff have received training in the protection of vulnerable adults and that a refresher course was to be run the week following the inspection of the home. The home has all relevant policies and procedures for the reporting and prevention of abuse Care Homes for Older People Page 18 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Knyveton Hall provides a homely and comfortable environment although many areas of the home are in need of redecoration with the laundry room in need of refurbishment. Evidence: The home provides a comfortable and homely environment for residents. The home employs dedicated domestic staff and on the day of inspection the home was clean and generally free from adverse odours. The building is an older type of property and some areas are in need of decoration. The providers are aware of this and there is a plan for long term redecoration that will have to be prioritized. The home has a large garden to the rear of the home and there are sitting areas for residents and a patio area. We saw that residents were able to personalise their rooms with their own possessions. Within bedrooms we saw that wardrobes had been fixed to the wall to prevent the chance of these toppling over and window restrictors are fitted to windows above ground level. Although risk assessments have been carried out as to the potential for residents getting burnt from hot radiators, the majority of radiators are uncovered. This was discussed with the Registered Manager and we recommend and it was also agreed that the home would develop a plan for covering radiators, starting with those assessed as Care Homes for Older People Page 19 of 28 Evidence: posing the highest risk. This will be followed up at future inspections. Thermostatic mixer valves are fitted to the hot water outlets of baths in order to protect residents from the risks posed by hot water. All of the staff have been trained in infection control and we saw that staff were wearing aprons and gloves appropriately. We were told that staff are also provided with alcohol gel dispensers. We looked in the laundry room. At the last key inspection a recommedation was made that the laundry room be relaid. We were told that this was attended to, however we recommend at this inspection that the laundry room is completley refurbished, as the wall surfaces cannot be cleaned properly and the flooring too is not completely sealed. This was discussed with the Registered Manager who agreed that refurbishment of the laundry room would be prioritized. We were told that linen is sent to an external launderers whilst residents personal laundry is done within the home. Care Homes for Older People Page 20 of 28 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. Residents benefit from good levels of staffing being provided, the staff being recruited in line with Regulations and through good training provided to the staff. Evidence: The home provides a good level of staffing. Residents we spoke with told us that there were always sufficient staff on duty to meet their needs. During the inspection we also spoke with six members of staff who also confirmed this. Between 7am and 9pm there are eight care staff on duty and during the night time period there are two awake members of staff and two sleep-in staff available. The head of care is also available six days a week and the homes administrator five days a week. The home employs separate domestic staff, cooks and laundry assistants. We saw a copy of the staff duty roster that reflected the above staffing. We looked at the staff recruitment files for three staff employed since the time of the last key inspection. We found that all the records and checks required under Schedue 2 of the Regulations had been complied with save in the case of two staff, as their application form was not on file and this contained information about their employent history and health declaration. It was explained that the two staff concerned had taken these to use as part of their NVQ Training. Copies of the application forms were sent to us after the inspection. In the case of all three staff, a POVAFirst check (the check Care Homes for Older People Page 21 of 28 Evidence: against the register of adults deemed unsuitable to work with vulnerale adults) had been obtained prior to staff starting work at the home and all three had a Criminal Record Bureau check on file. Concerning staff training, the home has achieved a level of over 90 of staf trained to NVQ level 2 or above. The home has a longstanding staff team and we saw that all had received core mandatory training in areas such as fire safety, moving and handling, infection contorl, basic food hygiene, first aid, health and safety, first aid and infection control. Care Homes for Older People Page 22 of 28 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. Residents benefit from a well managed home that is run in the interests of the residents. Evidence: The home has a strong management team. At the last inspection of the home a requirement was made that the Regisitered Manager complete the Registered Managers Award and this has now been achieved. Residents we spoke with told us that they could always gain access to managers should they wish and that there was a open management culture. The home carries out surveys each year consulting both residents and relatives. This ensures that there is continual development of the home to meet residents needs. From the feedback from the residents we spoke with there was evidence that the home was run in the interests of the residents. Care Homes for Older People Page 23 of 28 Evidence: We saw that portable electrical equipment wiring had been checked and the AQAA informed that servicing of equipment in the home was being carried out to the required timescales. We looked at the fire log book and saw that tests and inspections of the fire safety system were taking place to the prescibed timescales. Care Homes for Older People Page 24 of 28 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 25 of 28 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 1 9 13 You are required to provide 20/07/2009 a controlled drugs cabinet that meets new Regulations. To ensure that these medications are stored safey. 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 7 We recommend that a photograph is attached to the front of a persons care plan as soon as possible after they are admitted to the home. We recommend that: -photographs are attached to the front of each persons medication administration records. -a maximum/minimum thermometer is pruchased for recording the temperature of the frigdge used for storing medication. -a list of staff members trained to administer medication with a sample of their signature is kept at the front of the medication administration records. We recommend that as agreed the home develop a programme for the covering of radiators in order to reduce the risk of residents receiving burns from hot surfaces. Page 26 of 28 2 9 3 19 Care Homes for Older People 4 26 We recommend that the refurbishment of the laundry area be prioritized. Care Homes for Older People Page 27 of 28 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). 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. 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