Care Home: The Knowle

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What the care home does well The Knowle offers a friendly and relaxed environment and service where some people have been living for many years. People liked the service, and the staff, and made a number of positive comments about them. They also liked the meals and the fact that they could be as independent as they wished within the restrictions of communal living. Most people had a range of activities and outings planned for each week, and some people were out every day including weekends. What has improved since the last inspection? Some bedrooms and most communal areas of the home have been decorated, and there is some new furniture, carpets and curtains. A new fence has been erected around the garden at the request of people using the service in order to give more privacy when using the outside area. All staff working at the home have a Criminal Records Bureau check prior to working in the home in order to help protect people living there. Staff have also had up to date medication training in order to further protect people in their care. What the care home could do better: The care plan information could give clearer instructions for staff to follow where peoples` routines are changeable in order to prevent confusion. As the lounge is also the smoking area and most people living at the home smoke, there could be individuals living or working at the home that find this a problem or health risk. This should also be made clear to potential residents before they make a decision about living there. Fifty percent of staff should have an NVQ level 2 in care or above, and the manager should have the Registered Managers Award or equivalent. Key inspection report Care homes for adults (18-65 years) Name: Address: The Knowle 60/62 Carterknowle Road Sheffield South Yorkshire S7 2DX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Stephanie Kenning     Date: 2 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Knowle 60/62 Carterknowle Road Sheffield South Yorkshire S7 2DX 01142583201 01142583201 none Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Michael Thomas Kelly,Mrs Sarah Bernadette Kelly care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The Knowle is a family run home supporting thirteen people who have mental health problems or learning disabilities. All service users have their own single room. There is a communal lounge, a small dining room and shared bathroom facilities. There is a small garden to the rear of the building. The Knowle is based in the Nether Edge area of Sheffield, close to shops, banks, pubs, public transport and health facilities. The homes fees are £312.61 to £337.23 per week with additional charges for hairdressing, activities, toiletries. 13 13 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 27 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection carried out by Stephanie Kenning regulation inspector. The site visit took place on 29th June 2009, between the hours of 9 AM and 3 PM. The Registered Manager, Ann Bolger, was present throughout the visit and the providers, Mr and Mrs Kelly, attended during the visit. Previously a key inspection was carried out in July 2007. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which stated what the home was doing well, and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home, and check some of the policies and procedures. Time was spent observing and Care Homes for Adults (18-65 years) Page 5 of 27 interacting with people, and feedback from people present during the visit is included in the report. The inspector checked all the key standards and some additional standards. We have reviewed our practice when making requirements, to ensure national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this reports recommendations, but only when it is considered that people who use services are not being put at considerable risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? 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 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 Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 had sufficient information on which to base their choice of home, and were assessed by the service in regard to whether their needs could be met. Evidence: We wanted to understand peoples experiences when they decide whether to choose this care home, and what it is like for people if they did decide to move there. We spoke to people living at the home who said: I cant say that I had a lot of choice, but I did get a chance to see this place and ask questions before I came. I did get enough information about the home before I came here. I came to visit and met everybody before I moved in. They are all really nice. Ive been in some other homes and they are alright, but Im very happy here. Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: I feel safe and at home here. People had been assessed before they came to live at The Knowle so that their needs were known. Sometimes health care professional or families were involved in the assessments to help the people using the service. People felt that their needs were being met by the service, and that they could speak to the manager and other staff about any concerns they had. There were clear links between the assessments and the care plans showing that the individuals needs were understood. People usually had a series of visits planned before admission so that they could meet people and decide if they would like to move there. Potential residents were given the managers telephone number so that they could ask questions about living at The Knowle. Following admission each person had a three month trial and were then reviewed to ensure that the home could meet their needs. People said that although they had been given Service User Guides they could not remember what was in them. They felt able to ask for any information they required and said that they had the information they needed. It was suggested that this information could be displayed in some way if needed. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 living at the home are able to make choices about their daily lives and know that their assessed needs are in their individual plans. Evidence: We wanted to find out if peoples individual needs and choices were being met. People said the following: I am helped to keep well here. If I have any problems they help sort them out. They help with appointments and with medications. I choose what I want to do. No one makes me do anything. I can decide what I do. I keep my own room tidy and make my bed. I go to different places during the day, on my own, like day centres and clubs. I dont do much around the house, not even my own room or my washing. I could do but I Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: dont want to. The staff are very nice and very caring, and keep things clean. I feel very much at home here. People living at The Knowle were encouraged to be independent and could make choices about many aspects of their daily lives. There were no set meal times or times for getting up or going to bed. People were coming and going throughout the day, some to day centres, some to clubs, some to classes, to see health professionals, friends and families. People had their own door keys and staff respected their privacy if they were in their own rooms. Each person had their own individual plan with preferences and some goals recorded, and worked towards. They were consulted individually regarding the content of their plan, and on any other aspects they wished to contribute to. The plans contained the areas of needs identified during the assessments. Sometimes other people such as families or health professionals also became involved in the care plans, and sometimes in the reviews looking at how well the plans were doing. Within the plans were risk assessments showing that areas of risk had been identified and steps taken towards reducing those risks. These risk assessments included financial areas where relevant and people said that this was an area that they required a lot of support with. There have been resident meetings held about every two months when people could be involved in changes or choices about how the home was run. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 living at the home have opportunities to take part in a variety of activities both within the home and in the community. People enjoyed the meals and had good choices. Evidence: We wanted to understand peoples daily experiences and opportunities for personal development and leisure. people said the following: I like living here, I can please myself, and I can read or watch TV or go out. I go for walks sometimes. I go out every day, sometimes to clubs. I do get bored here, but what I really want is a job. I want more money and I would get paid if I had a job. Then I could really do Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: what I want and wouldnt get bored. I see my family and friends quite a lot, but I would like a girlfriend. That is what I really want. I would like to do something like gardening, but I dont know what to do. I might ask the staff about it. Individually people had a range of activities and places to go to planned into their lives. Some people chose to do less organised activities and to walk or read or watch TV. Some people attended day centres, clubs, college classes, evening activities or went shopping, walking or to see family and friends. Links had been established with the local churches, and some people attended services or events there. Care plans identified some goals that people were working towards. The manager stated that it was proving difficult to get, for example, paid employment for people, despite their willingness to work. However staff were still trying to help people meet their goals. People liked the meals and said that they could choose to have different items than were offered on the menu. Menus provided a good choice of balanced meals with healthy options. A range of snacks were available at all times and people were seen making themselves drinks throughout the visit. Special diets were catered for including those for health and for cultural reasons. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People have their health and personal care needs met and receive medication safely. Evidence: We wanted to understand how people were supported with health and personal care. People said that they were well supported. One person said, the staff help with whatever I need, and I do what I can. They remind me about things that I forget. Another person said if I want some help they are there. I usually go to appointments on my own such as to the doctors, but they will make the appointment for me. Someone said I have to take a lot of medication, which helps me, but they need to give it to me or I would get muddled. The care plans had details of how people were supported, and how they preferred to be supported. One stated that they preferred to have a wash, but records showed that they had been having frequent baths and showers. The staff clarified that they supported the person to do whatever they chose. It was discussed that the care plan could show more detail so that new staff would be clear. Care plans also had health Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: information in them and linked these to medications people were taking. One person needed to balance their diet for health reasons and all meal details were recorded, showing that staff were monitoring the diet. Care plans were reviewed well and the manager had implemented a summarised care plan for each person that gave a good overview of the support needed. Staff had received further training in medication administration in November 2007 following a previous inspection recommendation. Medication systems and records were clear, and there was evidence of regular visits by the local pharmacy to look at these. Medication was now kept in a locked cupboard further improving the safety for people at the home. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 living at the home were protected by the systems and procedures in place, and felt that they were listened to. Evidence: We wanted to understand how people were protected from abuse or neglect and how the service responds to complaints. People felt safe at the home, and were listened to. One person said, I dont have any complaints with the home, they are good to me and help whenever I ask. Another person said, the staff are nice and they listen to me. People at the home have opportunities to raise concerns or worries on an individual basis or through the resident meetings. There is a complaints procedure that has been updated since the last visit. One complaint from an anonymous source was recorded, raising concerns about the decor and cleanliness of one particular area. This was recorded as being dealt with. No other complaints or safeguarding issues have been raised. Staff records showed training in adult protection and staff were aware of what to do if they suspected abuse. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: A previous requirement regarding peoples monies was not relevant as the manager is no longer an appointee. Care Homes for Adults (18-65 years) Page 18 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in a home that is safe, comfortable and meets their needs. Evidence: We wanted to understand what it was like to live in the premises and whether they were appropriate for the lifestyles of the individuals living there. We were shown around the premises and were invited into two bedrooms by the people living there. The premises are not purpose built and therefore do not meet some of the national minimum standards, as described in their Statement of Purpose. People were happy with the premises generally, and had made suggestions for improvements via residents meetings, such as putting up a fence around the garden to provide more privacy, which was done. One person said, I feel at home in my room, it has been redecorated in my choice, but the furniture is a bit old fashioned. Another person said, yes, I like my room, I can come and be on my own if I want to. The AQAA stated that some bedrooms had been redecorated and some have had new Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: beds, furniture and bedding. Also all communal areas had been redecorated and the outside of the building. There had been some new carpets, flooring, curtains and dining chairs. The pots and tubs outside had been replanted for the summer and providing some colour in the mainly paved area. A carpet that was badly soiled at the previous inspection had been replaced, but the new one was showing some signs of wear too, and the manager stated that she would get it cleaned or replaced as appropriate. The lounge of the home was also the smoking area of the home and most people living there liked to smoke. The Statement of Purpose and Service User Guide should be clear about this for the benefit of potential residents, and the service needs to identify people who are living and working at the home that may find this a problem or health risk. The home had been awarded three stars for Food Hygiene from the Environmental Health department. Care Homes for Adults (18-65 years) Page 20 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 supported by staff that are recruited safely and trained in basic skills in order to protect people. Evidence: We wanted to understand how staff were recruited and trained to ensure that they carry out their jobs well. People liked the staff, felt safe with them and felt that they listened to them, and helped them. One person said, the staff are nice and there is always someone to talk to if I need it. Another person said, the staff look after us well. A staff member said, I like working here and helping people. I had not done this work before, but I have had some training to help me do the job. A sample of staff files were examined in order to look at recruitment and training. People had been recruited using checks with the Criminal Records Bureau and taking two references, which helps to ensure that they are suitable people to work with vulnerable adults. Relevant induction and other training had been given since the last Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: visit including, medication, food purchasing, food preparation, food hygiene, care plans, daily reports, meeting peoples needs, telephone manner, fire, quality assurance, general maintenance, adult protection/safeguarding, mental health and learning disabilities. Staff continue to have supervision every two months and an annual appraisal of their performance. Two people are awaiting the start of NVQ level 2 training. The manager and deputy both have qualifications in care and management, and one of the people sleeping in at night is a qualified nurse. The possibility of training more staff to at least NVQ level 2 in care and Learning Disabilities was discussed and the manager agreed to look into training available. This would be to develop staff in order that they can help people in the home develop their skills. She is hoping to enroll on the NVQ level 4 in Care and management next year. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 live in a home that is managed well and for their benefit. Evidence: We wanted to understand how the home was managed and ensuring the quality of service for people who live there. People felt that the home was managed well by people who worked with them and listened to them. Previous inspection requirements had been met and they were working to wards meeting the recommendations. One person said, I have the freedom to live my life, but I am part of the big family at The Knowle. Another person said, It is nice here, and they listen to me. The manager Ann, has over 20 years experience working at the home that is owned by her parents. She has the Residential Care Management Certificate and is planning to enroll on the Registered Managers award/ NVQ level 4 next year. The deputy is her husband Mark, who has achieved an HNC in care management. They are involved in Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the day to day support of people as well as the management of the home. They survey people in the home each year and include comments in the service user guide. They hold resident meetings every eight weeks and have taken action on issues raised., showing that they value the views of people living there. A quality assurance system has been implemented to help monitor practices in the home and to identify areas of future development. Records were well presented and up to date. Regular maintenance of the building and equipment was carried out and staff had regular fire training to help keep people safe. Care Homes for Adults (18-65 years) Page 24 of 27 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 Adults (18-65 years) Page 25 of 27 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 2 18 24 Peoples preferences and experiences should be recorded in more detail in order to be clear. Identify people who are living or working at the home that find the smoking area a problem or health risk, and take appropriate action. Ensure that potential residents are made aware of this and include it in the Service User Guide. 50 of staff should have an NVQ level 2 in care or above. The Registered Manager should hold the Registered Managers Award or equivalent. 3 4 32 37 Care Homes for Adults (18-65 years) Page 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). 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