Care Home: The Knowle Care Home

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What the care home does well The people living at The Knowle spoken with and who completed surveys considered the home to be a friendly place. They felt that they had been provided with enough information prior to moving to the home to make an informed decision. The staff provide care and support to help people continue to be as independent as possible. Some people spoken with had continued to be part of their local community , for example by being able to go to church regularly and take part in social events. All people spoken with and who completed surveys understood how to raise a concerns if needed, and they were also confident that any issues would be sorted out. Staff spoken with were able to explain how they deal with any concerns. Staff confirmed they receive encouragement to do further training and that they felt supported in their roles by the manager of the home. The comments received included: `I am very happy here. The staff are very good.` `We all work together as a team and communicate well.` `The staff let me do as I please, I always keep my own room clean and tidy.` `The staff are helpful and the food is good. There`s no messing if I need the doctor, the staff arrange this straight away.` What has improved since the last inspection? There has been some redecoration and maintenance work carried out at The Knowle. The owner has ensured that health and safety requirements and recommendations have been complied with. The home was clean and there are dedicated domestic staff employed. The people living at the home felt that there were enough staff on duty. Staff were able to respond in a timely way to any requests for assistance. Staffing levels are monitored by the manager to ensure that the personal and health care needs of people at the home are met. The owner has made regular visits to the home and has gathered the views of people living there. In this way he is aware of the quality of care and any issues that need to be sorted out. The manager has completed a National Vocational Qualification in Management and Care. What the care home could do better: The manager should ensure that risk assessments are complete for equipment that is in use. The records kept by staff should ensure that medical treatment and referrals aremonitored to ensure that people living at the home get the treatment they require. A clear and consistent way of recording medical treatment should be used. There continues to be areas of the home that require redecoration and refurbishment, in particular the shower and bathroom facilities at the home. The bedding used at the home should be replaced. There are infection control measures in place which must be monitored by the manager and it is important that the staff receive regular training up dates. The complaints record should be reviewed to ensure that it meets the requirements of Data Protection and Confidentiality. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Knowle Care Home 5 - 7 Egerton Road Ashton Preston Lancashire PR2 1AJ     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: Felicity Lacey     Date: 0 8 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Knowle Care Home 5 - 7 Egerton Road Ashton Preston Lancashire PR2 1AJ 01772727485 01772731670 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Burns Type of registration: Number of places registered: The Knowle Care Home Ltd care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category 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: 23 Date of last inspection Brief description of the care home The Knowle is registered as a care home providing accommodation and personal care for up to 23 older persons. There were 18 people living at The Knowle at the time of this visit. The home is situated in a residential area on the outskirts of Preston. The Knowle is a large Victorian property that is in keeping with the surrounding area and it has retained many of its original features. Residents accommodation is provided on the ground and first floor and access is provided by a passenger lift. There are fifteen single and four double bedrooms, five of which have on-suite facilities. Communal Care Homes for Older People Page 4 of 26 Over 65 23 0 Brief description of the care home areas comprise of two lounges, a dining room and a conservatory, these are situated on the ground floor. There is a pleasant secluded garden at the rear of the home with ramped access. The Knowle is reasonably close to shops and local amenities, and has excellent transport links for the city centre. The fees at the home are 412 pounds per week. Care Homes for Older People Page 5 of 26 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 inspection included an unannounced visit to The Knowle Care Home. Prior to the visit information was gathered from the manager including her assessment of how the care needs of the people living at the home were met, staffing levels and qualifications and about the health and safety of the premises. Staff and some of the people living at the home were given the opportunity to complete surveys about their experience of The Knowle. There were five surveys returned which had been completed by people living at The Knowle, and two from staff members. During the visit to the home, people living at The Knowle, members of staff and the manager were spoken with. The premises was also toured. The care records and other information used by staff at the home were looked at for three people living at The Knowle. Staff recruitment records and training records were also looked at. Care Homes for Older People Page 6 of 26 The last key inspection of The Knowle took place on 2 October 2007, and there were also Random Inspections which took place on 20 December 2007 and 15 February 2008. What the care home does well: What has improved since the last inspection? What they could do better: The manager should ensure that risk assessments are complete for equipment that is in use. The records kept by staff should ensure that medical treatment and referrals are Care Homes for Older People Page 8 of 26 monitored to ensure that people living at the home get the treatment they require. A clear and consistent way of recording medical treatment should be used. There continues to be areas of the home that require redecoration and refurbishment, in particular the shower and bathroom facilities at the home. The bedding used at the home should be replaced. There are infection control measures in place which must be monitored by the manager and it is important that the staff receive regular training up dates. The complaints record should be reviewed to ensure that it meets the requirements of Data Protection and Confidentiality. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 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 have information and the opportunity of a trial stay, in this way they are able to make an informed decision about moving to The Knowle. Evidence: Some people spoken with during the visit to the home confirmed that they had the opportunity to visit before moving to The Knowle. Other people had come to live at the home on discharge from hospital or in an emergency. In all cases there is a trial period during which the person can decide if the home can support them as they wish, and equally to ensure that the staff are able to meet the care needs of the person. Prior to a person moving to the home, the manager completes an assessment of their needs. Examination of case files showed this was completed and that other assessments had also been gathered, for example from Health and Social Services. One person spoken with had moved from another care home and was pleased that she had been able to continue with her social and community contacts since moving to The Knowle. Care Homes for Older People Page 11 of 26 Evidence: The admission process also includes a check list which ensures that the room the person is moving into is clean and properly furnished. There are a number of forms completed which ask about the persons preferences, for example whether they wish to have correspondence sent to themselves or a relative. Care Homes for Older People Page 12 of 26 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. The people living at The Knowle have their personal and health care needs met in line with their personal preferences, this promotes their well being and shows respect for personal choice. Evidence: The system of care planning at the home includes all the key areas of daily living. The care plans are supplemented by District Nurse plans for those people with health care needs. The care plans also include additional information where needed, for example if a person follows a religion the staff are not familiar with additional information is provided, and this is used in conjunction with the persons own requests to ensure that care is provided in a way which respects personal beliefs. The manager has completed some risk assessments.Examination of one persons case records showed that a hoist was in use however there was no risk assessment regarding this. It is important that all equipment used with a person has a risk assessment completed, which identifies the risks posed to that individual and the steps Care Homes for Older People Page 13 of 26 Evidence: taken to minimise the risk. The people spoken with and who completed surveys considered their personal care and health needs to be met at the home. There was evidence of the involvement of a range of health professionals. Care should be taken to ensure that all health care appointments and recommendations are documented and followed up. The case record for one person indicated that a referral had been made to a specialist, however it was not clear from the records completed if an appointment had been arranged or attended. There are a number of people with specialist conditions, such as Diabetes. There was evidence on personal care records that specialist advice and regular check ups where in place for these people. It was noted that there seemed to be a number of people who required their toe nails cutting, the manager explained that the N.H.S Chiropodist visits but these visits are every 6-8 weeks, she has arranged for a private chiropodist to attend the home. She will also discuss foot care for those people with diabetes with health support staff, to ensure that these people are receiving the treatment they are entitled to under the N.H.S. It is important that all medical advice is recorded in a consistent way. Currently notes are maintained of visits and treatment, and other notes were found on daily log sheets and the information had not been transfered to give an accurate on going record of medical assessment and treatment received. People spoken to during the inspection were confident that the staff would access any medical advice required. They confirmed that the G.P was called when they requested this. The medication storage and administration arrangements in place were looked at during the visit to The Knowle. Medication training was discussed with the manager and staff. The storage arrangements in place for medication are satisfactory.The Medication Administration Record was completed. People living at the home who wish to retain control over their own medication are able to do so in line with an individual risk assessment. People spoken with during the inspection felt that staff treated them with privacy and dignity. Medical treatment and consultations take place in the privacy of the persons own room.People spoken with felt that they were encouraged to maintain their Independence, and that staff respected their choices. Care Homes for Older People Page 14 of 26 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. The people at The Knowle are able to continue to follow their chosen lifestyle and maintain contact with their local community, in this way personal social and cultural preferences are respected. Evidence: The manager and staff continue to try and involve people in activities. There are pamper sessions which are enjoyed by some people at the home. There are opportunities to enjoy a glass of sherry or wine and have a chat. Staff spoken with during the visit explained that they did have time to spend with people living at the home, usually in the afternoon. The people living at the home enjoy watching a video, or playing cards or dominos. Some people prefer to do their own thing or are not able to take part in structured activities because of their condition. Efforts are made to provide some form of social contact for those people who have restricted mobility and limited awareness of their surroundings. There are some organised events at which families and friends can join in, such as the Christmas Party. Visitors and family members are welcome at any time. The staff explained that relatives are able to enjoy a meal when they visit if they wish. Efforts are made to Care Homes for Older People Page 15 of 26 Evidence: include families in celebrations, for example when celebrating Birthdays. The opportunities for people living at the home to go out are limited, however efforts are made to help people continue with their community activities. One person spoken with continues to attend her church regularly and take part in church organised events , and arrangements are in place for a member of the church to pick her up and take her. There are no regular organised trips out from the home, the manager feels that people are reluctant to go out and this makes it difficult to organise and fund excursions.The people spoken with during the visit felt they had their own routines and had some enthusiasm for organised activities. People spoken with felt that their personal preferences were understood and respected, including whether they chose to spend time alone or with others. People living at the home are able to manage their own financial affairs and if this is not possible they are encouraged to appoint a representative to act on their behalf. People are encouraged to bring their own possessions to the home and to arrange their rooms as they choose. The people spoken with felt that the food was of a good standard. They thought their personal likes and dislikes were taken account of and they could ask for an alternative if they wished. Meal times are flexible and take into account personal preferences. Main meals are served in the dining room, however some people wish to eat in the privacy of their own rooms and this is respected. there are some people who require assistance with food and this is provided in a sensitive way. There are weight records maintained and records of dietary intake for those people who require this type of monitoring. Care Homes for Older People Page 16 of 26 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 complaint and safeguarding procedures in place are understood by people living at the home and staff, this promotes the welfare of people at The Knowle. Evidence: There is a complaints procedure in place. People spoken with and who completed surveys indicated that they knew how to make a concern known and were confident that any concern raised would be acted upon. There is record of complaints maintained at the home and it is recommended that this be reviewed to ensure it meets Data Protection guidelines and confidentiality. The format also limits the amount of detail that can be record and would not be suitable for some complaints which require in depth investigation and consideration. Staff spoken with understood the complaints procedure and would try to resolve any issues without delay. There is a safeguarding policy in place at the home and whistle blowing procedures in place. Staff are aware of these policies and procedures. Staff have completed training, as part of their National Vocational Qualification studies which considered adult abuse and safeguarding practices. Care Homes for Older People Page 17 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The decor and furnishings of the home are in need of updating this will improve the environment for people living at the home. Evidence: The Knowle has a number of communal rooms and a large conservatory. The decor and furnishings of the home are in need of some updating and replacing and the manager explained that there is programme of planned renewal in place. Some rooms have been redecorated and efforts have been made to make rooms look homely and pleasant. The bedding at the home is in need of replacement, the manager indicated that this is in the process of being ordered. The bathrooms and toilets of the home are in need of up grading. The bathrooms are plain and uninviting. There are some bedrooms with en suite facilities. The bathrooms seen were clean and infection control gels, gloves and aprons were in place. Bins and paper towels were in place, and there is a contract in place for the disposal of waste. Staff have undertaken infection control training in the home, and it would be advisable that staff have the opportunity to up date this training. The local health services are able to offer advise and training in infection control and the manager is to investigate this. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 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. Staff are employed in sufficient numbers and have the required skill to meet the needs of the people living at the home. Evidence: The home is fully staffed. The people living at the home felt that there were sufficient staff on duty and that they did not have to wait for assistance. The staff spoken with felt they had enough time in which to carry out the tasks they had to complete and spend time with people living at the home. The Knowle has exceeded the recommended ratio of staff who hold a National Vocational Qualification in Care. Staff spoken with and who completed surveys felt they were encouraged to undertake training and that they had sufficient training to carry out their job roles. Staff files showed that the recruitment practise in place included a written application form, interview process and the completing of required checks before a person commences employment. Staff spoken with and who completed surveys indicated that they had completed an induction programme, and evidence of this was seen on staff files. Care Homes for Older People Page 20 of 26 Care Homes for Older People Page 21 of 26 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 in an open way and the views of people living there are listened to, in this way the welfare of people living there is promoted. Evidence: The manager of the home has now completed her National Vocational Qualification in Management and Care. She is supported in her role by senior carers and a stable staff team. The people spoken with who live at the home and the staff consider the manager to be approachable. the Knowle is owned by a company and the manager is answerable to the Responsible Individual and has regular contact with him. During the visit the records of monthly monitoring visits from June to September,by the Responsible Individual where seen. These contained records of discussion with people living at the home and observations about the standards of care at The Knowle. These records show that the Responsible Individual is aware of the standards and quality of care experienced by people who live at the Knowle. The home has also Care Homes for Older People Page 22 of 26 Evidence: achieved an Investors in People Award. The information provided by the manager of the home indicates that the required health and safety checks and routine maintenance check have been completed. The recommendations made by the Environmental Health Department have been complied with. Training is given in health and safety topics. Care Homes for Older People Page 23 of 26 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 24 of 26 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 7 8 Risk assessments should be completed for equipment used to assist a person at the home. Medical advice and treatment should be consistently recorded and monitored to ensure people receive the recommended medical treatment and their health needs are met. The complaints record should be reviewed to ensure it meet the requirements of Data Protection and confidentiality. The planned refurbishment and redecoration of the home should be completed, including the replacement of bedding. 3 4 16 19 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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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