Inspection on 01/08/06 for Knoll House

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Knoll House 04/03/10

Knoll House 04/11/09

Knoll House 13/01/09

Knoll House 03/04/07

Knoll House 21/12/05

Knoll House 06/09/05

Knoll House 07/01/05

Knoll House 19/08/04

Knoll House 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW Lead Inspector Joy Hoelzel Key Unannounced Inspection 09:00 1st August 2006 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knoll House Address The Avenue Penn Wolverhampton West Midlands WV4 5HW 01902 335749 01902 333575 knollhse.aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Knoll House Nursing Home Limited Mrs Jill Roberts Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (32), Terminally ill (4) of places Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories except 4 (max) Terminally ill Date of last inspection 21st December 2005 Brief Description of the Service: Knoll House is a care home providing accommodation, personal and nursing care for up to thirty two older people. It is also registered to accommodate people with a physical disability and up to four people who require palliative care. Weekly fees range from £336.00 -£ 428.00 It is a privately owned establishment and is situated in a secluded avenue, south of Wolverhampton, but close to local amenities and public transport. Knoll House is a detached property consisting of a two storey building with single and twin bedded rooms, communal lounge and dining areas. There is a passenger lift to access the top floor. The gardens are well maintained and easily accessible to service users. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the first of key inspections for 2006/07 and took place over five and a half hours on Tuesday 1st August 2006. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty four of the thirty eight National Minimum Standards for Older People were inspected. Thirty people are currently living at the home; staffing levels appeared to be satisfactory. The manager was on the premises supported by one registered nurse, six care staff and domestic and catering staff. Four case files were selected for case tracking, relevant documents were inspected, discussions were held with service users, visitors, members of staff, the owner and manager. Observation was made of the various daily activities and a tour of the premises was conducted. What the service does well: What has improved since the last inspection? All care plans are reviewed and revised on a regular basis or when a change of need has been identified. The plans are comprehensive and easy to follow and contain information enabling staff to fully meet the needs of individuals. Additional pressure relieving equipment has been purchased. The patio doors in the sitting area have been replaced with a safer alternative. Plans are in hand for the replacement of the hot water system, some windows and redecoration of some parts of the home. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,3,6 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The home provides a statement of purpose that clearly sets out the objectives and philosophy of the service supported by a service user guide that summarises the statement of purpose and provides good clear information about the home. EVIDENCE: The home has produced a comprehensive and extensive statement of purpose and service user guide detailing all aspects of the service provision. Both documents are readily available and in a format suitable for the current service user group. All case files selected for inspection contained a pre admission assessment of a person’s individual need, undertaken by the local authority and/or primary health care trust and the home. Information gained from the pre admission assessments is used to generate an initial plan of care at the point of admission. The home does not offer an intermediate care service. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Staff are sensitive to the individual needs of each service user and meet these in a professional manner. There is a clear and consistent care planning system in place, which provides staff with the information they require to meet service users’ needs. EVIDENCE: All service users have a plan of care which is reviewed at regular monthly intervals or when a change in need has been identified. The case file of a person most recently admitted to the home contains some useful social history, detailing the significant periods of her life. This information had been given by a relative and enables staff to have a clear understanding and an indication of her past life and personal preferences. The statement of purpose states that whenever possible service users and their representatives are encouraged to be fully involved in the care planning process. Discussion with one visitor confirms that she is invited to attend the regular care reviews but prefers to ‘leave it to the staff as they know what they Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 10 are doing’. She also commented that her relative is unable to contribute but ‘feels that she is being very well cared for’. All four case files inspected contained current risk assessments and where a problem had been identified a care plan had been formulated, explaining the problem, expected outcome and goals and actions. The care plan for catheter care was very explicit and detailed, giving staff the guidance for reducing the risk of infection and what to do in the case of an emergency. All four case files inspected identified a need of pressure relieving equipment for the prevention of developing pressure areas and a potential breakdown in the skin integrity. Observation of the bedrooms for these people confirmed that the equipment is available and in use on the beds and chairs. The home currently operates a monitored dose system for medication administration using some additional boxes and bottles. The manager stated that a change in the supplying pharmacist is imminent because of some problems experienced with deliveries. The registered nurse was observed carried out the morning medication round and was seen assisting the more frail people in an appropriate manner with their medication. The Medication Administration Record charts were signed at the time of the administration. The fridge for storing the medications that require cool storage recorded a temperature on the day of 16-20 degrees centigrade; the temperature was last recorded, 12/07/06, of 5-6 degrees centigrade. The care staff were observed to be assisting service users with personal care discreetly and in a manner which promotes service users’ dignity. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The daily living and social activities arranged for service users takes into account the differing expectations, preferences, lifestyle and capacities of each individual. EVIDENCE: The manager explained that an allocated member of the care staff arranges social and recreational activities and that most in house activities occur during the afternoon. Trips out to places of interest are arranged through out the summer months and entertainers are arranged to visit the home. The statement of purpose includes details of the activities that are arranged. A survey, based on a persons experiences of living at the home, was completed and returned during the inspection and indicated that usually activities are arranged for people to take part in but an additional comment was made ‘sometimes activity may have to be cancelled owing to staff involvement with looking after others’. Visitors commented that in their opinion there was ‘sufficient going on’ for their relatives as they preferred to sit quietly and watch television. One lady was knitting and others were listening to music and watching television. Staff were Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 12 observed to be interacting well, encouraging and supporting people through out the day. One lady who spends most of the time in her bedroom due to health problems has been provided with the Asian television channel. One member of staff confirmed that there are sufficient people that are able to speak Punjabi to assist with effective communication. Translators are accessed when required. Details of visiting times are included in the statement of purpose, visitors at the home stated that they are able to visit at times suitable to themselves and their relative and are always welcomed by the staff. During the tour of the premises many of the bedrooms were individualised with personal belongings. Staff were observed to be offering choices to service users throughout the day, the choices and options very much dependent on the capacity of the individual. Breakfast and the lunchtime meal were observed with service users being offered a choice of menu. One service user stated ‘ the chef does a varied selection for everyone. Always well presented and always fresh fruit available’. Another service users thought the ‘food was good’. The regular cook was not on duty on the day of the inspection, a member of the care staff team was preparing the meals. Discussions with her and observation of working practice evidenced a good knowledge of the preferences and requirements of service users and both meals were prepared and served well. Records are now being maintained of the daily diet taken and offered to people. Staff were observed to be assisting service users with food supplements during the morning and actively encouraging and supporting the people to take them. One person did not like the flavour of the supplement, an alternative was offered, again this was not liked so a supplement mousse was offered and the service user was observed to be reasonably happy with this. The staff member discussed the reason and importance of this person receiving regular dietary supplements and demonstrated a good knowledge of this task. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Concerns or complaints are dealt with promptly and professionally and the arrangement for the protection of vulnerable adults is satisfactory. EVIDENCE: The home has its own complaint procedure, a copy of which is displayed in the hall. One service user stated that if he had any concerns he would feel ‘ happy’ with discussing it with the manager. The last complaint was investigated through the homes procedures; the complainant was satisfied with the outcome. Following the referral of a complaint to the Vulnerable Adults Team, recommendations and requirements were issued with which the home has fully complied. No concerns or complaints have been directed to Commission for Social Care Inspection and the manager stated she has received no complaints since March 2006. A policy and procedure for Adult Abuse and whistle blowing are available for staff reference. Observation of staff personnel files indicates that training in abuse awareness has been facilitated. The manager has a good knowledge and approach when dealing with complaints and abuse issues. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19, 22, 24, 25, 26 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable place in which to live, the proposed improvements and planned expenditure will further enhance the environment for the people living at the home. EVIDENCE: The manager and owner discussed the planned programme of maintenance and redecoration of the premises and have identified areas for improvements to be made. The manager explained that she has had recent contact with the local fire service in relation to developing a fire risk assessment for the property and agreed a date for when this will be completed. The family of a person most recently admitted to the home confirmed that they were extremely happy with the bedroom that has been allocated, they suggested some minor alterations to the lay out of the room that they thought would benefit their relative. This was attended to immediately. They Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 15 commented ‘ we are so pleased that she has settled so quickly, she looks so comfortable’. Other service users stated that the bedrooms were ‘comfortable’. During the tour of the premises bed rails were in use on the beds, some were not fitted correctly. The manager was advised to contact the manufacturer to ensure that the correct bed rails are fitted to the different types of beds. The last date for the weekly bedrail checks was recorded as 12/05/06. Locks have now been fitted to all doors to private accommodation, this will now offer service users a true choice of whether they wish to lock their door or not. The owner explained that a new hot water boiler is to be installed shortly; this will then eliminate the ongoing problem of maintaining the temperature of the hot water at the required level. The carpets in the communal toilets have all been replaced with a more easily cleanable covering. Some carpets remain in the private en suite facilities. The owner confirmed that these would be replaced shortly. Not all bedrooms, where personal care interventions are required, have been supplied with suitable hand wash facilities for staff use and to reduce the risk of cross infection. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported and protected by the homes robust recruitment policy and working practices. EVIDENCE: Staffing levels remain in line with the dependency needs of service users, with first level nurse cover for the twenty four hour period supported by six care staff during the day and two care staff at night. The manager stated that recruitment is ongoing for a deputy manager as the current deputy is unable to continue in this role. A member of the care staff team has been promoted to care supervisor to assist the registered nurse; this arrangement appears to be working well. The statement of purpose details the training requirements for all staff, observation of the personnel files indicate that training in core and specialist topic areas is being maintained. One member of staff discussed a training need for learning and speaking English. This was facilitated for her and she went on to train at National Vocational Qualification level 2 in care. Three staff personnel files were selected for inspection, each contained the required information with references, identity checks and a recent criminal record bureau disclosures disclosure. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The manager is service user focused and leads and supports a staff team to successfully meet the needs of the people living at the home. EVIDENCE: Jill Roberts remains in the registered managers position, and has the expertise and knowledge to manage the home on a day-to-day basis. Staff, service users and visitors all commented positively on her leadership skills and approach. Service users and staff meetings are arranged on a monthly basis and are used as part of the quality assurance and monitoring process. A satisfaction questionnaire is sent to service users and their representatives one month after admission to obtain a view of their experience of life at the Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 18 home. The manager explained that further methods of reviewing and monitoring quality would be reintroduced later this year. Weekly fire alarm and emergency lighting testing is being carried out and the findings recorded. Portable electrical appliance testing is due 02/02/07. Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person must ensure that the fridge for the cold storage of medications is in good working order and that the temperature is monitored on a regular basis. The registered person must ensure that a fire risk assessment for the premises developed and reviewed at regular intervals. The registered provider must ensure that all bedrails in use are compatible and suitable for the purpose and that rail bumpers are available and in use. Previous timescale 14/04/06 not fully complied with. The temperature of the hot water must be provided close to 43°C Previous timescale 14/04/06 not fully complied with. Carpets in private WCs need to be replaced in order to promote good hygiene and infection control. Timescale for action 31/08/06 2 OP19 23(4) 31/08/06 3 OP22 23(2) 31/08/06 4 OP25 23(2)(j) 31/08/06 5 OP26 13(4)(a) 31/10/06 Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 21 6 OP26 13(3) Suitable hand wash facilities must be available for staff use at the point of the delivery of care to promote good hygiene and infection control. 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knoll House DS0000017187.V297440.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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