Inspection on 13/01/09 for Knoll House

This inspection was carried out on 13th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Knoll House 04/03/10

Knoll House 04/11/09

Knoll House 03/04/07

Knoll House 01/08/06

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW     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: Joy Hoelzel     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW 01902335749 01902333575 knollhse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Knoll House Nursing Home Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 0 0 old age, not falling within any other category physical disability terminally ill Additional conditions: 0 32 4 No number division between categories except 4 (max) Terminally ill Date of last inspection Brief description of the care home 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. 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. Weekly fees range from £357:00 for accommodation and personal care with an additional charge where nursing care is Care Homes for Older People Page 4 of 27 Brief description of the care home required. More information on the fees is available directly from the service. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Older People Page 5 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 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: The last key inspection for this service was completed on 3rd April 2007 with an annual service review 8th August 2008. The home were unaware that we were visiting for this key inspection. The registered manager was at the home, supported by a registered nurse, care staff and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Care Homes for Older People Page 6 of 27 Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. 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 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 8 of 27 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 9 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 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 can be confident that the care home can meet their individual care needs. This is because an accurate assessment of their needs has been made. This tells the home all about them and the support they need. Evidence: Information on the service and what is offers is available in two documents the statement of purpose and service user guide. They are available directly from the home and are designed to give people a quick guide and overview of Knoll House. The weekly fees for the service as stated in the statement of purpose are 357.00 pounds per week for accommodation and personal care with nursing care provided at an additional cost. This information ensures that people can decide whether the care home can meet their support and accommodation needs. The case file of the person who recently moved into the home was looked at to see if Care Homes for Older People Page 10 of 27 Evidence: information had been sought regarding this persons needs prior to moving in. Information had been gathered from the previous health care setting and a pre admission assessment was completed by the service. Other case files looked at included a pre admission assessment by the home in addition to social worker reviews, assessments from Primary Care Trusts and community care services. Where the home has short notice of a person moving into the home, information from the previous placement is obtained and an assessment of care needs is completed as soon as possible after admission. This gathering of information ensures that the service can be confident of meeting a persons care needs. A visitor stated that they arranged for the placement, as there relative was unable to make decisions due to frailty and poor health. They were generally satisfied with the admission procedure and stated that it went well. The home does not provide an intermediate care service. Care Homes for Older People Page 11 of 27 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. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons care plan to ensure that care needs can be fully met. Evidence: Each person has a written plan of their care that is based on the assessments of their care needs. Three plans were selected to be looked at in depth with other plans looked at briefly to follow up any observations made during the day. Each plan contained assessments for maintaining a persons safety and when a risk is identified it is linked with a corresponding plan of care. Some of the documents within the plan had been signed as agreed by the persons next of kin. There was no evidence that the person was included or indeed involved in the planning process. It is acknowledged that some people may be unable or do not wish to be involved but people should be offered the opportunity to comment. Generally the plans contained the information and guidance for staff to ensure that the care needs of a person can be met. For example some people are experiencing difficulties with eating and drinking due to being very frail and Care Homes for Older People Page 12 of 27 Evidence: in poor health. The care plan described the actions needed to monitor that adequate nutrition is being taken on a daily basis. Care staff were observed to be encouraging people with eating and drinking to make sure they remain well nourished and hydrated. One person required regular interventions from the nursing staff for a specific condition. Records were seen for the monitoring of this and included the frequency of the interventions and any changes that may be observed. The plans documented the visits and guidance made from other health care professionals when the home has requested assistance. The staff described the diverse care needs of the people living at the home and the way they helped and assisted each person with daily life. Medication is administered to people by the registered nurses using a monitored dose system with additional boxes and bottles of medicines. The procedures were looked at, staff explained the processes and all evidence points to good arrangements being in place for the safe administration of medications. During the day staff were observed to be offering and providing the care to people in a discreet way, although they appeared to be very busy and rushed. Staff commented that they were always very busy trying to give people the care they needed. Care Homes for Older People Page 13 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are given the opportunity to take part in activities both within the home and in the community. However this could be improved upon to ensure the activities meet the needs and personal preferences of all the people living at the home. Evidence: A member of the care staff is currently responsible for arranging and facilitating social and leisure activities in addition to their allocated care duties. An entertainer visits the home each month and provides some form of entertainment for the residents. In house activities are arranged at intervals, with people stating that they enjoyed taking part in the games and the bingo sessions. Opportunities for religious observance continue to be available each month. One person commented that they had been provided with a bible that is produced in Braille this enables them to continue to enjoy reading the Holy book. People spoken with stated that generally they enjoy the activities that are available but spend the majority of the day in their own rooms. They described their individual ways of passing the day. During the time of this inspection there appeared to be very little structured social activity available, as staff seemed to be very busy attending to the personal care needs of people. They had very little time for anything else. People sitting in the lounge areas were either asleep, watching other Care Homes for Older People Page 14 of 27 Evidence: people or waiting for staff assistance. Except for when staff were offering refreshments there were very little interactions or conversations occurring. A visitor to the home spoke of the very limited social and recreational stimulation available and felt that this was sadly lacking in an otherwise satisfactory home. Visitors to the home expressed a general satisfaction with the service and the visiting arrangements, I am able to visit every week, and feel comfortable with visiting, the staff are very good . The service user guide includes details of maintaining contact with family and friends and states visitors are welcomed at all times. The main front door is kept locked for security reasons staff answer the door and allow entry, a push button device is used for exiting the building. No other doors around the building are locked with the exception of storage cupboards and the treatment room. People can have free access to areas if they so wish. The bedrooms are all very different and personal to the person residing in the room with people encouraged to bring with them their treasured possessions. Meals are prepared by the catering staff and served by the care staff mainly in the dining areas, but people are able to have their meals in their preferred place. People commented that they have a choice of food and that generally they are satisfied with the menu. During the morning two people were in the dining room having a late breakfast and appeared to be enjoying it. One person commented that she hadnt eaten since supper time the previous evening; the other person was unable to fully comment. Staff commented and documentation indicated that some people are not being offered diet or fluids for in excess of twelve hours. Both people however, appeared well nourished but this practice is not conducive for maintaining adequate nutritional status. This was discussed with the manager who offered an assurance that working practices will be swiftly amended to ensure a consistent approach with providing all people with adequate nutrition. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and others involved with the service say that they are satisfied with the service provided and know what action to take if they have concerns. Evidence: The statement of purpose and service user guide both offer details of how to raise a concern or complaint about the service. The procedure is also displayed on the notice board in the home. Three people spoken with stated that they would see the manager if they had any concerns or worries and they were certain that the manager would be able to help sort it out. Visitors also stated that they would see the manager or one of the nurses if they had any complaints. One person had cause to speak with the manager and stated that they were satisfied with the response they had. Two complaints/concerns have been raised with the service in 2008; both are fully documented and reached a satisfactory solution. We, the commission, have received one complaint regarding concerns of the level of staffing particularly at weekends. This was discussed with the manager who acknowledges that there are times when it is not possible to cover shifts at weekends. This is mainly due to staff calling in sick at short notice. Arrangements have been made with the other homes within the company to share staff at times but again this is not always possible at short notice. Agency staff are used occasionally. Care Homes for Older People Page 16 of 27 Evidence: One referral has been made to the safeguarding adults team follow concerns of the care provided to a person. This investigation is ongoing and has yet to reach a conclusion. The manager and provider of the service are aware of the referral and have offered their cooperation with the process. Staff spoken with are aware of the action they should take if they become concerned regarding the welfare of people at the home. One staff member confirmed that they had received training in this area. For the continuing safety and well being of people at the home it is recommended that all staff should have training in the protection of vulnerable adults. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Care Homes for Older People Page 17 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, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable and has a programme to improve the decoration, fixtures and fittings. Evidence: Knoll House is situated just off the main Penn road in Wolverhampton. It is a detached two-storey property offering accommodation for up to thirty-two people. People spoken with stated that they are satisfied with the accommodation and that their personal rooms are satisfactory. During the tour of the premises most of the bedrooms seen were highly personalised and all very different. The furniture provided by the home is of varying quality with some items requiring replacement. To reduce the risk of injury to people, wardrobes should be fitted so that they are stable and do not topple over and old and worn toilet equipment should be replaced. The bedrails in use appeared to be incorrectly fitted to the bed, with the potential risk of harm to the person. This was discussed with the manager and provider and immediate attention was given to ensure that all bedrails were fitted correctly, safe and fit for the purpose. The plans to have a bathroom refurbished and for a walk in shower room have not been completed. The programme for 2009 includes this and when completed will offer people a choice of bathing facilities. Care Homes for Older People Page 18 of 27 Evidence: All areas of the home were clean, the people responsible for the cleanliness of the home work hard to maintain a good standard. Hand wash facilities have been provided for the control of the spread of infections. However some of the soap dispensers were empty and appeared to be out of use for a considerable period of time. Care Homes for Older People Page 19 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally satisfied that the care they receive to meet their needs. Evidence: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the registered manager was on the premises supported by a registered nurse and six care staff. Domestic and catering staff were also on the premises. The manager stated that these are the usual staffing levels for the day with a reduction overnight of one registered nurse and two care staff. Observations and discussions with staff suggest that the staffing levels are sufficient to provide the basic care but insufficient to spend quality time with people. Staff stated they were always very busy and they were observed to be rushing from area to area. The people who were able to comment stated that the staff were very good to them and were available when they needed some help and assistance. People who were unable to comment appeared to have variable standards of dress and grooming. The people being cared for in bed appeared comfortable and cosy. Visitors to the home generally felt the staff were competent, kind and provided satisfactory care. There is a training matrix available to indicate the training and updates that staff have completed during the year. This specified that of the twenty-one care staff, eleven Care Homes for Older People Page 20 of 27 Evidence: have achieved accreditation in National Vocational Qualification levels 2 or 3 in care. Three staff files were selected for inspection and included different grades staff. Two of the files contained all the information and details required by regulation. One staff file was lacking references to verify the suitability of the person to work with vulnerable adults. The manager offered an explanation; nevertheless, the recruitment procedures must be sufficiently robust and rigorous to ensure people are safe. The manager and provider discussed the training and development opportunities for all levels of staff during the past year. They discussed the difficulties encountered with obtaining confirmation and the certificates to evidence the training undertaken and completed. The personnel files contained limited training certificates for 2008, and did not include evidence of the mandatory core topics or many specialist areas. Staff discussed the training they had received but again there was no evidence available to support this. Care Homes for Older People Page 21 of 27 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 manager has the required qualifications and experience, is competent to run the home and provides effective outcomes for people living at the home. Evidence: Mrs Jill Roberts continues in the role of registered manager, is a first level nurse and has the experience and knowledge to run the home on a day-to-day basis. There are good support networks in place with the providers who continue to be involved in the service and visit regularly. People offered positive comments on the direction and leadership of the manager, all stated that they would have no hesitation to see her if they had any concerns or worries. It was obvious during the time of this inspection that good, professional relationships had been developed and maintained with the manager and people living, working and visiting the home. Quality assurance of the service continues with regular audits throughout the year with satisfaction surveys being distributed to residents, staff and relatives. Staff and Care Homes for Older People Page 22 of 27 Evidence: resident meetings are arranged at regular intervals offering people the opportunity to discuss and comment of how they find living and working at the home. The provider continues with the monthly formal visits as part of the monitoring of the service, reports are produced of the visits and available for inspection. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Records, documents and certificates are available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. The record for the checks made to ensure the safety of the bedrails were not available. It was recommended to the manager that a competent person on a regular basis check the bedrails in use and records the findings. Care Homes for Older People Page 23 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 Older People Page 24 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 1 22 13 Bed rails must be assessed, fitted and maintained in accordance with Medicines and Healthcare products Regulatory Agency and the Health and Safety Executive guidance. This is to protect the person from the risk of harm and promote their safety 19/01/2009 2 27 18 Staffing levels must be determined according to the assessed needs of the people living at the home. This will ensure that the health, personal and social care needs of people are fully met. 30/01/2009 3 29 19 A robust and rigorous recruitment procedure must be implemented To ensure that people are suitable to work with vulnerable adults. 30/01/2009 Care Homes for Older People Page 25 of 27 4 30 18 Staff must receive training and regular updates in the mandatory and specialist subjects relating to the provision of the service. This will ensure that staff are well trained and competent to do their job and fully meet the needs of people living at the home. 30/01/2009 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 12 More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. The interval between meals should be no more than 12 hours to ensure that people remain well nourished. To ensure that people are not at risk of contracting infections, hand wash facilities should be available in all areas. 2 3 15 26 Care Homes for Older People Page 26 of 27 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!