Inspection on 16/11/05 for Knoll House

This inspection was carried out on 16th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Knoll House 29/01/09

Knoll House 30/01/07

Knoll House 04/04/05

Knoll House 22/09/04

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

CARE HOMES FOR OLDER PEOPLE Knoll House Ingram Crescent West Hove East Sussex BN3 5NX Lead Inspector Linda Boereboom Announced Inspection 16th November 2005 10:00 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 DS0000060589.V250689.R01.S.doc Version 5.0 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 DS0000060589.V250689.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knoll House Address Ingram Crescent West Hove East Sussex BN3 5NX 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) 01273 267588 01273 267589 Brighton & Hove City Council Miss Heather Lyn Barden Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That service users are aged eighteen (18) years and over on admission. That service users are only admitted whose needs are assessed as requiring Intermediate Care. 4th April 2005 Date of last inspection Brief Description of the Service: Knoll House is an Intermediate Care Service residential unit that provides rehabilitation services for up to twenty service users for a maximum of six weeks following discharge from hospital, or for the prevention of admission to hospital. The home has been purpose built and refurbished, completed in 2004 to comply with the National Minimum Standards. It is owned and managed by Brighton and Hove Council and South Downs Health NHS Trust. It is situated in Hove, East Sussex, close to local transport and amenities. Accommodation is provided in twenty single en-suite rooms, all of which include a shower or bath. Separate assisted bathing facilities are also available. Rooms are fitted with a telephone, television, and lockable facilities. The home is on two floors, separated into three units, each providing accommodation for six or seven residents, and there is a passenger lift to all levels. The staff team includes Rehabilitation Assistants, Registered Nurses, Physiotherapists, Occupational Therapists and Social Workers. The home has a range of specialist facilities; aids and adaptations for meeting intermediate care needs, including a physiotherapy room and a rehabilitation kitchen. There is communal seating and a dining area on each of the three units. There is also a day service unit on the ground floor of the building with a communal canteen/dining area, which can be accessed by residential service users. A local General Practitioner visits the home weekly, and can be contacted by staff whenever medical treatment is required. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and was facilitated by Mrs A Hampson and Mrs D Neville. Mrs Hampson is currently the Manager of Knoll House and will be applying to the Commission for Social Care Inspection for registration. The inspection took eight hours and was undertaken by two inspectors; feedback was given at the end of the day. During the inspection the Inspectors were able to look at the administration within the home, speak with both residents and staff, and tour the premises; they would like to thank everyone for making the inspection a pleasant and positive one. What the service does well: What has improved since the last inspection? As this was the first inspection undertaken by the Inspectors it is difficult to pinpoint improvements, however through conversation and a tour of the premises it was clear that requirements from the last inspection have been addressed. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 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 DS0000060589.V250689.R01.S.doc Version 5.0 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 DS0000060589.V250689.R01.S.doc Version 5.0 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): 3 and 6. Residents receive comprehensive needs assessments before being admitted to the home for intermediate care. On admittance they receive care and attention that is focussed on ensuring they are rehabilitated sufficiently to maximise their independence in readiness for their return home. EVIDENCE: Although not all standards in this section were assessed the Inspectors were made aware that both the statement of purpose and service user guide for the home were being prepared and it is hoped they will be available in January 2006. Residents are visited by trained staff from Knoll House to assess them for admission. As residents are admitted to Knoll house from hospital, or from home in an emergency, it is common that they do not have the opportunity to visit first, however all are given a leaflet and should a relative wish to visit on their behalf, staff are happy for them to do so. The Inspector was able to look at pre-admission assessments in residents’ files and found them to hold appropriate information. Once admitted to the home; Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 9 further assessments are carried out by a Physiotherapist, Occupational Therapist and Registered Nurse. A treatment plan is then drawn up based on the individual requirements of the resident. Following admission, an agreement to take part in a rehabilitation programme is signed by each resident. This may include helping residents to recover their independence with walking upstairs, making cups of tea or preparing a meal. The home was designed for intermediate care and has treatment rooms, activities rooms, kitchenettes, specialist equipment and all aids and equipment required to meet the needs of the residents. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 10 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): 7,8,9 and 10. Although healthcare needs are met the care plans require addressing to ensure that they can easily be accessed for quick referral, in some incidences paperwork requires completion and dates entered. EVIDENCE: Each resident has a personal plan of care and rehabilitation, however on looking through them it was evident that some areas do need addressing. Although plans are reviewed they had not all been updated to include full aspects of care required, two residents with dietary needs did not have the full details of their requirements in their care plan. Risk assessments are generally completed on admission or within a few days following admission. It was discussed with the manager during feedback that section 2 of the care plans be reviewed and made easier to use for quick reference. Through discussion with staff and residents it appeared that healthcare needs are being met even though there was a lack of clarity within the written care plans. The home does have a GP working with them who is available to give guidance and support, out of hours the staff use the Bright-doc service that is available within Brighton and Hove. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 11 Only trained staff administer medication, all residents spoken with by the Inspector said they were given their medicines by the nurses or they did not need to take any at all, one resident described how she was given instruction on how to use her new inhaler. Concerns were raised about the recording of medication brought into the home by residents and the home’s procedure on checking medicines received to ensure the correct amount has arrived. This was discussed during feedback and a requirement will appear in this report requesting the matter is addressed. Residents each have their own pay-phone in their room, the Inspector did notice that some residents were sitting on the opposite side of the room and may have had a problem reaching the ‘phone, in addition the phones are not set at a suitable height to be reached from a chair. It was also unclear in the care plans of the preferred name to be used for each resident, although staff said they always enquired on admission. The Manager confirmed that residents receive medical examinations and treatment in their own rooms even though the home does have designated treatment rooms in place. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 12 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): 12 and 15; all other standards were assessed at the inspection undertaken earlier in the year. Although activities are in place these tend to be part of a rehabilitation programme and social activities appear limited. The standard of meals produced in the home is good; meals are well balanced, nourishing and wholesome with attention paid to particular diets required by the residents. EVIDENCE: During the inspection the Inspector was able to speak with residents about activities. All said they had their own rehabilitation programmes, which they did find tiring, some said they liked to read or watch television but most of this took place in isolation. One resident did say that to have other activities would make the day pass more quickly. Care plans showed limited information on social activities that residents usually enjoyed in their everyday life at home. The Inspector was able to look at the kitchen in the home that has recently been refurbished to a good standard. Kitchen staff ensure that records are kept of fridge and freezer temperatures in both the main kitchen and the kitchenettes that are situated in the home for use by staff and residents for making snacks and drinks. The Inspector saw a programme of menus and records kept of meals taken by the residents. Residents spoken with by the Inspector commented ‘the food is actually really nice, like home cooked’, and ‘the food is excellent and we have a choice’. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 13 There were concerns that some records of the daily food serving temperatures had not been recorded; the manager agreed to address this oversight. This standard will be assessed as meeting the standard with a recommendation made that staff ensure daily food serving temperatures are recorded. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 14 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): 16,17 and 18. The home handles complaints objectively and keeps appropriate records. Residents’ legal rights are protected by use of the postal voting system and the home ensures that policies, procedures and staff training protect residents from abuse. EVIDENCE: The home has a detailed complaints procedure and records showed that all complaints are recorded appropriately with details of the complaint or concern, action taken and outcome. Looking through records the Inspector noted that the outcome included letters to the complainant ensuring they are happy with the process undertaken. The last complaint noted was 27/9/05. The Manager also ensures that the Inspector is made aware of any serious concerns that are raised within the home. Through conversation with an administrative assistant it was clear that residents are able to vote by using either the postal voting system or being taken to the local polling station. Records kept in the home were relevant to the last election. Staff receive training on the procedure to take in the event of an adult protection alert and are aware of the whistle blowing policy. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 15 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): These standards were not assessed at this inspection as they were all assessed at the inspection earlier in the year. EVIDENCE: Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 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): 27 28 and 30. The home ensures residents’ needs are met by employing staff from different professional backgrounds. The recruitment procedure is good and protects residents, however refresher courses relating to some staff training has been overlooked. EVIDENCE: On the day of inspection the home was well staffed and the Inspectors were able to see that the skill mix included qualified nurses, rehabilitation assistants, physiotherapists, occupational therapists and social workers. In addition to this there were also administrative and domestic staff on duty. The home also has the support of district nurses and other healthcare professionals if necessary. The Manager told the Inspector that currently the home is recruiting new staff. Recruitment is a shared responsibility between South Downs Health NHS Trust and Brighton and Hove Council. The Inspector looked at staff recruitment files and found them to have relevant information including Criminal Records Bureau checks on application. Staff files showed records of sickness and leave, terms and conditions of employment, supervision having taken place and training undertaken. The home should ensure that all staff receive refresher courses in mandatory training, evidence was found that some staff require updating in moving and handling and fire safety. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 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): 31,33,35,37 and 38. All other standards were assessed earlier in the year. The home has a friendly atmosphere where residents live in a well-managed environment and staff are supported and supervised. Care is taken to ensure the residents are protected; overall staff training is good however some staff training in fire safety, requires updating. The Inspector suggested that moving and handling training for care staff is reviewed annually. EVIDENCE: The Manager’s post has now been agreed and the Manager should apply to the Commission for Social Care Inspection to become registered. The home does not have a system of publishing surveys given to residents to ensure they are happy that their needs are being met; this was discussed and agreed that a recommendation be made in this report that this is addressed. The home has a detailed procedure in place for handling residents money, generally staff request that a relative or advocate takes this responsibility, however the Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 18 Manager said that should a request for shopping occur, receipt books are used to ensure records are kept of any transactions undertaken. Residents have a small lockable unit in their individual rooms for small amounts of money or valuables. All records kept by the home are stored appropriately. The home has an Intermediate care policy for documentation and record keeping that supports records being clearly written, dated, timed and signed. Policies and procedures are reviewed regularly and where necessary in line with Brighton and Hove guidelines. The Inspector regularly receives Regulation 26 and Regulation 37 reports from the home thus ensuring that any new information is stored on the home’s service file at the Commission for Social Care Inspection. The Home has health and safety policies and procedures in place relevant to the running of the service these include policies for the prevention of healthcare associated infections. There are appropriate health and safety signs on view in the home. All cleaning fluids are kept locked in designated storage cupboards. The Inspector looked at records that showed risk assessments take place on the building including the kitchen area, laundry, offices, all staff and public areas, the activities area, bedrooms bathrooms and treatment rooms; the next assessment is due in December 2005. Regular checks are undertaken on the water system, which includes temperatures, showerheads and all water outlets. The lighting system is checked weekly and all equipment regularly serviced. PAT (portable appliance testing) is recorded as having taken place on 1/6/05. Fire safety is addressed however the Inspectors noted that the doors to some individual bedrooms were propped open, some at the request of the resident. This was discussed and it was agreed that the Manager should contact the local Fire Service and ask for guidance on the matter. The last fire drill took place on 10/08/05 and a fire risk assessment was undertaken on 12/04/05. Records of fire drills did not give a list of staff that attended, again this was discussed and the Manager agreed to address the issue. Staff do receive training in moving and handling, fire safety, food hygiene, health and safety, cross infection and first aid as appropriate. It was noted when looking through records that some staff had missed updates and a requirement will show in the report that this is looked into by management staff. First aid boxes are checked by nominated persons on each unit where notices for first aid are on view. The Inspector noted that all incidents and accidents are recorded. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 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 x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 3 2 Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? 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 2 3 4 Standard OP77 OP77 OP77 OP99 Regulation 13(4)(5) 15(1)(2) 15(1)(2)b 13(2) Timescale for action All residents to be risk assessed 04/12/05 fully on admission to the home. Individual care plans to include 04/12/05 full and comprehensive details of the resident’s care needs. All care plan reviews to show 04/12/05 clearly the changes in care needs. Staff to ensure that records are 04/12/05 maintained of amounts of medication brought into the home by residents. Residents to have the 01/01/06 opportunity to participate in activities that are of a social interest to them in addition to their rehabilitation activities. Records to be maintained of food 01/12/05 temperatures served to residents. All staff to receive regular 04/12/05 training updates in moving and handling All staff to receive regular 04/12/05 training updates in fire safety. The new manager to apply for 01/02/05 registration with the Commission for Social Care Inspection. Consultation be sought from the 10/12/05 DS0000060589.V250689.R01.S.doc Version 5.0 Page 21 Requirement 5 OP12 16(2)m 6 6 7 8 9 OP15 OP38OP30 OP38OP30 OP31 OP38 13(4)c 13(5) 23(4) 8(2) 23(4)c(v) Knoll House fire service re the fire doors to residents rooms being propped open. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP10 OP33 OP38 Good Practice Recommendations Section 2 of the care plans to be reviewed to ensure they can be accessed for easy reference. The height and distance of pay-phones to be considered when residents who have poor mobility are sitting in their armchairs. Results of the quality questionnaires to be published and a copy readily available for inspection. Records to be maintained of the names of staff who attend fire practice drills. Knoll House DS0000060589.V250689.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 DS0000060589.V250689.R01.S.doc Version 5.0 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. 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