Inspection on 21/12/05 for Knoll House

This inspection was carried out on 21st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 01/08/06

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 Unannounced Inspection 21st December 2005 08:00 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 DS0000017187.V273523.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 DS0000017187.V273523.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knoll House Address The Avenue Penn Wolverhampton West Midlands WV4 5HW 01902 335749 01902 333575 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.V273523.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories except 4 (max) Terminally ill Date of last inspection 6th September 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. 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.V273523.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over five hours on Wednesday 21st December 2005 and is the second of the statutory inspections for 2005/06. Twenty eight people were resident at the time of inspection; staffing levels were seen to be at the previously agreed levels. The inspection included discussions with six residents, members of staff, the deputy manager and the owner of the home. Four care plans were examined in depth together with supporting documents and two of the complaints recently received were followed up. A tour of the home was conducted. What the service does well: What has improved since the last inspection? A deputy manager has been recruited, it is anticipated that this person will take over the role of the registered manager. The care plan of the most person most recently admitted to the home was prepared by the information gained from preadmission assessments and highly individualised to the persons needs. Knoll House DS0000017187.V273523.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 DS0000017187.V273523.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 DS0000017187.V273523.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): EVIDENCE: This set of standards was not inspected on this occasion. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 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): 7,8,9 Although the care plans are being reviewed on a regular basis, important information is being omitted, this potentially is putting residents at risk by not providing staff with all the information they need to fully meet resident’s needs. EVIDENCE: Four residents case files were inspected and indicated that the care plans are being reviewed at least monthly and that the resident and/or relative are being involved in the process. One care plan identified a regime for pressure area care but did not record the wound location, the current dressing treatment being used or the frequency of the change of dressing. Entries made in the daily report indicated that on occasions additional dressings were required to the hand, elbow and scrotum, the care plan had not been updated to record the required interventions to these areas. The risk assessment for maintaining skin integrity identified a high risk score, an air mattress had been provided for pressure relief purposes. On observation, the mattress was turned to the maximum setting, staff were unsure that this was correct for this persons size and weight. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 Page 10 Another care plan indicated that following assessment, a high risk score had been identified for maintaining skin integrity and that the use of an air mattress was required. On observation a mattress has not been provided, the deputy manager explained that additional air pressure mattresses have been ordered. Another care plan identified a need for catheter care, from the plan and comments in the daily report it was difficult to establish whether this person still required a catheter for continence care. Speech and language therapists have been contacted where assessments have indicated a high risk in maintaining adequate nutrition. The care plan of the person most recently admitted to the home evidenced a full individualised plan had been generated; the core care plans had not been used. The home continues to use the ‘Boots’ monitored dose system for the administration of medication. A drug round was in process at the time of the inspection. The staff nurse was observed to be dispensing the tablets from the blister pack into medicine pots; the name of the person was written on a scrap of paper and placed into the pot. These were then placed on a tray and taken to residents on the first floor to be administered. The staff nurse explained the problems of transporting the medications in the drugs trolley on the first floor due to the thick pile of the carpet and the lay out of the bedrooms. This secondary dispensing of medication is an unsafe method and practice and must cease. The deputy manager was informed the Commission for Social Care Inspection pharmacy inspector would be contacted for advice. A pot of Sudocrem was observed in a bedroom, the pot was without a label or opening date. The Medication Administration Record for one resident had not been fully completed, there was no indication that the medication had been administered/refused or disposed of. Two freestanding oxygen cylinders are stored in the treatment room; the cylinders were not secured to the wall or placed on a trolley. The soap dispenser in the treatment room was empty. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 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): 15 There is no evidence to suggest that residents are being consulted on their choice of meals or that the food provided is to their preference. EVIDENCE: The home operates a four weekly rotational menu for the provision of meals. The cook and one member of staff when spoken with, were unsure of which week they were working to. One resident was being assisted to have breakfast and was requesting a cup of tea and a bacon sandwich, the mug of tea offered was extremely hot, this resident was at risk of scalding as she is visually impaired but was left with the tea. The inspector instructed the staff member to return the mug of tea to the kitchen to ensure a safe temperature. A bowl of bran flakes was then given to this resident. The member of staff explained that this resident would have a bacon sandwich each day but this was not permitted due to a weight problem. The cook stated that there was no bacon on the premises anyway and that the day before this resident had bacon, sausage and egg for breakfast. Observation of the food record for the previous day indicated that porridge had been given; there is no evidence to suggest, on this or previous records, that anything but porridge is offered. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 Page 12 A member of the care staff completes the food record for the whole week. At the time of the inspection the record was fully completed for the week 19th-25th December 2005. The staff stated that they are too busy to make any changes to the record if different food is offered. The cook did not appear to use the information, but stated that she ‘knew what people liked’. Kitchen cleaning records were not available and the temperature of the food record was not completed sufficiently. A bottle of bleach was by the sink; the cook stated that it is used for the dishcloths. Medicine pots are being washed in the main kitchen, the treatment room has a sink for this purpose. The freestanding electric fan, mops and buckets in the kitchen are in need of cleaning and/or replacement. . Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 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): 16,18 Concerns or complaints are dealt with promptly and professionally EVIDENCE: Four complaints have been received since the last inspection, two of which have been referred to the Vulnerable Adults Team for investigation. Two complaints were partly upheld, with requirements being issued to the home relating to the findings of the investigations. Two complaints have yet to be fully completed. The registered manager has cooperated fully with the investigation process. Whistle blowing and abuse protection procedures are in place and available for staff reference. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 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): 19, 24, 26 Improvements continue to be made to the environment; however, some areas of the home continue to present risks of falling or tripping to staff, residents and visitors. EVIDENCE: The communal areas were all clean and tidy; domestic staff were busy around the building attending to areas when unoccupied by the residents. Breakfast was being served to the residents in the dining room, the cloths on the tables were creased and old looking, replacements would greatly enhance the appearance of the dining area. During the tour of the premises the majority of the soap dispensers in the communal and private areas were empty, paper towels were not available in the sluice area. The concrete floor in the main corridor has not been repaired and continues to be a hazard for residents, staff and visitors. Suitable door locks or a lockable storage space have not been provided to all of the private bedrooms. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 Page 15 Two residents commented that their bedrooms were ‘very comfortable’ and that they ‘had no complaints’. Knoll House DS0000017187.V273523.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): 27,29,30 The recruitment practices currently used are potentially leaving residents at risk, appropriate checks not being carried out. EVIDENCE: Staffing levels remain as usual 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. A deputy manager has been recruited since the last inspection and has one supernumery day per week; the remainder of the time is for clinical duties. Ancillary staff are additional. Following a recent complaint, additional specialist training opportunities have been arranged for all levels of staff. Core topic training and updates continue to be accessed. Three staff personnel files were examined; only one file contained a criminal record bureau (CRB) disclosure. The administrator explained that the disclosures had been applied for but had not been received. Only one file contained two references and one file did not contain valid work permit. The staff member stated that she would provide the home with a copy of the work permit; the administrator was requested to forward a copy to the Commission for Social Care Inspection local office. Knoll House DS0000017187.V273523.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): 31,36,38 The recent changes to the management team will provide the opportunity to further monitor, improve and promote the welfare and interests of the residents. EVIDENCE: A deputy manager has been recruited in October, it is anticipated that she will take over the position of manager at the home. A formal application for the position of registered manager must be submitted to Commission for Social Care Inspection local office. Formal staff supervision has commenced for all staff. The administrator stated that a revised format is being trialled. Portable electrical appliance testing is now outstanding, the last test being March 2004. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 Page 18 A store cupboard in the main corridor is used for storing surplus foodstuffs; on observation the area is used for storing cleaning chemicals and a pair of stepladders in addition to food. The deputy manager was informed that all cleaning chemicals must be removed immediately and securely stored separately Knoll House DS0000017187.V273523.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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 2 Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 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 OP7 Regulation 15(2) Requirement The care plans must be updated to reflect the changing needs and current objectives for health and personal care and actioned. The registered person must ensure that the incidence of pressure ulcers, their treatment and outcome, are recorded in the residents individual plan of care and reviewed on a continuing basis. The registered person must ensure that equipment necessary for the promotion of tissue viability and prevention and treatment of pressure ulcers is provided. The registered person must ensure that the practice of secondary dispensing medications from the original containers to a medicine pot ceases. Medication including creams and lotions must only be used for the person for whom it is prescribed. Previous timescale 31/10/05 Not met. The Medication Administration DS0000017187.V273523.R01.S.doc Timescale for action 31/01/06 2 OP8 17(1)(a) Sch.3(p) 01/01/06 3 OP8 16(1)(2) (c) 31/01/06 4 OP9 13(2) 01/01/06 5 OP9 13(2) 01/01/06 6 OP9 13(2) 01/01/06 Page 21 Knoll House Version 5.0 7 OP9 13(2) 8 OP15 12(2) 9 OP15 17(2) Sch.4(13) 13(3) 10 OP15 11 OP15 13(3) 12 13 OP15 OP15 13(3) 13(3) 14 OP19 13(4) 23(1)(2) (a) 15 OP19 23(2)(b) 16 OP24 12(4) Record must be fully completed at the time of administering the medications. The oxygen cylinders stored in the treatment room must be securely fastened to the wall or placed on a trolley. The registered person must ensure that all residents are consulted on their choice of meals each day. The registered person must ensure that accurate records are kept of the food offered to and taken by residents. The registered person must ensure that the kitchen cleaning and food temperature records are maintained and available for inspection. The registered person must ensure that only appropriate chemicals are used in the kitchen. The registered person must ensure that medicine pots are not washed in the main kitchen The registered person must ensure that all equipment used in the kitchen area is kept thoroughly clean and fit for the purpose The two patio doors to the one side of the dining room must either be replaced with a more suitable and safer alternative or a safe patio area on an equal level provided outside of each patio door. This requirement is carried forward from the previous inspection The concrete floor in the main corridor must be repaired. Previous timescale 31/10/05 not met The registered person must ensure that suitable locks are DS0000017187.V273523.R01.S.doc 31/01/06 01/01/06 31/01/06 14/01/06 14/01/06 14/01/06 14/01/06 01/04/06 31/01/06 31/01/06 Page 22 Knoll House Version 5.0 17 OP24 23(2) 18 OP26 13(3) 19 OP29 19(1)(c) Sch.2 para.1-7 20 OP38 13(4) 21 OP38 13(4) provided on all private accommodation doors. The registered person must ensure that a lockable storage space is provided in all bedrooms. The registered person must ensure that hand washing facilities are readily available in all staff working areas. The registered person must ensure that two satisfactory references are obtained for each employee prior to staring work at the home. Previous timescale 31/10/05 Not met. The registered person must ensure that all portable electrical appliances are safety tested annually. The registered person must ensure cleaning chemicals, foodstuffs and maintenance equipment are securely stored separately 31/01/06 01/01/06 14/01/06 31/01/06 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP19 OP31 Good Practice Recommendations The table cloths should be replaced to enhance the appearance of the dining room The application for the position of registered manager must be submitted to the Commission for Social Care Inspection local office. Knoll House DS0000017187.V273523.R01.S.doc Version 5.0 Page 23 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. 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