Inspection on 29/01/09 for Knoll House

This inspection was carried out on 29th 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 30/01/07

Knoll House 16/11/05

Knoll House 04/04/05

Knoll House 22/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Knoll House Ingram Crescent West Hove East Sussex BN3 5NX     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: Jennie Williams     Date: 2 9 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 30 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Knoll House Ingram Crescent West Hove East Sussex BN3 5NX 01273267588 01273267589 annie.hampson@brighton-hove.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brighton & Hove City Council Name of registered manager (if applicable) Anna Hampson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - PD Date of last inspection Brief description of the care home Knoll House is an Intermediate Care Service residential unit that provides rehabilitation services for up to twenty residents with an average stay of between seventeen and twenty six days following discharge from hospital or to prevent admission to hospital. There is no charge to the resident for the service. The home has been purpose built and refurbished to comply with the National Minimum Standards. It is owned by Brighton and Hove City Council and managed by Brighton and Hove City Council and South Downs Health NHS Trust. Care Homes for Older People Page 4 of 30 care home 20 Over 65 0 20 Brief description of the care home Knoll House 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 located throughout the home. Rooms are fitted with a telephone, television, and lockable facilities. Accommodation is provided over two floors, separated into three units, each providing accommodation for six to eight residents. There is a passenger shaft lift providing access 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. A local General Practitioner visits the home weekly, and can be contacted by staff whenever medical treatment is required. Care Homes for Older People Page 5 of 30 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: It should be noted that following CSCI consultation, it was identified that service users prefer to be called people who use services. For the purpose of this report, people who use the service will be referred to as residents. The Registered Manager facilitated this inspection. This unannounced site visit took place on the 29 January 2009 for eight hours. Evidence obtained at this site visit, previous information regarding this service and information that the CSCI have received since the last inspection forms this key inspection report. The last key inspection was undertaken on the 30 January 2007. An Annual Service Review (ASR) was undertaken on the 12 March 2008. Care Homes for Older People Page 6 of 30 Ten surveys were sent for residents to complete prior to the site visit, of which two were returned. A further two residents were spoken with at the site visit. Ten staff surveys were sent to the home prior to the site visit, of which five were returned. A further 13 staff were spoken with in a group at the site visit, plus the Registered Manager. Staff spoken with included members of staff from across the multidisciplinary team and ancillary staff. One visitor was spoken with. A care plan was viewed and specific areas of care looked at in a further seven care plans. Medication procedures were viewed. Procedures and records for handling residents finances were discussed. Four staff files were inspected, along with training records. A tour of the environment was undertaken and some individual rooms were viewed. The quality assurance system, complaint records and quality monitoring checks in place were viewed/discussed. There were twenty-one residents residing at the home on the day of the site visit. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to ensure that they send a letter to prospective residents confirming that having regard to their assessment, the care home is suitable for the purpose of meeting the residents needs in respect of their health and welfare. Action needs to be taken to ensure prospective residents are provided with information about the service to be able to make an informed decision if the home is the right place for them. A comment received was could have been a better admission, would have liked to have more information about the home Work needs to be undertaken to provide residents with sufficient stimulation within the service to fulfil their needs and expectations and peoples time within the service are not spent being bored. Care Homes for Older People Page 8 of 30 More robust recruitment procedures will ensure residents are better safeguarded. Work needs to be done to improve the ethos and staff morale within the service. Developing and implementing a service specific quality assurance and quality monitoring will assist in evidencing that the home meets its aims and objectives and provide the Registered Manager with information on how the service at Knoll House can be improved. . Any other shortfalls noted of which no requirement or recommendation made has been reflected throughout the report. The AQAA identifies areas that the service has improved in the last 12 months and identifies areas that they could do better and their plans for improvements in the next 12 months. Whilst there are improvements that could be made within the service, this service has been rated as providing good outcomes for residents for short-term accommodation only. Where there are areas for improvement, we are confident that the provider can manage these. The registered providers have demonstrated a history of ensuring compliance. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are not provided with sufficient information to make an informed decision if the home is the right place for them. The admissions process may place some residents at risk of all needs not being met. Evidence: The home has a Statement of Purpose available for prospective residents. The home is proposing to place a laminated copy of the Statement of Purpose in every room for people to read. There is no Service Users Guide available, however the Registered Manager confirmed that they are currently getting published a brochure that is condensed information about the service and is to be provided to all prospective residents. Residents admitted to this service receive very limited information about the home prior to arrival. Feedback from residents confirmed that they had no input into the decision to be Care Homes for Older People Page 11 of 30 Evidence: admitted to Knoll House. There is no choice provided in which intermediate care service they use. The two residents surveys returned identified that they did not received enough information about the service to decide if it was the right place for them. One residents spoken with stated that it could have been a better admission, would have liked to have more information about the home. They were given no information regarding intermediate care. There are different homes throughout the council area that provide intermediate care. An assessor from the National Health Service (NHS) Intermediate Care Team undertakes an assessment of prospective residents. This assessment is for placement in an intermediate care bed and not specifically for this service. It was confirmed that people sign up for intermediate care, not service specific. Information from assessments is shared with the home, who makes the final decision if all needs are able to be met with the services and facilities provided. Prior to this site visit, an emergency contingency plan had to be implemented due to a bed crisis within the local NHS hospitals. The home temporarily increased their bed numbers by seven places. It was confirmed that there continued to be one additional room in use at the time of this site visit. This is a single room with no en suite facilities. It was confirmed that this room would continue to be used until the end of February 2009. The Registered Manager confirmed that people admitted into this room must be independent and must be informed about the room prior to admission. This criteria was not followed on the day of the site visit. A relative requested to speak to the Inspector regarding this. It was confirmed that they were not informed about the room prior to admission, their relative is not independent and the size and layout of the room would actually hinder the residents recovery. The Registered Manager was spoken with following the inspection, who confirmed that she did not make the decision to admit this person and that a meeting was being held with the intermediate care team to ascertain how the admission came about and to ensure that a similar incident does not occur again. The home is a purpose built home and has the equipment and facilities provided to provide intermediate care. The home is divided into three separate zones, with each zone containing between six to eight beds. There are other dedicated areas equipped to assist in providing rehabilitation care, such as a physiotherapy room and a rehabilitation kitchen. Care Homes for Older People Page 12 of 30 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. Residents rehabilitation needs are met with the information contained in care plans. Residents are generally safeguarded by the medication procedures in place. Evidence: Care plans were observed to be in place and specific areas of care were noted to be reflected and provided guidance to staff on how to meet the needs. Care plans were not viewed in detail as there were no shortfalls noted at the last inspection and the process has not changed. Care plans were noted to have pre populated information in place and staff ensure that these are personalised to the individual to promote person centred care. For recently admitted residents, where no care plan was observed to be in place, a staff member confirmed that care plans would be completed by that day. There was no night care plan in place for a resident who had been at the home for six days. A staff member confirmed that this should have been done immediately. The Registered Manager must ensure this is addressed. A resident, who could not remember their Care Homes for Older People Page 13 of 30 Evidence: involvement in developing this document, was happy to view the information with the Inspector. They confirmed that they had discussed the information with the staff and residents sign their plan of care. Residents have access to other health professionals when needed. Records are maintained of all multidisciplinary health visits. Due to the high turnover of residents and the reason for admission being for rehabilitation, care plans provide a brief overview of peoples needs and staff monitor progress for the proposed discharge date. Both resident surveys received identified that they always receive the care and support they need and that staff listen and act on what they say. Feedback from staff identified that they could do with more monitoring equipment ie. Blood Pressure machines, Oxygen saturation machines. This is for the home to assess and action if necessary. A registered nurse confirmed that there are policies and procedures in place for dealing with all aspects of medicines. Medication Administration Record (MAR) charts viewed identified that medicines are generally signed at the time of administration. It was observed that on one occasion some medication had been given, however not signed for. No requirement or recommendation has been made in relation to this, as the Registered Manager can identify who was responsible and address the shortfall with the individual involved. Medication is stored in cupboards within the individual bedrooms and residents are provided with an opportunity to self medicate, if they wish and a risk assessment identifies that it is safe for them to do so. A resident commented that their privacy and dignity are generally respected, however staff sometimes knock on the room door and just enter without waiting for an answer. The importance of waiting for permission to enter must be reiterated to the staff. Care Homes for Older People Page 14 of 30 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. Residents are not always provided with sufficient stimulation to fulfil their interests and needs. Residents are provided with a choice in meals. Evidence: Feedback from residents identified that there are not enough activities provided at the home for them to participate in. One resident identified that they had not been provided with any information about the provision of activities and was sometimes bored. Feedback from staff also identified that they felt there were insufficient activities provided at the home. Staff try and initiate activities if they have time. The Registered Manager confirmed that activities had not been provided for the last couple of weeks due to an infectious outbreak within the service. When asked what the service could do better a written comment was Social activities for service users. To consider the needs of younger service users more. Some younger service users express they feel out of place. It has previously been identified that the level of participation is dependent on the Care Homes for Older People Page 15 of 30 Evidence: residents residing in the home at any given time. It was confirmed that for some residents they find that the exercise classes and physiotherapy they undertake as part of their rehabilitation is enough for them. The provision of activities was discussed with the Registered Manager. It was confirmed that due to the policies and procedures implemented by South Downs Trust and Brighton and Hove council, she is unable to undertake an internal quality assurance surveys at the home to ascertain the residents wishes is relation to activities. Feedback from staff identified that the provision of activities is adhoc and that some residents have previously complained about the lack of stimulation and boredom with the service. The provision of activities needs to be addressed within the service. Visitors are welcomed into the home and are able to see their friends or relatives in private if they wish. There are no restrictions for visiting the service. Feedback from residents identified that there are mixed feelings regarding the provision of food. It was confirmed that residents are provided with a choice in meals. The Registered Manager confirmed that they undertake in house questionnaires regarding the provision of catering services. No requirement or recommendation has been made in relation to food, as this needs to be addressed through the homes quality assurance process. There are small kitchenettes at the home where some food is stored so that residents can make their own snacks, should they wish to. Fresh fruit is also available and this is replenished every day. Care Homes for Older People Page 16 of 30 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. Complaints are dealt with by the home and action taken where necessary, ensuring those who raise complaints that they are listened to. Residents are protected from risk of harm, neglect and abuse so far as practicable. Evidence: There is a complaints procedure available at the home for all people to access. Feedback from residents identified that they know who to speak to if they are not happy about something within the service and know how to make a complaint. Feedback from staff identified that they know what to do in the event that a resident or representative wishes to raise concerns with them. The AQAA identified that there have been ten complaints made in the last 12 months of which eight were upheld and 90 percent were resolved within 28 days. An additional complaint had been raised with the service since completing the AQAA that is currently ongoing. Records viewed identified that the home takes all complaints seriously and clear records are maintained and copies of any correspondence kept. There is a summary of complaints kept to assist the Registered Manager to identify if there is a recurring theme. Records identify what action was taken to resolve the complaint, if necessary. Care Homes for Older People Page 17 of 30 Evidence: Staff spoken with confirmed that they are provided with Safeguarding Adults training and know what procedures to take in the event of an allegation being made. This training includes procedures for whistle blowing and staff would feel comfortable to whistle blow within the service. The AQAA identifies that there have been eight Safeguarding Adults investigations in the last 12 months. Records viewed identified that the home is proactive in making Safeguarding Adults referrals. Records were viewed with the Registered Manager that identified eight referrals relating to practices within the home were raised since January 2008 of which one was substantiated, four were inconclusive, one was unsubstantiated and one is currently continuing to be dealt with through the Safeguarding Adults procedures. The home did not receive an outcome for one investigation. The home is pro active in ensuring that people who use the service are safeguarded and have made a further five Safeguarding Adults referrals not related to practices within the service. These were concluded as being unsubstantiated. The home keeps records of what further action they may have taken as a result of any investigations. There is a poster on display within the service providing information to all people who use/visit the service what to do if they suspect any forms of abuse occurring. All Safeguarding Adults investigations are audited. Feedback from staff identified that some felt there could be better support for staff when abuse is made towards them. This is for the home to address. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a purpose built home and are provided with suitable facilities to enhance their rehabilitation. Evidence: Knoll House is a purpose built home designed to provide intermediate care placements for a short-term period. Residents rooms are located over two floors and divided into three different zones, each containing between six to eight beds. Zones are named after flowers/colours that are reflected in the decoration. All rooms are for single occupancy and all have en suite facilities, including a bath/shower. There are additional bathing and toilet facilities located throughout the home. There is a passenger shaft lift within the service to provide access to all levels. Suitable furnishings and lockable facilities are provided in all rooms. 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. The home has recently had extensive works done to replace the roofing of the service. The home notified the CSCI of this and ensured all safety measures were in place and Care Homes for Older People Page 19 of 30 Evidence: that the works had minimum impact on the running of the service. This work was continuing on the day of this site visit. Laundry facilities are placed away from the communal and kitchen areas. There was protective clothing, gloves and aprons, located throughout the home for staff to readily use to assist in promoting infection control. The AQAA identifies that 44 out of 58 staff have received training in prevention and control of infection. The home was clean and free from offensive odours on the day of the site visit. Care Homes for Older People Page 20 of 30 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. Residents needs are being met with the skill mix of multidisciplinary staff on duty. More robust recruitment procedures will ensure residents are better safeguarded. Evidence: Knoll House employs a number of multidisciplinary staff including social workers, qualified nurses, rehabilitation assistants, support workers, occupational therapy assistants, catering staff and other ancillary staff to meet the needs of the residents. The home also has the support of other healthcare professionals if necessary. Residents surveys received identified that staff are always/usually available when needed and that staff listen and act on what they say. Feedback from staff surveys identified that four felt there was always/usually enough staff on duty to meet the needs of residents and one felt sometimes enough staff were on duty. It was confirmed by staff spoken with that they tend to be short staffed when there is short notice if someone goes off sick. A written comment from a staff was Residents often report feeling staff are limited for time. It was confirmed that staffing levels are discussed at team meetings. Three care workers work a waking night. The AQAA identifies that in the past three months, an additional 30 nursing shifts had been covered by nurses at the home doing Care Homes for Older People Page 21 of 30 Evidence: extra shifts and 240 care shifts had been covered by temporary staff or staff from an agency. Staff confirmed that additional staff were on duty for the period when there were additional beds. The AQAA identifies that the reduction of temporary support staff is an area in what they could do better and their plans for improvement in the next 12 months is to continue to recruit and review the permanent staff establishment to ensure they can deliver effective care. Four staff files were viewed. Human resources (HR) within the trusts undertake the recruitment of staff and copies of files are sent to the home. Two staff files did not have any information regarding dates of previous employment. One application appeared to have pages missing. The Registered Manager and another staff member could not clarify if this was the case. All staff files had references in place, however for references returned electronically, there was no evidence to identify the authenticity of these. Criminal Record Bureau (CRB) checks were not available for viewing at the service, however confirmation is sent from the HR department confirming when they have been undertaken and if they were clear. Where information had been returned from the CRB, there was a record of what action had been taken. There was no evidence on the information provided to identify that these were enhanced or if it included a Protection of Vulnerable Adult (POVA) check. The home does not see any CRBs. The Registered Manager confirmed that she only gets involved in the recruitment of more senior positions. The Registered Manager confirmed that HR will in future be sending them very limited information. These changes are being implemented due to Data Protection. The Registered Manager was unable to provide any further information about the process at this stage until the meeting has been held. Procedures need to be implemented to ensure compliance with the Care Standards Act 2000 and Care Homes Regulations (as amended). The AQAA identifies that all people who have started work in the home in the last 12 months have satisfactory pre-employment checks. There are systems in place to ensure registered nurses Personal Identification Numbers (PIN) is kept up to date with the Nursing and Midwifery Council (NMC). It was confirmed that all training is monitored on a database and all staff are kept up to date with mandatory training. Feedback from staff confirmed that they are provided with opportunities to attend training, however commented that there is not enough forward planning with supervisions and training. Staff commented that they are told not to attend training sessions if they are short staff. Staff identify training needs through supervision. A written comment from a staff survey was there could be more training around issues of mental health, race, specific illnesses and disabilities and Care Homes for Older People Page 22 of 30 Evidence: more emphasis on equality. The AQAA identifies that staff receive mandatory training on equality and diversity and there is a fact file within the service providing staff with basic information regarding cultural preferences and religious beliefs to refer to. The AQAA identifies that they will soon benefit from a part time practice education facilitator to help staff develop the skills they need to match the changing and complex needs of the residents. It was confirmed that new staff complete Common Induction Standards as set by Skill for Care and all staff complete an in house induction. The AQAA identifies that all staff have a development programme that meets the National Minimum Standards for their service. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interest of residents, however further work on monitoring the service will assist in evidencing that the home meets its aims and objectives. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. Evidence: The Registered Manager is a registered nurse with current registration with the NMC. She is registered with the CSCI and has the necessary skills and experience to manage the home. She keeps herself up to date by being involved in a variety of working groups and attends training sessions. It was confirmed that some areas of responsibility are delegated to other people within the trusts or within the service. Feedback from staff identified that there is low morale within the service and staff feel support from management is lacking at times. They confirmed that there are not clear roles and responsibilities at the home (however not with all seniors) and there are Care Homes for Older People Page 24 of 30 Evidence: good days and bad days. Sometimes staff feel there is no team work, depending whos on duty. When asked what the service could do better, written comments from staff were: there could be more done to take in the considerations and well being of the staff that work here, stress levels appear high and other feedback identified that some management within the service are not supportive and do not have flexibility in the way they run the place. They felt there was a lack of understanding on all the work that was done when there were extra beds within the service. Feedback identified that staff morale has been low for a period of time, however they confirmed that the needs of people continue to be met. When asked what changes could be made suggestions from staff were: better teamwork, team building, better attitude with managers, clearer roles and responsibilities, there is a lack of communication within the service. Feedback from staff was shared with the Registered Manager, who was surprised, but confirmed that she would take on board the comments and discuss with other senior management on ways to improve staff morale. The quality assurance and quality monitoring system was discussed with the Registered Manager. It was confirmed that a survey is done of intermediate care services and is not service/home specific. Surveys are sent to people on discharge to their own homes. Verbal feedback is asked for whilst people are within the service and it was confirmed that comment cards are left around the building for people to complete. An audit is done every two weeks and the service receives an audit from South Downs Health, collated about intermediate care provision and not related to a specific care home. There is a separate in house survey for the catering at the service. This is audited every quarterly. Residents are asked to complete this while they are at the home. Surveys are audited and an action plan is devised. This information is not currently shared with people with an interest in the service and the Registered Manager is not sure if she is able to share results. The Registered Manager confirmed that she is unable to implement local surveys, as South Downs Health deals this with. She is governed by policies and procedures within South Downs Health Trust and Brighton and Hove Council. Annual NHS staff surveys are provided and Brighton and Hove council also have annual staff surveys. Staff meetings are held monthly. There are separate staff meetings according to roles. Action needs to be taken to ensure that an effective quality assurance and quality monitoring system is implemented relating to Knoll House, to assist the Registered Care Homes for Older People Page 25 of 30 Evidence: Manager in ensuring this home is run in the best interest of residents and that results of any residents surveys are published and made available to all stakeholder who have an interest within the service. The AQAA returned was clear and gave us the information we required. It identifies areas in what they could do better, how they have improved in the last 12 months and their plans for improvements in the next 12 months. A representative for the registered provider undertakes monthly visits. It was identified at inspection that that the home had recently had an outbreak of an infectious illness. The CSCI were not advised of this. This information was sent following this site visit. Other notifications as required by legislation had been shared. The home does not get involved with dealing with residents monies. The Registered Manager confirmed that residents manage their own finances or make alternative arrangements themselves. A safe is available at the home for residents to deposit any money/valuable for safekeeping. The Registered Manager confirmed that there is a fire risk assessment in place and staff attend fire training, however dont undertake fire drills but discuss evacuation procedures. The Registered Manager confirmed that they dont do fire drills following information from the National Patient Safety Agency. Information from the Department of Health identifies that for care homes, they need to evaluate the effectiveness of the fire training and the best way to do this is to perform a fire drill. This should be carried out at least annually or as determined by your fire risk assessment. This is for the home to address and seek advice from a fire officer. The Registered Manager confirmed that there are processes in place to ensure all areas within the service are free from risk. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant policies and procedures are in place. Care Homes for Older People Page 26 of 30 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 27 of 30 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 3 14 That written confirmation be 16/04/2009 provided to service users confirming that their needs can be met at the home. To confirm that following an assessment the care home is suitable for the purpose of meeting their needs in respect of their health and welfare. 2 12 16 That service users are 16/04/2009 consultated about the programme of activiites arranged by or on behlaf of the care home and action taken if identified as needed. To ensure service users are provided with sufficient stimulation and provided with activities that are within their interest and ability. 3 29 19 That robust recruitment procedures are followed. 31/03/2009 Care Homes for Older People Page 28 of 30 This will ensure that service users are better safeguarded. 4 33 24 That a service specific 30/04/2009 quality assurance and quality monitoring system is developed and implemented. This will assist in evidencing that the home meets its aims and objectives and provide the Registered Manager with information on how the service at Knoll House can be improved. 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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