Inspection on 03/04/07 for Knoll House

This inspection was carried out on 3rd April 2007.

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

The inspector 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 04/03/10

Knoll House 04/11/09

Knoll House 13/01/09

Knoll House 01/08/06

Knoll House 21/12/05

Knoll House 06/09/05

Knoll House 07/01/05

Knoll House 19/08/04

Knoll House 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW Lead Inspector Joy Hoelzel Key Unannounced Inspection 03 April 2007 10:15 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.V332316.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knoll House Address The Avenue Penn Wolverhampton West Midlands WV4 5HW 01902 335749 01902 333575 knollhse.aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Knoll House Nursing Home Limited Mrs Jill Roberts Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (32), Terminally ill (4) of places Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories except 4 (max) Terminally ill Date of last inspection 1st August 2006 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. Weekly fees range from £336.00 - £ 428.00 Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the first of key inspections for 2007/08 and took place over six hours on Tuesday 3rd April 2007. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty three of the thirty eight National Minimum Standards for Older People were inspected. Thirty people are currently living at the home. The manager was on the premises supported by a registered nurse, six care staff, and ancillary personnel were additional. Three case files were selected for case tracking, relevant documents were inspected, discussions were held with people living at the home, visitors, members of staff and manager. Observation was made of the various daily activities and a tour of the premises was conducted. Four visitors and three people at the home completed comment cards, their comments have been included in this report. What the service does well: What has improved since the last inspection? New equipment has been purchased and a new hot water boiler has been installed. A buffet style breakfast has been introduced and is available from 7am onwards. For the control of cross infections and for general hygiene purposes hand wash facilities are available at the point of the delivery of care. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken by a senior member of the staff team, this ensures that the home is confident that all assessed care needs of the individual can be fully met. EVIDENCE: Three case files were selected for inspection each containing a pre admission assessment conducted by a member of staff together with information from the previous placements i.e. other care home, local hospital. A care plan is generated from this information at the point of admission to the home. The person that had most recently decided to stay at the home confirmed that he had been visited by a member of staff prior to making the decision to move in, but due to certain circumstances he was unable to visit the home himself. Nevertheless he stated that he was ‘settling slowly’ and finds the home ‘ok’. No intermediate care is provided. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. EVIDENCE: The three case files selected for inspection all contained a full plan of care based on the activities of daily living, with additional monitoring and assessment tools and risk assessments. The plans are based on the problem, the expected outcomes and goals and the action to be taken. They are reviewed at monthly intervals or when a change in need has been identified. The care plans cover all areas of healthcare including mobility, pressure area care, maintaining a safe environment, continence, and nutrition. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 10 Where a risk has been identified, following assessment, a specific plan of care has been formulated offering full details for the action to be taken by staff to reduce the risk. A nutritional risk assessment indicated that a person was at risk, the care plan instructed of monthly monitoring of weight, and for the speech and language therapist to been contacted. A plan was made to offer thickened fluids and diet this resulted in a small weight gain over a period of two months. Pressure relieving equipment is supplied and seen in use for people who are at risk of developing pressure areas due to immobility or general frailty. Medication is administered using the monitored dose system with the additional use of bottles and boxes. The Medication Administration Record charts appear to be completed correctly with codes used for the reasons why medication was not given. Latin abbreviations are being used when hand written entries are required on the Medication Administration Record during the month i.e. TDS instead of three times a day. The instructions on the Medication Administration Record must mirror the instructions printed on the dispensing label. No protocols have been developed for when as required medications are to be given or needed, without this staff have no clear instructions for when the medication is to be given, what triggers the need for the medication or the timescales for when it can be repeated. The medication trolley contained only one bottle of a liquid medicine; the staff nurse stated that approximately 16 people are currently prescribed it and stated the reasoning for this being the lack of space in the trolley to hold all 16 bottles. Insulin that is in use is being stored in the fridge contrary to the manufactures instructions. Some medications are not being ordered on a regular basis and as such as are out of stock during the month resulting in some people not receiving their medications in line with the instructions. The issues with regard to the procedures for the supply and administering the medication were discussed with the manager at the time of the inspection she confirmed that action will be taken to amend the procedures. Staff were observed to be helping and supporting the people with respect and dignity however some of the more frail people appeared to be a little unkempt in their appearance, one lady did not have on any stockings or tights but had small bed socks on during the day. Other people had creased and stained clothes on. It is acknowledged that some difficulties may arise from time to time during the course of the day; nevertheless staff should be in sufficient numbers to ensure that standards are maintained. One visitor commented that the relative looks unkempt but equally acknowledged that this person was ‘very difficult to care for’. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily living and social activities arranged for service users takes into account the differing expectations, preferences, lifestyle and capacities of each individual. EVIDENCE: The care staff arrange the in house activities in addition to their care duties and some planned activity is arranged each day. The manager spoke of future in house interest groups that may be arranged e.g. cookery and gardening clubs. Some people spoken with stated that they enjoyed the activities arranged whilst others prefer to stay in their bedrooms and have TV’s, music centres etc. One person stated that he gets pleasure from all sorts of music and had a wide range of cd’s to enjoy; he spoke of the plans for an outing from the home that he is arranging with a relative. One person has been supplied with Asian television channel; some staff at the home can speak Punjabi to assist with communication for this person. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 12 It is acknowledged that some people living at the home are very frail and have challenging cognitive difficulties and as such are unable to contribute to the planning of activities however staff support, encourage and facilitate participation either in groups or on a one to one basis. The statement of purpose details the content and frequency of activities planned both in house and in the community. Visitors are welcome to visit the home at times suitable to the person living at the home. One visitor spoke stated that he visits most days and is pleased that he is able to do so. There is a facility for the home to safe keep small amounts of personal monies on behalf of the people living at the home. Some people are supported with having their own cash, a small lockable safe is provided in all rooms for the safekeeping of cash and valuables. An assessment is made for a person’s capacity of holding the key. Staff were observed to be discreetly assisting some people with their midday meal. A variety of food had been prepared and included a range of soft, pureed and normal diets. Records are kept of the food offered to all people. One staff member demonstrated a good knowledge of maintaining adequate nutrition and offered fruit smoothies during the morning in addition to tea and coffee. People spoken with stated the food is ‘ok’; one person stated the Sunday roast dinner was greatly enjoyed. The cook explained the different tea menu being prepared during the afternoon and the variety of food on offer. One person felt that the quality of the food was not too good and thought that improvements could be made in this area. A buffet style breakfast is now available from 7 am onwards and available in the dining area of the main lounge. Three dining areas are used for serving the meals each differed greatly in appearance with some tables not having a table cloth, no condiments and/or sauces on the tables, it appeared that the areas had not been sufficiently prepared to ensure that the meals are taken in a congenial setting. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. It is available upon request to help anyone living at, or involved with, the service to complain or make suggestions for improvement. EVIDENCE: The complaint procedure is displayed at the entrance to the home. One visitor stated that they had had cause to raise some concerns with the manager, and stated that they would have no hesitation but to speak with the manager should they have any further concerns. The manager stated that no complaints had been received since February 2006 but went on to discuss some concerns of a person when a wallet had gone ‘missing’. The wallet had been put in the office for safekeeping. It was recommended that incidents and concerns such as these be recorded in the complaints log for auditing and quality assurance purposes. Two people stated that they have been offered a key to their bedroom but do not feel there is a need to lock their door as ‘ nothing has ever gone missing’. Visitors during the day stated that nothing has ‘gone missing’ belonging to their relatives. A policy and procedure for Adult Abuse and whistle blowing are available for staff reference. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 14 The home has a procedure for dealing with personal monies and/or valuables held for safekeeping. All transactions are recorded on individual balance sheets and the cash is accounted for a separately named envelopes. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,22,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings. The proposed improvements will further enhance the environment for the people living at the home. EVIDENCE: During the tour of the premises bedrooms were observed to be personalised with the occupants own belongings. Three people stated that they were satisfied with the bedroom and had many home comforts. The programme for the routing maintenance and renewal of the fabric and decoration of the premises for 2007/08 was previously forwarded. The fire risk assessment for the premises was completed in August 2006. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 16 Plans are in hand for a bathroom to be refurbished and a walk in shower to be installed. A new boiler has been installed to ensure a continual supply of hot water. One person thought that an additional hoist for the transferring of people from one area to another would be beneficial for both residents and the staff, the manager offered an explanation of why she thought there are sufficient hoists at present but stated that she would review the situation. Airflow mattresses in use appeared to be in good working order. All bedrooms have been supplied with hand washing facilities for staff to reduce the risk of cross infections. Some bedrooms are in need of redecoration and refurbishment, and some carpets require cleaning and/or replacement. The manager agreed that in some bedrooms attention is required to reduce the risk of unpleasant odours. Some bathrooms and en suite facilities have carpet on the floor, it was agreed that a more easily cleanable floor covering would be beneficial. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are generally satisfied that the care they receive to meet their needs. Staff receive relevant training to meet the individual needs of people using the service. EVIDENCE: The manager stated that during the day staffing levels are maintained at one registered nurse and six care staff reducing to one registered nurse and two care staff at night. The duty rotas indicated that these levels are maintained, however some service users and visitors expressed their concern of the staffing levels particularly at weekends. Of the four comment cards received from visitors, three people thought that there are insufficient staff on duty but were generally satisfied with the care provided. The manager explained that at times there are difficulties with staff going off sick at short notice and the inability to obtain cover either through the existing staff or through the agencies. Two staff personnel files were selected for inspection and contained evidence of the necessary checks that are required. Training in the core and specialist topics continues and includes dementia awareness, ageism and falls Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 18 preventions. Care staff spoke with enthusiasm of the opportunities offered them for National Vocational Qualification training. The statement of purpose contains details of the current staff group and their qualifications and experience. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. She works to continuously improve services and provide an increased quality of life for residents with a strong focus on equality and diversity issues. EVIDENCE: Jill Roberts remains in the registered managers position, and has the expertise and knowledge to manage the home on a day-to-day basis. People living at the home who are able to comment, staff and visitors all made positive comments on the management style, one person stating the relationship they had with the manager is ‘ very special’. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 20 The owners are very supportive and visit the home at regular intervals during the week. Quality assurance and monitoring of the service continues with the monthly provider visits, regular staff and service users meetings and satisfaction questionnaires. The manager audits the medication procedures and care plans on a monthly basis. The home has a procedure for dealing with personal monies and/or valuables held for safekeeping. All transactions are recorded on individual balance sheets and the cash is accounted for a separately named envelopes. Lockable safes are provided in all bedrooms for use when a person wishes to have their own money and to safe guard valuables Maintenance checks continue for fire alarm, emergency lighting, pat, wheelchairs, bedrails etc. records are kept. Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 21 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 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person must ensure that the processes for administering medication are amended to ensure a safe and robust system is adopted. Timescale for action 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knoll House DS0000017187.V332316.R01.S.doc Version 5.2 Page 24 - 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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