Inspection on 04/04/05 for Knoll House

This inspection was carried out on 4th April 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 29/01/09

Knoll House 30/01/07

Knoll House 16/11/05

Knoll House 22/09/04

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

CARE HOMES FOR OLDER PEOPLE Knoll House Ingram Crescent West Hove East Sussex BN3 5NX Lead Inspector Penny Bailey Unannounced 4 April 2005 at 10:30 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Knoll House Address Ingham Crescent West Hove East Sussex BN3 5NX 01273 267588 01273 267589 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brighton and Hove City Council Miss Heather Lyn Barden Care Home with Nursing 20 Category(ies) of Physical Disability (20) registration, with number of places Knoll House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. That service users are aged eighteen (18) years and over on admission. 2. That service users are only admitted whose needs are assessed as requiring intermediate care Date of last inspection 22 September 2004 Brief Description of the Service: Knoll House is an Intermediate Care Service residential unit that provides rehabilitation services for up to twenty service users for a maximum of six weeks following discharge from hospital, or for the prevention of admission to hospital. The home has been purpose built and refurbished, completed in 2004 to comply with the National Minimum Standards. It is owned and managed by Brighton and Hove Council and South Downs Health NHS Trust. It is situated in Hove, East Sussex, close to local transport and amenities. Accommodation is provided in twenty single en-suite rooms, all of which include a shower or bath. Separate assisted bathing facilities are also available. Rooms are fitted with a telephone, television, and lockable facilities. The home is on two floors, separated into three units, each providing accommodation for six or seven residents, and there is a passenger lift to all levels. The staff team includes Rehabilitation Assistants, Registered Nurses, Physiotherapists, Occupational Therapists and Social Workers. The home has a range of specialist facilities, aids and adaptations for meeting intermediate care needs, including a physiotherapy room and a rehabilitation kitchen. There is communal seating and a dining area on each of the three units. There is also a day service unit on the ground floor of the building with a communal canteen/dining area, which can be accessed by residential service users. A local General Practitioner visits the home weekly, and can be contacted by staff whenever medical treatment is required. Knoll House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours, and was undertaken by two Regulation Inspectors. A partial tour of the premises took place, staff records and care records were inspected. Six of the ten residents spoke with the inspectors, and three staff members were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Although individual plans of care are completed for each resident, these do not address all of the residents physical, social and psychological needs. The home must ensure that where residents with specialist needs are admitted, that staff have the necessary experience, skills and training to plan for and address those needs. Plans of care must also contain plans for all identified health care needs, and clearly record all of the nursing care provided. Residents psychological health must be monitored, and where mental health needs are identified a plan of care to address such needs completed. It is Knoll House Version 1.10 Page 6 recommended that ‘sit-down’ scales be provided, to enable staff to monitor the weight of residents who are unable to stand. The home does provide some activities but one resident spoken to said they would like to have more activities available, particularly in the evening. The home must also ensure that residents preferred activities, likes and dislikes are ascertained, and recorded within their plan of care. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knoll House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Knoll House Version 1.10 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 standard(s) 1, 2, 3, 4, 5 & 6 Although admission procedures ensure that there is a proper assessment prior to people moving into the service, the home must ensure that the specialist needs of residents are provided for, and ensure that the residents admitted are well enough to take part in a rehabilitation programme. EVIDENCE: Knoll House employs a Registered Nurse who visits all prospective residents before they are admitted to the home. An assessment of each prospective resident is carried out to ensure that the home is able to meet their needs. Once admitted to the home, further assessments are carried out by a Physiotherapist, Occupational Therapist and Registered Nurse, as required. A treatment plan is then drawn up based on the individual requirements of the resident. As residents are admitted to Knoll House following a hospital admission, or from their own home as an emergency, in practice, many residents do not have the opportunity to visit the home prior to their admission. However, all of the residents spoken to had been given a leaflet about Knoll House. Knoll House Version 1.10 Page 9 Residents do not pay for their accommodation or treatment whilst at Knoll House, therefore a written contract or statement of terms and conditions is not required. Following admission, an agreement to take part in a rehabilitation programme is signed by each resident. This may include helping residents to recover their independence with walking upstairs, or making cups of tea or meals. Individual records are kept for each of the residents, and an inspection of these records showed that two residents with specialist health care needs were accommodated. The records provided little evidence that these specialist needs were being fully addressed or planned for, although the home had been made aware of these needs from the initial assessment. This situation was also seen at the last inspection visit, when a requirement was made for action to be taken to ensure that the specialist needs of service users were fully met. Knoll House Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9,10& 11 Limited progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. Staff must ensure that every time a change of care is identified, that this is written in the care plan. These shortfalls have the potential to place residents at risk. EVIDENCE: Individual plans of care are available, and staff have worked hard since the last inspection to improve these to ensure more consistent communication between staff members. However, there remains a need to ensure that all aspects of health, personal and social care needs are identified and addressed, with clear guidance provided for care staff to follow. Although plans were regularly reviewed, they were not all updated to include all of the care that was being given, and the specialist needs of individual residents were not always planned for. This was particularly evident for two residents with mental health care needs. There was no record of a psychological assessment or planning, or record of how these needs should be addressed. Discussion with staff suggested that some needs were being addressed even though there was a lack of clear plans and guidance. Daily records did not always identify the Knoll House Version 1.10 Page 11 actual care provided. Residents are at risk of not having their health care needs met if informal systems break down, and care needs are not fully identified and recorded. The home did not have equipment available to weigh residents who are unable to stand. In the case of one resident who was unwell and had difficulty with eating, the home had been unable to regularly measure their weight and there was no record of whether dental needs that had been identified as contributing to the eating difficulty were addressed. The plan of care for a terminally ill service user did not fully reflect the care and support that was required, or clearly identify what level of support was being provided. Whilst medicine administration at the home was not looked at by the inspectors, a further inspection was carried out by the CSCI Pharmacist Inspector and a report provided to the home. Staff who spoke with the Inspectors found the risk assessment regarding the safety of residents who may be able to manage their own medication was unclear. This could lead to unsafe assessments that place residents at risk. Knoll House Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 Whilst activities to help people maximise their independence are well managed, it is recommended that residents preferred social activities are identified and some provision is made to enable residents to participate in their chosen leisure activities. EVIDENCE: A number of residents were spoken to, and everyone who commented on the food said how good it is. There is also a kitchenette on each unit where residents can make snacks and drinks. During the day activities consist of a morning arm-chair exercise class, and a second exercise session with the Physiotherapist in the afternoon. Although all rooms have televisions, and some board games are provided for residents to use, one resident commented that the evenings “could be long” and would welcome some type of social activity in the evening. Other residents commented that they were generally tired after participating in the day-time classes and were happy to relax in their rooms in the evenings. When asked by the Inspectors, several residents reported that they were not asked about their likes and dislikes during their initial assessment. Residents who spoke with the Inspectors indicated that staff respected their independence and choices throughout the day, and that their visitors were welcomed into the home. All residents spoken to confirmed the sensitive care Knoll House Version 1.10 Page 13 they receive from the staff team, who were observed by the inspectors to operate in an appropriately caring and patient manner. The home receives visits from a money advisor on a regular basis to provide advice to residents on managing their finances independently. Weekly advice sessions on foot care are also provided. Knoll House Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Records show that complaints are handled objectively, and the home has taken steps to ensure that allegations of abuse are followed up and acted upon. Adult protection training has either been undertaken or arranged for all staff, and the home is now aware of local adult protection arrangements in the event of any concerns. EVIDENCE: The home has a detailed complaints procedure, and the complaint records demonstrated that this is followed. No complaints have been received directly by CSCI since the last inspection, however, there have been three adult protection concerns raised in relation to care planning and practices. These were partially substantiated and the home has taken steps to address these concerns. Staff have commenced training on the procedures to follow in protecting vulnerable adults since the last inspection visit. Knoll House Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 Knoll House provides the residents living in the home with safe, comfortable surroundings. EVIDENCE: The home was warm, accessible and well-maintained on the day of the inspection. Knoll House was refurbished to a high standard prior to its opening in 2004, and provides single, en-suite rooms for all residents, with a private bath or shower. The home also has an assisted bath for the use of residents who may require more help with bathing, and two further baths for those who may not wish to use a shower. Each room is well furnished, and contains a television, pay phone and lockable facility. Residents rooms are provided with locks, and each resident is provided with a key. As residents only remain at the home for a short time, there is limited scope for them to bring personal possessions into the home. There is a small lounge and dining area on each of the three units, where residents can eat together or take part in group activities. There is also a well-equipped gym on the ground floor, and a Knoll House Version 1.10 Page 16 rehabilitation kitchen where residents are able to cook meals. A good range of equipment is provided to help service users regain their independence, and enable them to move around the home. Temperature control valves are in place in hot water outlets, and records show that the home tests the temperature regularly to ensure safety. However, the records do not currently make clear which outlets have been tested, or record the temperature of hot water at the time of the test but records the information as “all o.k.”. Knoll House Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The home employs a large number of staff from different professional backgrounds to ensure that the needs of residents are met. Checks are carried out for all new members of staff, but the home needs to ensure that all relevant copies of employment documentation are available within each staff members file. EVIDENCE: The home is not fully occupied at present, and recruitment is ongoing to enable the third unit to be opened. A copy of staff files are kept within the home, and these indicated that recruitment checks are undertaken to ensure the protection of residents. However, copies of two references were not available in all staff files, and photocopies of identity documents were not always clear. The record of Criminal Records Bureau checks for staff did not make clear whether a check of the Protection of Vulnerable Adults list had been completed. The home was well staffed on the day of inspection, and copies of staff rotas showed that there are a minimum of seven staff on duty throughout the day, including rehabilitation assistants, nurses, physiotherapists, occupational therapists and social workers. This is in addition to management, administration and domestic staff. There are two rehabilitation assistants on the night shift. There are no Registered Nurses on night duty, but Community Nurses can be contacted by staff if required. Staff informed the inspectors that they felt there were always sufficient staff numbers on duty. Knoll House Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 36, 37 & 38 There is a friendly atmosphere in the home both for residents and staff. Adequate health and safety measures are in place. The home is run with the emphasis on the safety and well-being of the residents. The home was found to be conducted in an open and friendly manner with staff supported to carry out their roles. EVIDENCE: Quality monitoring visits of the home are carried out monthly by a representative from the Local Authority. Reports of these visits were provided to CSCI, and demonstrated that most of the issues identified during the inspection had been noted during their last visit, with plans put in place to address them. The Deputy Manager was in the process of completing comprehensive risk assessments on all areas of the home, and was receiving guidance on this from a Health and Safety Specialist. Weekly environment Knoll House Version 1.10 Page 19 checks are carried out and incidents and accidents are recorded. Records demonstrated that all members of the care staff receive regular supervision. Knoll House Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 N/A 3 2 N/A 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x 3 x 3 3 3 Knoll House Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 Regulation 12 (1), 18 (1) (a) Requirement That the home demonstrates the capacity to meet the assessed needs of service users, and ensures that all specialised services offered are demonstrably based on current good practice, with staff that collectively have the skills and experience required to deliver the care and services that the home offers to provide. (Previous timescale of 22nd September 2004 not met). To ensure that the care planning tools used are fit for purpose by clearly presenting an up-to-date assessment of the service users needs, and providing clear guidance for staff regarding the actions to be taken to meet the assessed needs of the service user and manage identified risks (Previous timescale of 22nd September 2004 not met). That where service users needs are seen to change, the care plan is updated to include clear guidance for staff to follow, and to ensure that plans of care accurately reflect all nursing interventions. Version 1.10 Timescale for action With immediate effect 2. 7 13 (4) (b) & (c), 15 (1) With immediate effect 3. 7 15 (2) (b) & (c) With immediate effect Knoll House Page 22 4. 8 13 (1) (b) 5. 10 12 (4) (a) 6. 12 16 (2) (m & n) 7. 25 13 (4) (a) & (c) 7, 9, 19 Schedule 2 8. 29 That each service users psychological health is monitored regularly, and where mental health needs are identified, a plan of care that provides clear guidance for staff to follow is completed. That screening is provided for treatment area doors that contain clear glass partitions in order to ensure the privacy and dignity of service users (Previous timescale of 22nd September 2004 not met). That service users preferred activities, likes and dislikes are ascertained and recorded within the service user plan of care. That the range of activities provided by the home takes into account the recorded preferences and capacities of service users. That hot water delivery monitoring records demonstrate the temperature and location of each outlet tested. That copies of all of the information specified under Schedule 2 are included within each staff members file. That records of comleted CRB checks also demonstrate when a satisfactory POVA check has been received. With immediate effect With immediate effect With immediate effect With immediate effect With immediate effect 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. Refer to Standard 7 Good Practice Recommendations That the service user plan meets relevant clinical guidelines produced by the relevant clinical bodies concerned with the care of older people, and demonstrates Version 1.10 Page 23 Knoll House 2. 3. 7 8 the full date, time, printed name, signature and designation of staff for each record made. That staff are provided with training in relation to completing care plans regarding all aspects of health, personal and social care. That equipment to enable the weight of services who are unable to use stand-on scales to be monitored be provided. Knoll House Version 1.10 Page 24 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knoll House Version 1.10 Page 25 - 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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