Random inspection report
Care homes for older people
Name: Address: Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW zero star poor service 19/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Tina Smith Date: 0 4 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW 01902335749 01902333575 knollhse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jill Roberts Type of registration: Number of places registered: Conditions of registration: Category(ies) : Elysian Care Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 0 old age, not falling within any other category physical disability Conditions of registration: 0 32 The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 32 Physical disability (PD) 32 Date of last inspection 1 9 1 1 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home Knoll House provides accommodation, personal and nursing for up to 32 people with physical disabilities and older people. The care home is near local shops and public transport, and has car parking. The detached property has single and twin bedded rooms, two lounges, dining room and garden, with a passenger lift to the first floor. Communal bathrooms and toilets are on both floors. Three offices are on the ground floor. Fee information is in the statement of purpose. Weekly fees are £361 for personal care. For nursing care there is an additional contribution paid by the local Primary Care Trust after their assessment. Fee information applied at the time of our visit; up to date enquiries should be made to management. Care Homes for Older People Page 3 of 10 What we found:
On 4th March 2010, 09:30 am - 18:00 pm, regulation and pharmacist inspectors visited the home in order to check previous requirements made; they did not know we were coming. We looked around the home, examined the medication system, two peoples care and health records, spoke to one person, a relative and staff. There were 28 people in the home and two vacant single rooms, and another admission was expected. We saw maintenance records, audits and schedules about the running of the home. We found improvements in the medication system, the environment, oversight and leadership. People were safe and the requirements we checked were met. No additional requirements were made. We had time to look at only one staff record and we learned that two nurses had recently resigned, so we did not assess existing requirements about staff on this visit. Senior carers were now administering medicines to people receiving personal care and the nursing staff were administering to people receiving nursing care. This change meant that there was less pressure on the nursing staff during the administration rounds and as the majority of the nurses were not permanent members of staff, the extra time hopefully will reduce the risk of errors. The nurses and senior carers working in the home had undertaken and completed a training course on the safe handling of medicines. Nurses had an assessment of their administration practices by an external assessor; senior carers were assessed by the registered manager. Of the medicines sampled by the pharmacist inspector on this visit, 81 per cent had been administered according to the prescription. To complete the audit trail for the receipt, disposal and administration of some medicines we had had to rely upon the Medication Recording Chart to resolve anomalies. This chart was used to check the stock level of each medicine that had not been packed into the monitored dosage system [MDS] after each administration. This recording system has helped the home to reconcile their medicine but was extra work for the staff during the administration round. We could not determine whether 29 per cent of medicines had been administered according to the prescription because of: signatures missing from the administration record; the quantity administered was not being recorded for a variable dose medicine and one tablet was missing from the quantity of another medicine. It is hoped that as the home moves towards having a more permanent nursing staff the need for the Medication Recording Chart will diminish and the MAR charts will once again be the primary source for determining whether people using the service have had their medicines administered as prescribed. At the key inspection on the 19th November we left an immediate requirement to set up a system to demonstrate that Warfarin tablets were being administered as prescribed. On the 17th December 2009 we revisited the home and we found that a system had been set up but was not able to demonstrate that the Warfarin for one person had been administered as prescribed. We found at this inspection that the system had remained the same but the nursing staff were more familiar with it and as a consequence it could be seen that the prescribed dose of Warfarin was being administered. The Controlled Drugs cabinet had been secured to the wall in accordance with the Misuse
Care Homes for Older People Page 4 of 10 of Drugs [Safe Custody] Regulations. A new drug fridge and daily records of maximum and minimum temperatures showed that medicines were stored within the correct range. One person still managed their own medicines. The home now has a risk assessment in place and checks twice daily that they had taken their medicines. The manager confirmed that medicines were taken as prescribed without incident, so the frequency of the checks could be reduced in response to the persons request. No one in the home on this visit had unstable diabetes, and we could account for their medication. District nurses attend for insulin of one person and blood sugar levels were stable. We established through two peoples records that preventative measures were introduced to try and avoid pressure sores developing when health deteriorated. Early referrals were made to tissue viability specialists to prevent further deterioration. The home appropriately made a safeguarding report to the council about pressure sores that deteriorated in hospital and an unsafe discharge by the hospital. The manager said that the home do not receive sufficient reports from health services about nursing needs. We raised this matter at a safeguarding meeting just after our visit so that the provision of essential information to care homes about peoples needs can be improved. The manager explained how the home will improve their own processes for hospital discharge to our query, in order to ensure arrangements are in place for any care and treatment changes, either at the home or by district nurses. On our visit there were care and nursing staff vacancies due to internal promotion and staff leaving. A nurse had just handed in their resignation, and a bank nurse had also resigned. Nurses are part time and also have jobs elsewhere so they cannot provide additional cover. The manager undertakes nursing shifts about three days a week, which provides some consistency as agency nurses are also used. Recruitment is underway and the provider confirmed to the manager that they will be fully supernumerary. The number of staff on shifts has not changed but staff deployment at peak time in the morning has improved. A second senior carer was introduced for people having personal care to maintain quality. Various staff told us that the running of the home had improved along with training for their roles. They felt well supported and told us what they had learned from recent training. Since our last visit the home sent us their policy on professional body reporting. The medication procedures were updated, re-issued and discussed in supervision, staff and clinical meetings. The manager is now able to identify errors and staff records show these were acted upon in accordance with the homes policies. We observed a lounge for people needing the highest level of care and passed onto the manager our compliments about how staff spoke to people respectfully, provided choice of food and drinks and explanation of how long they would be on their break. We also fedback that transfers from a wheelchair to an armchair could have improved, that staff present did not assist a person and colleague when a wheelchair tipped up. The manager planned to speak to the staff team. We confirmed that unannounced monthly visits are now shared by Directors and are robust - any health, safety or infection control actions are timetabled and progressed. On our visit we saw a safer and very clean environment. The manager said that the Primary Care Trust re-assessed their infection controls and the home has now achieved a Silver Award for 92 per cent compliance with standards, which is very good. On the whole we saw high standards. The roof was under repair; a bedroom had plaster and wallpaper replaced; the laundry and bathrooms were refurbished and
Care Homes for Older People Page 5 of 10 easier to clean, according to domestic staff. Essential aids in communal toilets and bathrooms were replaced. New cleaning schedules and safe hot water temperatures were well kept by staff and checked by management. The quality of the environment and facilities had significantly improved. We fedback observations about two corridors, hoist storage and the bathroom by the dining room during our visits to prevent accidents although two issues had been addressed when we checked again. The manager planned to share our comments with staff and check these areas of the home more frequently. The home had already planned to replace a frayed carpet and broken room divider with a continuous carpet. We confirmed that action was taken after our visit in November 2009 to confirm a workers right to work in the U.K. A new checklist is in place for the administrator to gather essential checks prior to interviews of prospective staff by the manager. We fedback that the checklist could provide dates of checks and does not currently ensure that the last care or nursing employer reference is checked. The manager must ensure legally required references are sought, which we will check on our next visit. On our visit the manager and director were confident that they are now exceeding adequate standards and felt that CQC were taking the right approach to enforcement the Director acknowledged that they needed to make their systems more robust and do not intend to let that happen again. They are proud of their achievements in short timescales, now take their responsibilities and quality seriously and provide leadership and staff support. Occupancy has also improved. What the care home does well:
We spoke to a person admitted that week from hospital and their relative, and they were very satisfied with the home. They had not read inspection reports, but they had visited a number of homes and liked the atmosphere at Knoll. We found the atmosphere improved - calm and welcoming, nurses were less pressured, and people interacted more with each other. We complimented how staff spoke to people and met their preferences. Changes and improvements in the way medicines were recorded and managed within the home enabled us to confirm that people had their medicines available when needed, administered as prescribed by their doctor, and they are stored safely. The medication system is now auditable, run by staff the home has determined to be competent, and action is taken if there are errors that can now be analysed. Changes were made to staff roles, deployment of staff and organisation of the home. Nurses have more time for clinical procedures and people with nursing needs, as well as leading the staff team when they are on duty. Staff and the manager had further training for their roles about medication, bandaging, staff supervision and safeguarding so that their skills and knowledge are updated. There are new schedules and checks about the environment, cleanliness and recruitment involving maintenance, shift leaders, administration and the manager. The home works in partnership with other statutory agencies to safeguard people from abuse and neglect. Early referrals are now made for specialist health advice about pressure sores to prevent deterioration. Care Homes for Older People Page 6 of 10 The manager took or planned action to a few queries we raised about cleaning and hoist storage. Repairs soon to be completed are addressing issues at source so that problems with the building do not recur. Refurbishments exceed the minimum required and are to a high standard so that everyone in the home benefits. Domestic staff particularly can undertake tasks more effectively and efficiently. Accountability has improved as well as quality control. The frequency and analytical nature of a range of management audits improved so that anomalies and actions are addressed in a timely way to protect peoples health, welfare and safety. The home kept us well informed in-between visits and responded to information we asked for. We found their reports to be accurate. Our guidance was obtained and the home notified us about serious matters affecting people. People can now have confidence in the homes systems, and the home runs smoothly. What they could do better: 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 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 29 19 A robust and rigorous recruitment procedure must be implemented. 30/01/2009 To ensure that people are suitable to work with vulnerable adults. (Not Met on 04/11/09; Not assessed on 04/03/10) 2 30 18 18(1)(c)(i) Staff must have 28/02/2010 training appropriate to the roles they are to perform. All staff and managers must have training to recognise and report abuse. People need to feel confident that they are protected and their needs will be met. (Not Assessed on 04/03/10) Care Homes for Older People Page 8 of 10 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, 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 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 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
