Inspection on 06/09/05 for Knoll House

This inspection was carried out on 6th September 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 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 03/04/07

Knoll House 01/08/06

Knoll House 21/12/05

Knoll House 07/01/05

Knoll House 19/08/04

Knoll House 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Knoll House The Avenue Penn Wolverhampton West Midlands WV4 5HW Lead Inspector Joy Hoelzel Unannounced Inspection 6th September 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Knoll House Address The Avenue Penn Wolverhampton West Midlands WV4 5HW 01902 335749 01902 333575 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Knoll House Nursing Home Limited Mrs Jill Roberts Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (32), Terminally ill (4) of places Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories except 4 (max) Terminally ill Date of last inspection 7th January 2005 Brief Description of the Service: Knoll House is a care home providing accommodation, personal and nursing care for up to thirty two older people. It is also registered to accommodate people with a physical disability and up to four people who require palliative care. It is a privately owned establishment and is situated in a secluded avenue, south of Wolverhampton, but close to local amenities and public transport. Knoll House is a detached property consisting of a two storey building with single and twin bedded rooms, communal lounge and dining areas. There is a passenger lift to access the top floor. The gardens are well maintained and easily accessible to service users. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over six hours on Tuesday 6th September 2005 and is the first of the statutory inspections for 2005/06. Thirty people were resident at the time of inspection, staffing levels were seen to be at the previously agreed levels. The inspection included discussions with six residents, members of staff and the manager Four care plans were examined in depth together with supporting documents and a tour of the home was conducted. What the service does well: What has improved since the last inspection? What they could do better: Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 The home has a satisfactory admissions procedure ensuring the individuals needs can be fully met. EVIDENCE: The three care plans inspected contained pre admission assessments of the persons needs, both from assessments by the home’s staff and other relevant professionals including the primary care trust and the consultant psychiatrist for older people. An initial care plan is generated from this information at the point of admission. The home does not offer an intermediate care service. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The service user plans contain the relevant information needed for each individual and are updated at appropriate intervals ensuring that individuals’ needs are met. EVIDENCE: Each service user has a plan of care based on the pre admission assessments of needs. The plans are divided into three sections 1. This file is kept at the nurse’s station and contains contact details, the pre admission assessments and a record of visiting professionals and the daily report. 2. This file is kept in the service users bedroom and contains risk assessments, care plans and information for the assessed needs. 3. This file is kept in the administration office and contains all confidential information relating to finances and agreements. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 10 There is evidence in the plan of service users involvement in the care planning and review processes. The care plans identify the problem area, the expected outcomes and the action required to reach and maintain the outcomes and goals. Assessments are in place for nutritional screening, maintaining personal hygiene and monitoring a person’s psychological health. The registered nurse stated that two people currently have pressure ulcers, which are being treated following discussions with the tissue viability nurse. The plans contain dressing charts, the type of dressing to be used, frequency of the dressing change and reports of the improvement/deterioration of the wound. One service user spoken with discussed his wish to have minimal staff interventions with maintaining his own personal hygiene but stated that he realised that he now needed some assistance. The home continues to use the ‘Boots’ monitored dose system for the administration of medication. A drug round was in process at the time of the inspection. The nurse was observed to be administering the medication in the correct way, and was assisting service users in a discreet manner. The medication administration record (MAR) charts were completed at the time and corresponded with the dispensing details on the containers. The registered nurse commented that no service users currently selfadminister their medication. Records for monitoring the temperature of the fridge for the safe storage of medications were seen to be within the required levels. A tub of Sudocrem was observed to be in use in a service users bedroom that had been dispensed for a different person. Staff were observed to be interacting well with service users, were respectful and attentive to the individuals needs. One service user spoken with stated that staff were very good and respected his wishes with regard to personal care but felt that at times they were ‘a little pushed’ and ‘very busy’. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 The residents at the home maintain contact where they wish with family and friends. Social and recreational activities are arranged by the care staff but are very much dependent on workload and time constraints. EVIDENCE: The care staff at the home arrange the social and recreational activities. A daily programme of activities has been implemented since the last inspection. An outing to the Black Country museum has taken place, which was enjoyed by service users and staff. The manager commented on the difficulties encountered with the use of wheelchairs and the problems accessing some areas when on excursions. Two staff have had additional training for arranging recreational activities for people with dementia type problems and the more dependent service users. The manager stated that training in this area is ongoing with courses arranged for staff to attend. One service user commented that he goes out with family and friends on a regular basis but is content with his own recreational facilities at the home. Another service user stated that he liked to go for walks and did so on every possible occasion Service users commented that friends and relatives are able to visit the home at times suitable for them. The communal or private rooms are used for visiting, which ever is the most suitable or convenient. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 12 One service user discussed the meals offered and stated that the food was ‘ok’ but that he is usually served too much. He felt that a smaller portion would help with his lack of appetite, he stated that he has requested this from staff but that large portions continue to be offered. He also stated that the evening cook visits and discusses what is the menu for the evening meal and an alternative is offered when he would like something different. This person likes to stay in his own room and the provision of a small fridge in his room may be of benefit to him. The care plan of this person indicates that a referral to the dietician has been discussed with the G.P and the service user, with the service users declining the offer. Another service user was feeling rather hungry mid morning, as she had had an early breakfast, she was asked if she would like a sandwich and this was readily supplied for her. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a satisfactory complaint procedure. EVIDENCE: The complaints procedure is included in the statement of purpose and service users guide. A copy of the procedure is displayed in the entrance of the home. A complaint has been received at the local office of Commission for Social Care Inspection since the last inspection. This complaint was investigated by the home using its own procedures and found the complaint to be upheld. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Improvements have been made to the environment, however, attention must be given to the maintenance of some areas of the home to reduce the risk to staff, service users and visitors of falling or tripping. EVIDENCE: The seven requirements made at the inspection in regard to the environment have all been complied with barring one, the replacement of the two patio doors. This was discussed with the manager and a revised date of April 2006 has been agreed. Part of the concrete floor under the carpet in the main corridor on the ground floor is crumbling and is unstable. The manager discussed the difficulties in repairing the area, never the less this is now a considerable hazard to service users, staff and visitors and must be attended to. Two service users are receiving their daily dietary intake through the assistance of a peg feed. A suction machine must be available for use when and if a problem occurs. Policies and procedures must be formulated for the Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 15 safe use of equipment and regular maintenance checks and audits must be undertaken. Bed rails are used on some beds, a risk assessment is completed for each individual but maintenance checks are not being carried out. At the time of the inspection the home was observed to be clean and hygienic. A sluicing disinfector has been installed since the last inspection. However as commodes were observed to be in most bedrooms a sluicing disinfector must be available for use on both floors of the building. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Staffing numbers remain at the agreed levels, however, the staffing levels must be determined by the dependency needs of the service users and maintained to ensure that a persons needs are fully met. Some improvements have been made to the recruitment procedures. EVIDENCE: Staffing numbers remain at the agreed level, this being six care staff from 8am to 8pm and two care staff for the night time period. A registered nurse is on the premises at all times with the manager being supernumery to these levels. At the time of the inspection 5 care staff were on duty as one person had called in sick during the morning. Staff were observed to be very busy attending to their duties, service users spoken with stated that the staff did not always have the time to do the job properly and ‘never come back when they say they will’. Three staff personnel files were inspected and were seen to include the application for criminal record bureau disclosures (CRB), two CRB checks had not been returned but the protection of vulnerable adults checks were on file. The manager stated that at times it was difficult to obtain two references particularly for overseas staff, nevertheless two references must be obtained prior to commencing work at the home. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,36,38 EVIDENCE: The registered manager is a first level nurse with the skills and experience to manager the home on a day-to-day basis. A new manager had been recruited at the last inspection (January 2005) but has since resigned. The current manager explained that recruitment is continuing but with out success at present. The manager is now supernumery and is not included on the rota for clinical duties and is supported by registered nurses and a team of care staff. Monthly monitoring visits from the responsible individual/owner are not being carried out. This was discussed with the registered manager at the time of the inspection. The annual business and financial plan was not available at this inspection. The registered manager was requested to forward a copy to the Wolverhampton Commission for Social Care Inspection office as soon as possible Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 18 Staff supervision is still infrequent, the registered manager explained that this is due to time constraints, however all staff must receive formal recorded supervision at least six times a year with an annual appraisal of their performance. The three staff files examined did not contain any information of supervision or appraisals. One member of staff was unsure of the procedure to use if discovering a fire at the home. The registered manager confirmed that recent fire safety training had been given, however, it was clear from conversations that this person that the she did not understand the correct procedures. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 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 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x x 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 2 x 1 x 2 Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 21 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 2 Standard 9 19 Regulation 13(3) 39(h), 13(4), 23(1)(2)( a) Requirement Medication including creams and lotions must only be used for the person for whom it is prescribed. The two patio doors to the one side of the dining room must either be replaced with a more suitable and safer alternative or a safe patio area on an equal level provided outside of each patio door. The concrete floor in the main corridor must be repaired. The equipment required to adequately meet a service users individuals needs must be available. Policies and procedures must be formulated for the safe use of equipment and regular maintenance checks and audits must be undertaken. The registered person must ensure that at all times the home has sufficient numbers of suitably qualified, competent and experienced staff to adequately meet the needs of all residents. The registered person must ensure that two satisfactory references are obtained for each employee prior to staring work at the home. Timescale for action Immediate 1st April 2006 3 4 19 22 23(2)(b) 13(3) 31st October 2005 31st October 2005 31st October 2005 Immediate 5 22 13(6) 6 27 18)(1)(a) 7 29 19(1)( c) Schedule 2 paragraph 1-7 Immediate Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 15 22 Good Practice Recommendations The provision of small domestic type refrigerators may be of benefit to some residents. Consideration must be given to installing a sluice disinfector on the first floor. Knoll House DS0000017187.V254367.R01.S.doc Version 5.0 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: 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 DS0000017187.V254367.R01.S.doc Version 5.0 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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