CARE HOMES FOR OLDER PEOPLE
The Knoll 335a Stroud Road Gloucester GL4 0BD Lead Inspector
Helen James Unannounced 13 June 2005 09:30 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. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Knoll Address 335a Stroud Road Gloucester GL4 0BD 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) 01452 526146 Alder Meadows Limited To be appointed Care Home - Personal Care 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11 January 2005 Brief Description of the Service: The Knoll is a large detached house that was extended in the early seventies to provide the present accommodation. It is located on the main Gloucester to Stroud Road (the A4173 near Tuffley). The Home stands in its own extensive grounds of 15 acres and has impressive views over the suburbs of the city of Gloucester and towards May Hill in the Forest of Dean. The Home offers care for older people over the age of sixty-five with residential needs. The Homes’ staff provide personal care and other health care needs are met via the GP’s and external health care professionals. It is not registered for dementia care, learning disabilities or service users with nursing needs. The Homes accommodation is on three floors and access to all floors is via a large shaft lift or stairs. Communal areas consist of one very large lounge/dining room on the ground floor and a large lounge on the first floor located at the far end of the building with views over the garden. All bedrooms are single and each room has a washbasin; one room can be used as a double. Toilet and bathing facilities are located on each floor with assisted bathrooms on all floors. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over eight and a quarter hours on one day in June 2005 and was completed by two inspectors. Nineteen standards for older people were looked at on this occasion. Twelve were met, four were almost met, two were not met and one was not applicable. The inspectors spoke to the acting manager, staff, a number of residents and one visitor. Appropriate records and a selection of care plans relating to the residents spoken with or newly admitted were looked at. The residents appeared well cared for and well nourished and all their care needs were met and those talked with confirmed their satisfaction with the care, nutrition, activities and staff. However, several management issues were identified which need urgent attention. What the service does well: What has improved since the last inspection?
The Home is now providing a range of social activities to suit the residents’ individual preferences. Many residents commented that they enjoyed the different entertainment; a regular resident meeting has yet to be implemented by the Acting Manager. There is now a greater emphasis on training in the home and the staff team are receiving the mandatory training required and training appropriate to their
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 6 needs to ensure that they have the skills and knowledge to assist them in caring for the residents at the home. This is an immense improvement and sets a good baseline to encouraging staff to progress to registering and completing the National Vocational Qualification level 2 (NVQ). Staff dispensing medication still need to undertake the accredited ASET training and this is being arranged. The new care planning system that has been introduced appears much easier to follow. During the case tracking exercise the care records seen had improved and now contained most of the relevant information. Some minor improvements still need to be completed i.e.; ensuring assessments are reviewed regularly, changes/amendments are dated and signed/initialled and that all the care plans reflect the current health and care status of the individual. All care needs identified as problems should be written using specific language to denote the care requirement rather than using very nonspecific terms such as ‘health’. There have been staff changes at the home since the last inspection and new staff have been recruited. The Deputy Manager has begun staff supervision and appraisals and evidence was seen of this system. . What they could do better:
The home needs to ensure that all policies and procedures relating to recruitment and record keeping are fully implemented to ensure the protection of the service users living at the Knoll. Recruitment practices are still not in line with Regulation 19 and schedule 2 and 4 of the Care Standards Act 2000. This has been an ongoing issue at the last two inspections and whilst there have been improvements it still is not satisfactory hence the Commission has served a Regulation Notice pertaining to recruitment practice within the home. The inspection highlighted that some staff were working excessive hours a week. The Manager needs to look at this issue in relation to ensuring that staff working excessive hours is not compromising safe care practice or the Health and Safety of residents in the home. There still appears to be some dissatisfaction/unrest from some staff about the relationship with the Provider and Acting Manager relating to the speed at which things are responded to or not responded and how things happen at the home. The inspectors could not find evidence that things are not dealt with, as many things have improved in the home, but there is obviously an issue that needs to be resolved as it is impacting on residents, noted from residents comments. Where supervision involves observation of care practice/working alongside staff, there must be a method of recording this. All supervision including induction supervision must be recorded/dated and signed to evidence that it is being completed.
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 7 Incidents involving residents, which are not classed as accidents but rather that ‘affect the well-being of a service user’, are still not being reported via regulation 37 notices to the Commission there must be compliance forthwith as this was an issue at the last inspection Whilst in the main the management of the home and the service the home offers residents is improving, the homes management is still failing to adequately protect service users in two crucial areas; - Recruitment practice and incident reporting. Immediate measures are required to ensure improvements in the Protection of Service Users through recruitment practice. Hence this inspection has resulted in an enforcement notice being served for continued non-compliance of five requirements relating to recruitment practice from the last inspection A further eight requirements have been made following this inspection. The home will be closely monitored to ensure the enforcement notice and requirements are met and improvements are made. 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 Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 8 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 The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 9 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) 3 & 6 is not applicable Service users each have a contract for their residency. Arrangements are in place to ensure that each prospective service user is fully assessed prior to admission, to confirm that all their particular care needs may be met in the Home. EVIDENCE: Each service user has a contract that includes the terms and conditions for admission and residency at the home. The Acting Manager was advised to ensure that the contract meets with the Office of Fair Trading Standards and Advice (2004). A number of service users were seen to include some who were new admissions. They confirmed that they had been given a service users guide and an opportunity to either visit or spend the day at the home prior to admission. Records of newly admitted service users were examined and all contained a pre-admission and a post admission assessment.
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 10 Some spoken with were very happy with the home and had settled well. One gentleman made particular reference to the good laundry service. They also confirmed that their needs are being fully met. There are three married couples in the home. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 11 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) 7,8,10 Although progress has been achieved, improvements are still required in the care planning systems to ensure that all members of staff have a clear understanding of the care each person requires. Residents are treated with respect and dignity. Medication systems require further improvement to ensure that residents are not put at any risk of potential errors. EVIDENCE: The records of five service users were examined on this occasion. They were all much improved compared with the previous inspection. All have assessments, which need to be reviewed regularly. Some changes had been recorded but were not signed and dated. All had care plans but not all of these reflected the current needs of the service users. For example, for one service user who has diabetes there was no instruction about blood sugar monitoring; another service user who has a catheter and a number of other problems recorded related to this but there was no ‘elimination’ care plan; one who stated that she had problems negotiating the heavy fire doors using a walking frame did not have a care plan
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 12 for mobility. Several identified needs referred to the problem as ‘health’, which is very non-specific. This was discussed with the Manager. One service user being seen by the district nurse for a pressure sore had no reference to this in any care plans. A high- risk mattress had been supplied through health services several days previously but it had not been put on the bed because it was not compatible with the bed rails. This problem was being addressed on the day of the inspection, which was several days later. This service user was to be reassessed as requiring nursing care but the assessment in place was out of date and did not reflect the deterioration of this service user. A visiting district nurse was also spoken with and she confirmed her satisfaction of the care she observed being given, although she was concerned that the pressure-relieving mattress had not been put onto the resident’s bed (see above). It was noted that there was a turning programme in place for anyone permanently in bed, and one service user observed throughout the day was in a different position each time she was seen and she confirmed that she was comfortable. Medication administration was not checked on this occasion. Only seven staff administer medication at the present time. The manager did report that further medication training for the staff has not been arranged yet. It was also reported back to her that one service user had had her tablets left, indicating that staff do not always witness that medication is being taken; there was also a daily record indicating that another service user had ‘saved’ a number of tablets, again not witnessed and a third had taken ‘over the counter tablets’ brought in by a relative that were not compatible with the other medication being taken. These incidents must be addressed. Residents who were able to converse with the inspector confirmed that they were treated with respect and that they had choice in their daily routine. They were addressed in a manner that they were comfortable with and were not told what they could do or could not do. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 13 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 & 15 Social activities and daily routines are managed as flexibly as possible to suit the individual preferences of residents living at the Home. Support systems are in place to enable the residents to lead as independent/interdependent life as possible and to maintain social contacts. Residents receive a nutritious balanced diet EVIDENCE: The manager reported and the notice board later confirmed that a programme of activities is in place in the home. This includes puzzle books, dominoes, darts, scrabble, floor/chair basketball, beanbag exercises and bingo, which was played on the afternoon of inspection, with good participation from the residents. A record of the activities undertaken and the number who participate was seen and indicated that bingo was played four times in June; beanbag exercises once, darts on 30/5 and floor basketball on 31/5. A sing-along was organised for 6th June. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 14 On receipt of a donation a coach has been hired and twenty residents will be going to Weston-Super-Mare shortly. Several confirmed this and said how they were looking forward to it. A full inspection of the kitchen was not undertaken on this occasion. It was reported that the Environmental Health officer visited recently and made a number of recommendations that are being addressed. The kitchen appeared clean during lunchtime preparations; lunch being served looked and smelt appetising as confirmed by the residents. Fridge and freezer temperatures are being recorded and a cleaning schedule was in place. A new cook has recently been appointed and was working with a new kitchen assistant. In their absence, one of the cleaners acts as kitchen assistant. Food hygiene certificates were seen for those staff that work in the kitchen. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 15 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. Arrangements for the protection of service users are not satisfactory placing them at possible risk of harm or abuse. Complaints procedures are in place. EVIDENCE: Recruitment practices within the home are totally unacceptable for the Protection of Vulnerable People and further information relating to this is in Standards 27 to 30 of this report. The Home’s Complaints Policy is included in the Statement of Purpose, a copy of which is kept in the entrance by the visitors signing in book, ensuring that it is readily available to anyone visiting the Knoll. Complaints and concerns are raised with the Acting Manager and deputy and they deal with them immediately. One anonymous complaint was received following the last inspection regarding issues already raised at the last inspection, that is Manager not doing job properly, shortage of staff and getting residents up out of bed at 5am. These issues were discussed with the Manager at the time and no evidence could be found to substantiate the anonymous complaint. Several members of staff were leaving at this time. One couple spoken with were a little upset by a recent incident involving missing money. This had not been reported to the CSCI in accordance with Regulation 37 although the police were called. This was followed up with the Acting Manager who was advised to ensure that an adequate locking device is fitted to their door and a lockable cupboard
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 16 made available in their room. The Acting Manager has informed the Commission that this has now been done following the inspection. All staff have completed Abuse awareness training and this was evidenced through certificates in personal files. Violence and Aggression management training is booked for the 24th June 2005 for all staff. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 17 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 & 26 Communal areas and residents rooms are pleasant and comfortably furnished. The Home is equipped with appropriate disability aids to ensure that the residents are able to live as independent a life as possible. Most areas of the home seen were clean and well presented and there are plans to update décor in the near future. EVIDENCE: A tour of the home took place and generally the standard of décor and maintenance of the building is satisfactory. Rooms appeared comfortable and those upstairs all have wonderful views either of the county or the grounds. Several residents spoke about all the wildlife that they spotted in the gardens. Most rooms have some personal items of furniture or other possessions individualising the rooms. There is some evidence of wear and tear in places and one carpet was noted to be stained and needed cleaning or replacing. The home is clean and free from odours. There were two cleaners working on the day of inspection but on occasions there is one alone to clean the whole
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 18 home, which means it can be difficult to maintain standards. Their work is currently made more difficult as they only have one hoover for the home (brought in by the acting manager, as the homes’ hoover is not working.) 11th July 2005, the Manager reports that a new hoover is now at the home. The Environmental Health Officer visited in January 2005 and the Acting Manager reports that all the requirements have now been addressed. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 19 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) 27,28,30 Staffing is adequate to meet the care needs of the residents living at the Home at the present time. The training opportunities offered to the staff have improved to ensure staff receive mandatory training and training to underpin care practice in the home to improve the quality of care provided to residents. But staff need to be encouraged to undertake the National Vocational Qualification (NVQ) to assist the home in achieving the 50 target for having NVQ trained staff. The procedures for the recruitment of staff are still not robust and do not provide the safeguards to offer protection to the service users. Improvements must be made. EVIDENCE: There were twenty-nine residents on the day of inspection and there were three care staff and the Acting Manager on-duty during the morning, three plus the deputy manager on the late shift and two waking staff overnight. In addition to the above there was a cook and kitchen assistant, two cleaners and a laundry assistant. At least five staff have left since the last inspection and three care assistants, a cook, a kitchen assistant and a handyman have been appointed. Several of the new staff are from overseas. Those spoken with had a good command of the English language although it was reported that some might be attending English lessons in the future to improve their English. Service users spoken with did not express any difficulties with communications and confirmed that all the staff were very kind.
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 20 The Inspectors were concerned to note from duty rotas and staff comments that overseas staff are working excessive hours - ‘they get called upon to do all the extra hours because they live on the premises’ was one comment. This has led to staff working up to 68 hours in a week which is excessive and also raises issues around safe practice. There are also no signed agreements or disclaimers pertaining to working over 40 Hours in their personnel files which needs to be addressed Other than the Acting Manager and deputy manager, no staff have NVQ 2 or 3. Records confirmed that quite a lot of other training has been undertaken recently to include fire training (April), food hygiene (May), moving and handling (May), Infection Control (March), Basic First Aid (May), Abuse Awareness (June) and Dementia Care (February). Care planning training is planned for 15th June. Training on how to deal with violence and aggression was cancelled and rearranged for 24th June. The Deputy Manager has begun the supervision and appraisal programme for staff at the home and four records were seen. Staff complete a staff selfassessment, training profile and pre-appraisal questionnaire. The Deputy then sees them and issues are discussed and documented. Where care practice supervision takes place this needs to be recorded so that the context of the supervision is identified and all records are dated and signed. A copy of the supervision and appraisal programme needs to be sent to the Commission. Recruitment record (personnel files) of the six new staff were examined by the inspector and inconsistencies were found with recruitment practice and the information kept on the individual personnel files resulting in non-compliance with the regulations. Five out of the six had begun their post before CRB/POVA checks had been completed (one was still outstanding). There was no evidence that for the duration of the new workers induction training that a member of staff who was appropriately qualified and experienced supervised the new worker; or that they were even delegated to another member of staff for daily supervision. Duty rotas reflected that all of the new workers were working as one of the team on duty for the shift, not as extra, except for two or three shifts when they started. The inspectors could not be sure that the new workers had not escorted service users away from the care home premises. The Alder Meadows Ltd application documentation only asked for the past ten years employment history and not a full employment history. Three staff recruitment files did not have a full employment history. Two of the six recruitment files had one reference and two had no references. There was no record of the interview process. From one recruitment file the inspector noted information that had not been disclosed on the application form that was of a concerning nature. This was discussed with the Acting Manager who told the inspector that it had been disclosed to her at interview
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 21 and she had made a risk assessment of the situation and employed the person. But there was no documented evidence to back this for the inspectors to see. It was also noted that whilst there was now a documented induction system, this had not been completed for four of the six new staff members who began in February, April and May 2005. The Acting Manager reported that a basic verbal induction was given but there was no documented evidence of this. These recruitment practices are totally unacceptable for the Protection of Vulnerable People and a regulation notice has been served. Recruitment practice at the home has continually been an issue and previous inspections have made requirements relating to recruitment practice and it still is not compliant. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 22 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) 31,36 & 37 There appears to be leadership, guidance and direction to staff from the Acting Manager and Deputy Manager to ensure that service users receive consistent quality care, although there still seems to be some discontent amongst some staff. The Quality Assurance processes in the home need to be developed and implemented to ensure the home is meeting its aims and objectives and statement of purpose. EVIDENCE: The Acting Manager has an application being processed by the Commission for the Managers’ post. The Management of the home has improved but there are still issues to address. One main theme is the discontent amongst staff, who still do not feel confident in the Acting Manager and Provider, for example they say that ‘if anything is reported no action is taken’. This has also filtered out to some
The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 23 service users, who report the same. Staff again reported that they seldom get to see/speak to the provider to express their concerns. The inspectors could not find evidence that things are not dealt with, as many things have improved in the home, but there is obviously an issue that needs to be resolved as it is impacting on residents. This needs to be addressed. There is poor attendance at staff meetings, because staff say ‘nothing gets done’, or they were on-duty and couldn’t attend. At the last meeting no-one attended and the manager then sent a three page letter to all the staff detailing the issues she wished to discuss with them and this was not well received by staff, as it was regarding their duties and responsibilities etc The inspectors questioned the Manager about this letter and she relayed what staff had said. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 2 x x x 3 2 x The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 25 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 7 Regulation 15(1) Requirement Ensure that the written care plan is amended detailing the current health and welfare status of the resident and how the new care needs are to be met. Ensure all additions and amendments to care records are dated and signed/initialled. Ensure the care plan is drawn up with the residents and signatory evidence is obtained. Ensure medication issues identified in the report are addressed A record must be kept of any accidents/incidents that affect the service user in the care home which is detrimental to the health or welfare of the service user, and notification be made to the Commission via a Reg 37 notice. (Previous timescale 28th February 2005). The homes recruitment policy/procedures including application form to be amended and updated to reflect current legislative changes with respect to employment practice. Since the introduction of the POVA scheme, and the Timescale for action 31st December 2005 31st December 2005 31st December 2005 16th September 2005 16th September 2005 2. 3. 4. 5. 7 7 9 18 15(2) 15(2) 13(2) 37 6. 29 Reg 19 16th September 2005 7.
The Knoll 29 Reg19 & schedule 16th September
Page 26 D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 2 8. 36 18(2) 9. 29 Schedule 2(5) 10. 29 19 11.
The Knoll 36 18(2) amendments to the Care Home Regulations on the 26/7/04 for recruitment and pre-employment checks on staff. The Home must ensure that its recruitment practice complies with the leglislation. (Previous timescales 28th February 2005 and 9th October 2004 were not met) Ensure that new staff are supernumerary and supervised until CRB/POVA checks are complete and provide evidence of this. a) An appropriately qualified and experienced member of staff must be appointed to supervise a new worker for the duration of their induction training. b) As far as is practicable the ‘staff member’ must be on duty at the same time as the new worker. c) The new worker must not escort any service user away from the care home premises unless accompanied by the ‘staff member’. (Previous timescales 28th February 2005 and 9th October 2004 were not met) All employment files must contain the following:a) A record of the interview.· b) A record of the induction. c) Two written references are taken. (Previous timescales 28th February 2005 and 31st December 2004 were not met) Ensure all new staff complete the induction standards within six weeks and that this is documented.(previous timescales of 9th October 2004 and 28th February 2005 were not met) Supervision records must include 2005 16th September 2005 16th September 2005 16th September 2005 31st
Page 27 D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 12. 32 12(5) 13. 32 12(1) the recording of the observation/working alongside staff during care practice. Provider and Acting Manager to address the discontent amongst staff and provide evidence to the Commission of this process. Review the issues relating to Health, Safety and Welfare of residents when staff are regularly working excessive hours. December 2005 16th September 2005 16th September 2005 14. 15. 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. 3. Refer to Standard 1 2 28 Good Practice Recommendations Ensure that the resident contract and terms and conditions meets with the Office of Fair Trading Standards and advice (2004). Cook to undertake the intermediate Food Hygiene/Safety certificate. 50 of the homes Care staff to achieve NVQ level 2 by end of 2005. The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 The Knoll D51_D03_S16613_The Knoll_V232805_130605_Stage 4.doc Version 1.30 Page 29 - 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!