CARE HOMES FOR OLDER PEOPLE
The Knoll 335a Stroud Road Gloucester Glos GL4 0BD Lead Inspector
Mrs Helen James Unannounced Inspection 14th November 2005 09:30 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 The Knoll DS0000016613.V255139.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. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Knoll Address 335a Stroud Road Gloucester Glos GL4 0BD 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) 01452 526146 Alder Meadows Limited To be appointed Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13 June 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 near Tuffley. The Home stands in its own extensive grounds of fifeen 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 Home’s 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 Home’s 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. Several of the rooms can be used as double rooms and each room has a washbasin. Toilet and bathing facilities are located on each floor with assisted bathrooms on all floors. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and a quarter hours on one day in November 2005 and was completed by two inspectors. This service has vastly improved since the June 2005 inspection and enforcement notices that were served following the inspection have been fully complied with. Twenty-two standards for older people were looked at on this occasion. Seventeen were met, four were almost met and one was not applicable. The inspectors spoke to the Acting Manager, Deputy, four staff, a number of residents and a visitor to the home. A tour of the premises was conducted. A selection of records relating to residents spoken with or newly admitted to the home were examined. Staff supervision and appraisal records, training certificates, health and safety records and policy and procedures were also examined as part of the inspection. The Acting Manager is to undergo a ‘Fit Person’ interview by the Commission on the 23rd November 2005, to determine whether she will be registered as the Manager of the home. What the service does well: What has improved since the last inspection?
There is now a stable team of staff at the home supported by an acting manager and deputy who have now been in place for a year. There appears to be a happy working environment now at the home and staff now enjoy working at the home and appear committed to the home and its residents. Interactions between staff and residents were positive and respectful. Staff enable where possible residents to make choices about activities of daily living and appear to be flexible in their approach and routines. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 6 Staff appear to have a good understanding of the needs of the residents living at the home and have developed good relationships with them. Better recording in the care assessment and care planning system supports this. Care records were looked at in detail and these are much improved compared to previous inspections. They are well maintained and consistent with all the appropriate information being recorded. There are some minor amendments required and these are referred to in the body of the text relating to standards 7-11. Staff now have access to regular and comprehensive training, which is geared to the needs of staff at the home and the mandatory training required by the Commission. There are now comprehensive management systems in place to ensure the health, safety and welfare of residents and staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Knoll DS0000016613.V255139.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 The Knoll DS0000016613.V255139.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): 2, 3 & 6. Residents have a contract for their residency, which states the required information. Arrangements are in place to ensure that each prospective resident is fully assessed prior to admission, to confirm that all their particular care needs may be met in the Home. EVIDENCE: The inspector saw contracts for residents who are funded by social services and one contract for a resident who is privately funded. The Manager reported that she is in the process of ensuring that all residents who are privately funded have a contract on their personal file. There was discussion on where these contacts should be kept. It was suggested that as they contain personal funding information they should be kept with all confidential material, as it is not information necessary for care practice. The Manager is to ensure that all new residents have contracts when they are admitted. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 9 There had been one new permanent admission since the last inspection, admitted from hospital, and one resident on respite care who was due home the following day. Pre-admission assessments were seen on both these files. Both were spoken with. The resident on respite care said that it was a very nice home and everyone was very kind but she was looking forward to going home. The second resident seemed quite settled and had the district nurse to attend to her health care needs during the inspection. Assessments were completed on all of the files seen but an initial assessment only was completed for the resident on respite care, rather than the detailed assessment, seen on other files. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 & 10. Improvements have been made in the care planning systems to ensure that all members of staff have a clear understanding of the care each person requires. There are still some minor improvements required. Residents health care needs are fully met. Residents are treated with respect and dignity. EVIDENCE: Care records of five residents were looked at in detail. These are much improved form previous inspections, well maintained and consistent. All had assessments, risk assessments and care plans completed. However, there is still some confusion over what is a problem, the aim and the intervention and in most instances the problem is actually identified within the intervention, this needs to be addressed. All care plans showed evidence of reviews and there was some evidence of care planning being completed with residents/ their relatives as some signatures were seen.
The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 11 There were some instances also where a care plan did not appear necessary, for example for medication when this was being administered by the staff and there were no problems with administration. Daily records were seen and these were appropriately detailed. From these records it was clear in one or two instances that there were no care plans for specific problems identified such a persistent nosebleeds or wound care. Records and residents spoken with confirmed multidisciplinary input where required. There was evidence of district nurse, GP’s, specialist doctors, community psychiatric nurses, the continence advisor, chiropodist (a notice board indicated monthly visits), optician and social worker visits to individual residents at the home. There was some concerns over the mental health of one of the residents, but the manager was fully aware of the situation and was taking appropriate action. Although one psychiatric consultation had taken place it was felt that another is now necessary. Exploration with other agencies was required with a couple of issues identified during the inspection pertaining to these individuals. The Manager has since reported back to the inspector on this and appropriate action has been taken regarding the issues. 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 DS0000016613.V255139.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 Social activities and daily routines are managed as flexibly as possible to suit the individual preferences of residents living at the Home. Support is in place to enable the residents to exercise choice and control in their daily routine and to lead as independent/interdependent life as possible. Residents maintain social contacts. Residents receive a nutritious balanced diet. EVIDENCE: A number of residents were spoken with during the inspection, either in their rooms or in the main lounge/dining room. All confirmed that they were happy with care received and commented how nice the staff were. Many also commented on how good the food was. One lady was celebrating her 90th birthday and a cake had been made for tea. One gentleman was looking through photograph albums and enjoyed relating all the sights in Vienna he had visited. Another lady recently lost her cat and the home had been to an animal shelter and got her another one after discussion with the family and she was very happy to still have a cat to look after.
The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 13 There are three married couples in the home. One gentleman stated his wife had gone shopping that morning with his daughter. One lady has her husband living at another home across the road and she visits him regularly. The notice board by the lounge/ kitchen indicates the daily activity session and when communion services are held at the home. Senior members of staff organise activities to include bingo, bean- bags and chair exercises. It was reported that trips have been organised in the past but then have to be cancelled because of lack of interest. Some residents go out regularly with their relatives. Lunch and supper menus for the day were also displayed on a white board and lunch was to be sausages, egg, chips and beans, with jelly, fruit and cream for dessert. It was noted that all the fried eggs had been cooked at least an hour before lunch was served and kept warm in the heated cabinet. Supper was beef burgers, cheeseburgers, sandwiches and cake. Two residents have soft diets and require assistance with meals, but generally just meat is liquidised and soft vegetable served with these. Special diets are required for diabetics, but it appears that their dessert choice tends to be fruit and yoghurts. This was discussed with the Acting Manager and needs to be addressed. A breakfast menu is also displayed on the notice board. The kitchen appeared clean and well organised during lunchtime preparation. There was a chef on duty but no kitchen assistant on this occasion. Fridge and freezer temperatures were checked and food stored in fridges and freezers were dated and labelled clearly. All the staff responsible for catering duties have food hygiene certificates, three completed this in May 2005 and the certificates are on display. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 Complaints procedures are in place Arrangements for the protection of service users are now in place ensuring that residents are not placed at risk of harm or abuse. EVIDENCE: 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. Records were seen and no complaints have been received since the last inspection and concerns have been dealt with as they have arisen. There have been a number of compliments received by the Acting Manager and it is recommended that a compliment record be kept. All staff have received training in ‘Abuse awareness’ and ‘Violence and Aggression’ and this was evidenced through certificates seen. Risk assessments are recorded for all issues where there is concern. All incidents are being appropriately recorded to the Commission for Social Care Inspection (CSCI) in accordance with Regulation 37. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 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 the following standard(s): 19 & 26 Communal areas and residents rooms that were seen 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 building was carried out, and most rooms visited. Generally they were in a good state of décor and were well maintained and furnished. The only areas that appeared to need attention were the assisted toilets on each floor. One of these had just been redecorated and it was reported that the others were due for redecoration. Carpeting with the exception of a badly stained carpet in room 17 (reportedly due for replacement), was also in a good condition and it appeared that several rooms have had new carpeting fitted over the last year.
The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 16 There was only one cleaner on-duty during the inspection; she was working her way around the building. The standard of cleanliness where she had been appeared satisfactory but there were several rooms seen where food and other bits were on the floor, these were in areas that had not yet been cleaned. The Acting Manager discussed with the inspectors the issue of clinical waste produced by Community Nurses who visit the home. She stated that the nurses were throwing their clinical waste in general waste bins in residents’ rooms. The Acting Manager had asked them to take it away with them, but some district nurses refused to take it. This was discussed with a district nurse visiting the home at the time of the inspection but she felt unable to comment as she was only agency, but she took her clinical waste with her. The Commission is to raise this issue with the Local Primary Care Trust. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 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. EVIDENCE: It was reported that there have been two new members of staff since the last inspection. One appointed as a kitchen assistant but currently doing the cleaning as the regular cleaner is on leave. It was reported by staff that the cleaning had improved significantly with the new cleaner at the home. The second is a new maintenance man. The recruitment files were unavailable to be seen on this occasion as the manager had left the filing cabinet keys at home. A further visit will be made to check staff files. In addition to the manager, the deputy manager and two care staff were onduty. They were supported by a cleaner, Cook and Laundry assistant. All the staff on-duty were spoken with and said that they enjoyed their work, and several confirmed some of the training they had completed. This included fire training, abuse training and Control of Substances Hazardous to Health (COSHH), and that they had received an induction and supervision.
The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 18 There appeared to be a much calmer and happier atmosphere in the home compared to some previous inspections. There are monthly staff meetings and minutes were seen. Six staff are to begin the National Vocational Qualification (NVQ) level 3 within the next two months and the Acting Manager is hoping to gain a place on the NVQ level 4 and Managers Award. Those staff whose first language is not English are attending language courses where it is deemed necessary by the Acting Manager. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35, 36, 37, 38. There appears to be leadership, guidance and direction to staff from the Acting Manager and Deputy Manager to ensure that residents receive consistent quality care, whilst ensuring their choice and dignity. The Quality Assurance processes in the home are continuing to be implemented and developed to ensure the home is meeting its aims and objectives and statement of purpose. EVIDENCE: Evidence was seen of the staff supervision and appraisal system and the records that are kept. This now appears to be well established and well coordinated by the deputy manager. Staffing now appears to be stable and there appears to be a happy working environment with commitment from the staff who appear to enjoy working at the home. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 20 The home does not deal with any finances for residents all fees are dealt with by head office. Secure facilities are available for residents’ valuables. All accidents and incidents are now recorded appropriately and notification sent to the Commission. The Admissions register contains all the required details. The Homes Risk Assessments were seen and these were last reviewed in April 2004 and they need reviewing, as this should be done yearly. Evidence was seen of the Portable appliance testing done in June 2005, the Gas safety checks done in February 2005 and the Pest Control checks undertaken in October 2005 Evidence was seen of the yearly Hoist checks done in October 2005 Evidence was seen of the Lift service done in November 2005 with the plan to undertake some remedial work on the lift this month. The Fire Officer is to visit the home on the 16th November 2005. The Environmental Health Officer visited in September 2005 and all issues identified have been addressed except the ventilation in the food storage area. This is to be addressed by the Handyman when he is next on duty. Residents meetings are monthly and minutes were seen, the last meeting was in October 2005. Up to nine residents attended, the Acting Manager distributes the minutes and goes to see residents who did not attend and/or talks with their relatives/friends/representatives. A Residents satisfaction survey is done monthly and the September survey is available to visitors when they enter the home. The quality assurance Audit that was been undertaken in April 2005 is available. Mr James is undertaking the Regulation 26 visits and has agreed to send these to the inspector at the Commission. These address all the required issues. The Quality Assurance Manager visits the home weekly at the present time to support the Acting Manager. The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 3 3 3 The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Amend care plans to ensure that the identified need, the aims of care and interventions are clearly identified. Ensure that residents who are diabetic are given variety of dessert. • Ensure that food is not cooked too far in advance of serving and left on warming plates so the texture becomes tough/rubbery. • Cook to undertake intermediate Food Hygiene/Safety Certificate. Address the following maintenance issues: • Attend to the décor in the assisted toilets on each floor. • Replace the soiled carpet in the identified room. The Acting Manager ensures that staff personnel files are available at all times. Review the Home’s Environmental Risk Assessments yearly.
DS0000016613.V255139.R01.S.doc Timescale for action 28/02/06 2. 3. OP15 OP15 16(2i) 16(2i) 28/02/06 28/02/06 4. OP19 23(2d) 28/02/06 5. 6. OP29 OP38 17(3b) 13(4) 28/02/06 28/02/06 The Knoll Version 5.0 Page 23 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 OP16 OP28 OP1 Good Practice Recommendations The Acting Manager at the home keeps a compliment record. 50 of the homes care staff to achieve NVQ level 2. Ensure that the resident contract and terms and conditions meets with the Office of Fair Trading Standards and advice (2004). The Knoll DS0000016613.V255139.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 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
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