Inspection on 31/10/06 for The Knoll

This inspection was carried out on 31st October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

The Knoll 17/11/08

The Knoll 14/11/05

The Knoll 13/06/05

The Knoll 11/01/05

The Knoll 09/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Knoll 335a Stroud Road Gloucester Glos GL4 0BD Lead Inspector Mrs Helen James Key Unannounced Inspection 09:30 31st October 2006 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.V309785.R01.S.doc Version 5.2 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.V309785.R01.S.doc Version 5.2 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 Mrs Theresa Johnson Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 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 fifteen 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.V309785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Unannounced inspection took place over eight hours on one day in October 2006 and was completed by two inspectors. Thirty-two Care Standards for Older People including all the twenty-two Key standards were assessed on this occasion. Of these twenty-nine met the standard, two almost met the standard and one was not applicable. Time during the inspection was spent speaking with the Manager, the Provider Mr James, staff, residents and visitors, examining documentation, management records and the environment. Those residents/visitors who were able to converse with the inspectors discussed the admission process, care, food, lifestyle, activities and relationships with the staff at the home. The information in relation to care and welfare gained from these discussions and observations were then cross-referenced with resident individual care records and other appropriate documentation. Questionnaires were sent out prior to the inspection and analysed prior to the site visit. The seven responses from residents were all very positive about the care, food, activities and staff. The five responses received from relatives / visitors were again very positive about the management of the home, care, food and attitude of the staff. A couple of respondents commented that they felt more staff were needed and referred to issues with food and activities. The inspectors could find no evidence to support that more staff were required and could find no issues relating to food. Activity issues are addressed in the body of the report. The six responses from the staff were very positive about the home, support, training and management they receive whilst at work. What the service does well: Prospective residents or their relatives/representatives can visit the home prior to admission to see the home, its facilities and the staff. They have all their care requirements fully assessed before they are admitted to ensure that the Home is able to meet their needs. The Home has the benefit of an experienced Manager who is greatly involved in the home on a day-to-day basis. There appears to be an open, friendly approach to the running of the home, whereby resident’s needs are paramount and this is reinforced in the training given to staff. This results in the home being run safely and efficiently with residents’ rights being safeguarded and protected. It was evident through discussion with residents/relatives who were able to talk to the inspectors that they felt their views were always taken into account. They found the Manager and staff approachable, caring and friendly. They The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 6 were complimentary about the care, of the food served and the pleasant friendly manner of the staff employed at the Home. Many stated that “staff were wonderful, friendly, approachable and helpful”, “they give assistance when it’s needed”, “ they treat people with respect and dignity”. “Staff spend time with you” and “you can decide your own daily routine and when you do things.” Those spoken with enjoyed living at the home, although many if they were able would like to be back at home. Where residents were unable to give a view, care and interactions were observed and it was noted that care was given appropriately; carers were undertaking tasks diligently, respectfully and compassionately. During tasks they were talking and engaging with the individuals during all interactions. They were all carrying out their duties in a calm unhurried manner retaining the resident’s dignity, privacy and respect. Care plans are well documented and are developed for each resident following admission and in the main contain all the required information for each resident. Management records relating to health and safety issues and regular checks were in place. There was evidence that if any action had been necessary that it had been completed. All incidents and accidents that require reporting under regulation 37 are completed and sent to the commission. Quality Assurance systems are implemented in the home. What has improved since the last inspection? What they could do better: The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 7 Recruitment records are more comprehensive although the Manager needs to ensure all written references are obtained prior to individuals starting at the home. Care plans are well recorded but it was noted that the problem/need is still indicated by one word, for example, ‘mobility’, not stating what the problem is with a description of the problem and then the care intervention. In some cases care plans did appear unnecessary. Care plans require management auditing regularly to ensure that all information is consistently recorded and appropriate. Care records are required to demonstrate involvement of the resident or their representative; where there is difficulty in gaining this it is imperative that this is documented. Ways of capturing agreement to the care plan need to be explored. Lifestyle and hobbies are recorded and social activities cater for individual interests but although activities are arranged it was apparent that they do not always take place. This causes frustration, demotivation and unfulfillment of expectations for those residents who plan to attend. It is imperative that when activities are arranged they take place and the manager must make sure resources are available to ensure this. In conclusion The Knoll provides good standards of care in a comfortable environment for its residents. The inspectors found a warm and welcoming atmosphere that felt homely and comfortable for the residents and visitors. The management are keen to continue improvements to the service that they provide for residents, this is reflected in their approach to the inspection process and the willingness to implement appropriate changes / improvements bought to their attention. 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.V309785.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 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 the following standard(s): 1,2,3,4,5, & 6 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are well informed about the home prior to admission. Arrangements are in place to ensure that each prospective resident is fully assessed prior to admission. This is reassessed on admission, to ensure that all their specific care needs can be met by the Home. Residents or their relatives have the opportunity to visit the home. Intermediate care is not provided. EVIDENCE: The Statement of Purpose and Service User guide is available to all prospective residents and their representatives. A yearly review must be carried out to ensure that residents and their families receive accurate information about the home and services provided. The present one requires some minor amendments when it is reviewed. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 10 Every resident has a contract either private or from social services, and terms and conditions of residency; these appear to comply with the Office of Fair Trading standards. All care records seen included an assessment of the residents needs prior to admission or on admission. All were signed and dated. Some were briefer than others but all were followed up by a full assessment on admission, again signed and dated and all reflected the current needs of the residents. The assessment was based on general information and on the activities of daily living in order to ascertain that residents’ needs could be met by the home. Residents may also receive an assessment from the community nursing service if required. New residents confirmed that they were given information about the home prior to or on admission; some said relatives visited the home for them and others said they had the opportunity to visit the home. Contracts were in place and seen at the visit and contained all the required information. Relatives/representatives of people recently admitted were spoken with and all confirmed that they are very happy with the home and they had no concerns. They felt they were kept well informed and feel that there is appropriate stimulation in the home. These relatives visit regularly each week. Short-term respite care is provided but not Intermediate care. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. All of the service user’s health, personal and social care needs are set out in an individual plan of care. Health care needs are fully met. Service users are protected by the home’s policies and procedures for dealing with medicines. Medicines are managed and given to residents in a safe way. Service users feel they are treated with respect and their right to privacy is respected. EVIDENCE: Following the admission assessment there was a care plan drawn up for each resident based on the assessed needs. Care plans seen had all the relevant documentation in and care plans relating to identified need were in place. These were good on the whole and again reflected the current needs of these residents. However, the problem/need in some cases is still indicated by one word, for example, ‘mobility’, not stating what the problem is, then going on with a description of the problem in aims The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 12 and objectives. In some cases care plans still appear unnecessary. For example - ‘Continence’ no problem identified and then they proceed to write a care plan. Only one of the records examined appeared to have the care plan and review completed with the service user/relative, as indicated by their signature, this should be done with all residents or reason stated why this was not possible. Whilst care records have improved some minor amendments are required. The Manager must audit them to ensure that they are completed appropriately and consistently to the same standard and contain all the required care needs, as on examination they did vary. Risk assessments were appropriate to individuals needs and all had moving and handling assessments recorded. Where restraint re: bedrails etc were used this was documented and the reason why in the care files; consent was also recorded. All information required is kept in one file including the activity/hobby assessment. The home works closely with the community health teams to ensure needs are met. The district nurse oversees the healthcare needs of residents at the home and guides and instructs care staff. Their care records were available in the home. Three residents have mental health needs. These are being managed well by the home and community teams at the present time. Discussions about care management are dealt with as and when they are required and care planned appropriately. Religious needs are recorded and catered for and death wishes are recorded in care records. One resident had specific religious care needs and there was a care plan relating to the specific religious and spiritual needs. There was also a medical directive in the care file related to this. Care files, accident records and other files are now kept in a cabinet in the lounge/dining room, during the day of the inspection this was not locked at anytime during the day, even when it was unattended. Care observed given was appropriate; carers were undertaking tasks diligently, respectfully and compassionately. During tasks they were talking and engaging with the individuals during all interactions. They were all carrying out the day’s duties in a calm unhurried manner retaining the resident’s dignity and respect. The home uses the Boots blister pack system of administration. Printed MAR sheets were seen and were well maintained. All medication is checked in, the amount recorded and signed for. There were no obvious gaps in recording and variables were recorded. All MAR sheets were looked at, with particular reference made to those residents whose records had been case tracked. Each resident has photo The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 13 identification. A specimen signature list is in place. All medication was stored correctly. Blister packs and other medication was secured appropriately. Stock levels were well controlled. External and internal medicines were stored separately. Liquid medicines and eye drops were dated on opening. Controlled drugs were stored and recorded correctly. Records of disposal were kept. The dispensing pharmacy conducts a three-monthly audit and reports were seen. Only one comment noted at the last audit in July indicated that a new ‘homely remedies’ policy should be signed by the GP’s and available. The manager said they were not currently using homely remedies although a box of medication and a recording book were seen. The British National Formulary (BNF) needs updating in the home. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Residents experience a stimulating and varied life at the home with visitors and community links encouraged. There is an activity programme available that aims to suit all abilities and preferences within the home but it is not always adhered to. Daily routines are managed as flexibly as possible to enable the residents to exercise choice and control over their daily routine and to lead as independent/interdependent life as possible at the Home. Residents continue to be able to exercise choice and control over their lives within the individual ability to do so and maintain contact with family and friends. The meals at the home are wholesome and nutritious with choice at each meal. EVIDENCE: Residents and staff confirmed that service users’ have the opportunity to exercise choice in relation to daily routines. There is access to advocacy services if required. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 15 Most had good life histories completed in their care records. An activity programme is available but it was obvious by comments from the residents that as a member of staff is allocated to this each day, care demands take priority over social activities; this was apparent during the inspection. The notice board by the lounge stated that the activity for the day was bingo and who was taking the session. Residents were waiting for the bingo which was scheduled for 2-pm, residents were sat waiting and were told at the last minute that it was not going ahead due to staff shortage. The four residents were very disappointed and stated their disappointment to the inspector when they were returning back to their rooms; one resident also stated that ‘this happens quite often’. This was discussed with the Manager and the inspector stated that it was not acceptable to cancel social activities as this impacts on the psychological well being of the residents. Resources must be planned to ensure activity sessions occur. Visitors were welcomed into the home at any reasonable time and residents spoken to were able to confirm this. One visitor told the inspector, “that they were always welcomed by the staff and always provided with a warm drink”. Meals can also be provided if required by visitors. Residents are supported by the home if they do not wish to see their visitors. One resident stated that: Everyone is very good and the food is lovely. She has a nice room upstairs. She doesn’t enjoy bingo. ‘Its not her thing’, but someone came to play the guitar and was very good. She has a daily paper which she enjoys reading and likes sitting watching the wildlife outside. Another stated that ‘everything is all right but I want to go home. I have a six roomed house fully furnished and want to get back there.’ One lady had been at the home six days and she said she was gradually settling, she now had all the equipment she needed. The district nurses were coming in to redress her legs and they had shown the staff the best ways to move her. So hopefully it would be less painful.’ Discussion with the manager about the administration of medication patches in line with the controlled drug administration policy means that staff are now able to administer the residents medication. Other residents stated that they had settled in well and were very happy at the home. They liked their rooms, the food, some liked their own company or the television/ radio or joining in the activities. All spoken with felt that the staff were kind, considerate, caring, polite and met their needs. The new cook has still to bring her food hygiene certificate in to the Manager although she is down to undertake an update as soon as a course is available. Individual likes and dislikes and special needs in relation to food are ascertained on admission, recorded on individual care records and shared with the catering staff. The inspector was told that the new Catering Manager meets with the Manager and audits the catering provision monthly to ensure it The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 16 complies with legislation. He also organises training and reports to the Manager of the home and gives her a copy of the quality audit. New menus started last week and these are to be run for a month and then will be reviewed. All residents/representatives spoken to stated they enjoyed the food and the quality and quantity was good. Staff were aware of the specialist dietary requirements of residents and ensured their needs were catered for at each meal. A choice of food is available at all meals and the menus provided evidenced this. Snacks and drinks were available as required. Meals seen were well cooked and well presented. The Kitchen was clean and in good order with the exception of one bin with no lid and a dirty dustpan and brush, which the cook said, should have been outside. Three residents need assistance and prompting is given to several at the dining table. Some choose to eat in their room but most enjoy the social occasion of the dining room, which is set well. There are no specific dietary needs at the present time. Weights are recorded. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: No formal complaints have been received by the home. All concerns/grumbles are dealt with as and when they occur. One local GP complained to the Manager about the fact that staff were not able to undertake blood glucose monitoring. The Manager discussed this with him and explained that the district nursing team are responsible for this procedure. The Manager is very approachable and this was validated by comments from several residents to the inspector during the visit and was also observed during interactions with visitors and relatives during the inspection. The home has a complaints procedure that all spoken with were aware of. One relative spoken with stated that ‘I have no concerns about the care or the home and I always feel confident to discuss concerns with the Manager, deputy and staff’. A second relative was also positive about the home, the care and the staff and said they had no complaints but would tell the staff if they did. This was also evidenced from the questionnaires received although a couple did say they didn’t know the procedure, although it is clearly stated in the The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 18 brochure and service user guide given to residents/representatives on admission and is available in the foyer of the home. The home has its own policy on abuse. The Manager needs to ensure that she attends enhanced adults at risk training. All staff undertake training in abuse awareness /adult protection on induction and this is updated regularly. Staff spoken with confirmed they had received this and knew what they would do if they saw abusive practice or saw anything that bothered them. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 19 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, 24, 25 & 26 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The standard of décor within this home is good and no maintenance issues were identified. Residents live in a safe well-maintained environment. The standard of cleanliness was good and there were no infection control issues identified. Residents live in a clean and hygienic home. EVIDENCE: A tour of the building was carried out, and most rooms visited. Generally all were well maintained and decorated. The home benefits from the attention of the maintenance man. There is a maintenance record in each room and a record of all the general issues. As they are addressed they are signed to ensure an audit trail. In one room a wardrobe door would not close and this need to be addressed. Since the last inspection toilets had been redecorated as had some bedrooms and there were some new carpets. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 20 There was no single hand towel dispenser in the medication cupboard and no hand washing facilities in the sluice hopper rooms. The Manager reported that these are not used for Health and Safety reasons. It was recommended that these be removed to prevent any type of contamination. The home has automated washers on two floors. There were no unpleasant odours or infection control issues highlighted during the visit. Gardens around the home are accessible, attractive and well maintained. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 21 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, 28,29 & 30 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers to meet the residents needs, although some staff have been working excessive hours over the last four weeks. There appears to be a good leadership of the care, which ensures consistency of care practice in the home. Morale remains high with a low staff turnover so there is consistency for the residents. The procedures for the recruitment of staff are good but can be improved further to protect the people living in the home. There is a full staff-training programme that covers all mandatory training and care practice for all staff. EVIDENCE: Staff spoken with felt that staffing was sufficient to meet the needs of residents and that they had time to do their job. There are good support staff that deal with domestic chores and catering and this frees them up to deal with care issues only. They receive good support from the Manager and Deputy and receive regular ‘one to one’ supervision. Team meetings occur regularly or when there is an issue to discuss. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 22 The Manager explained why staff have been working excessive hours and that this was exceptional and not routine. Off duties evidenced this. Staffing has been a bit stretched recently due to two staff having to take unplanned extended annual leave (7 weeks instead of 4) and other staff having leave planned. This will resolve on the 13th November as the staff members will return to duty. A handover is given at each shift change. The care staff write the daily records and feedback any changes to the Manager or Deputy. They all have access to the records and know all about the residents and how to meet their needs. Staff said that it was a good supportive team at the home and it was a happy place to work. They feel there is enough time to give care to the residents and that residents are given choice. Residents spoken with confirmed that the staff were very caring and met their needs. Five staff recruitment files were inspected. Three were found to contain evidence that most pre-employment checks had been appropriately undertaken prior to employment to comply with regulation 19. But in two cases only telephone references had been taken and not written references. One had no full employment history or induction record. This is not compliant with Regulation 19 and must be addressed. There were interview records and induction training records on all other files seen. The inspector was unable to sample new staff Criminal Record Bureau (CRB) disclosures as these are held at Head Office and will be looked at a later date. Two staff are waiting for their CRB disclosures to be returned but have had POVA clearance; one is working with supervision and the other starts on 13th November. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35,36, 37 & 38 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The Management of the home is good and the Manager provides leadership, guidance and direction to staff on a ‘day to day’ basis. The systems for service user consultation and Quality assurance are well developed in the home. Staff are appropriately supervised. There are processes in place to safeguard the financial interests of residents. The health, safety and welfare of the people using the service are protected and safeguarded. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Manager appears to have a clear direction and leadership qualities that have improved the home significantly in the last year. She has now started the NVQ level 4 Managers Award. Staff have received training and been given clear direction and so have begun to work taking responsibility and being accountable for their role within the team ensuring that the needs of the residents are paramount. The staff reported that the Manager is approachable and has an open door policy so is accessible at all times. They feel they have good support from her and enjoy their yearly appraisals with her. Staff reported that they attend training and any training needed is arranged. Mandatory training and updating is implemented well in the home now with many courses requested and preplanned for staff through an outside agency. The training planned includes fire; health and safety, moving and handling, food hygiene and first aid training etc and training records for the staff were seen. A Quality Assurance system is in place and there was evidence in the home of the reports from the data gathered. The Manager has some documented auditing tools in place but needs to implement further audits to examine quality of systems and effectiveness of care procedures/practice in the home and the Health and Safety audit needs to be formalised. All records for the maintenance, health and safety and protection of residents were in place and were seen. Accidents and incidents are appropriately recorded in the accident book and notified to the Commission for Social Care Inspection (CSCI) via Regulation 37 notices. But the accident audit to demonstrate the risk management process of accident management in the home has stopped and needs to be reintroduced. The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 26 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 written and appropriate. The Manager is to explore ways of evidencing the involvement of residents/representatives in the development of their care plan/reviews, agreement or disagreement. Ensure a programme of activities is arranged and carried out by the care home, having regard for the needs of service users. Top floor room wardrobe issues to be addressed or wardrobe replaced. Cupboards /sluice rooms which hold some cleaning materials to be kept locked at all times. • • Paper towel dispenser to be sited in the medication room. Hand washing and drying facilities to be sited in the sluice hopper rooms OR remove the sluice hoppers Timescale for action 28/02/07 2. OP7 14(1c) & 15(2c&d 28/02/07 3. OP12 16(2n) 28/02/07 4. OP26 16(2c) 28/02/07 5. OP26 13(4c) 28/02/07 6. OP26 16(2j) 28/02/07 The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 27 7. OP29 19 & Schedule 2 if they are not used to minimize health and safety issues. The Manager must ensure that two written references and full employment history are obtained prior to employment in line with Regulation 19. • Manager to re-implement the accident audit to demonstrate the risk management process of accident management in the home. Manager to develop the Quality assurance system in the home. 28/02/07 8. OP38 13(4) 28/02/07 • RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Manager to audit care records to ensure that they are completed appropriately, to the same standard and contain all the required care needs. The Manager to attend enhanced adults at risk training 50 of the homes care staff to achieve NVQ level 2. Manager to ensure that where staff are observed during practice this is recorded to make it apparent that formal observation of practice occurs as part of supervision 2. 3. 4. OP18 OP28 OP36 The Knoll DS0000016613.V309785.R01.S.doc Version 5.2 Page 28 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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