Inspection on 14/11/06 for The Knoll Nursing Home

This inspection was carried out on 14th November 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 Nursing Home 28/10/08

The Knoll Nursing Home 20/08/05

The Knoll Nursing Home 21/06/05

The Knoll Nursing Home 14/02/05

The Knoll Nursing Home 11/10/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 196 Dover Road Walmer Deal Kent CT14 7NB Lead Inspector Mrs Susan Hall Unannounced Inspection 09:30 14 November 2006 th 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 Nursing Home DS0000026103.V301615.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 Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knoll Nursing Home Address 196 Dover Road Walmer Deal Kent CT14 7NB 01304 374679 01304 374679 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) Raj & Knoll Limited Mrs. Amita Patel Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Terminally ill over 65 years of age (3) of places The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 11 of the 28 beds can be used for Service Users who only require residential care. Three Service Users sharing a room. These are identified by dates of birth, 30/04/1904, 19/09/1930 and 26/12/1909. This room is to be changed to a shared room for 2 people when any of the existing service users leave the Home. 20th September 2005 Date of last inspection Brief Description of the Service: The Knoll Nursing Home is a large detached building, situated in a residential area of Walmer. It is near to local shops and amenities, Walmer Castle, and the sea, and is within easy reach of the town of Deal. The home is owned by Raj and Knoll Limited, and managed by Mrs. A. Patel, one of the providers. Accommodation is mostly provided in ground and first floor bedrooms, although there is also a shared room on the second floor. All floors can be reached via a small passenger lift. Eight rooms have en-suite facilities. Outdoor space is currently limited to a small patio area which is accessible for service users to sit out in good weather. However, there is a large public park almost opposite The Knoll which is often used to take Service Users out for walks. The providers have purchased the adjoining premises, and are in the process of obtaining planning permission to enable demolition of the adjoining building, and extensive new building work to link the two properties. Some structural alterations and refurbishment of the existing building are due to commence in November 2006. Fees range from £475.00 - £675.00 per week, depending on the type of room, and the amount of nursing care required. This information was provided by the manager on pre-inspection documentation, and checked on the day of the inspection visit. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which includes information obtained about the home since the last inspection. The Inspector sent out survey forms to a selection of service users and relatives, care managers and GPs, and obtained eight replies, which were all completed with positive responses. There have been no complaints or allegations made to CSCI about the home since the last inspection. The Inspector visited the home from 09.30 – 16.30, and during that time talked with seven service users, and met several others. She also held conversations with three relatives and eight staff. These included care staff, domestic staff, the cook, and the deputy manager. There is a low turnover of staff and they said that they “worked well together”. Relatives said that they were “glad to have the opportunity to speak about the home, which is excellent. The staff are all very good, and we were so pleased to find somewhere so caring for our relative.” A GP wrote that “the staff are always well informed and up to date, both in their professional skills and development, and in their knowledge of patients.” Service users were observed as being well groomed, with attention to their appearance by the staff. Several said that they were happy being in the home, and there are sufficient activities provided if they wish to join in. The food is very good. The Inspector viewed most of the building, and noted that improvements had been made to the décor, some carpeting, and some furnishings. The premises were clean in all areas, except for one carpet which was in the process of being cleaned. This is an old building, which needs considerable ongoing maintenance. Planning permission has been granted for a number of alterations to this existing building, which will include altering some shared rooms to single rooms, and enlarging the clinical room, the manager’s office, and the lounge. A small quiet room will be made available on the first floor. Service users and relatives have been kept fully informed of proposed alteration work. Several service users, relatives and a GP expressed their disappointment that planning permission was refused for the proposed rebuilding work of the next door premises. The plans are currently being altered prior to putting them forward again for planning permission. The Inspector also viewed documentation, which included care plans, medication charts, staff recruitment and training files, and maintenance records. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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 Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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 Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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): 1-5 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides adequate information to enable service users to make an informed choice. EVIDENCE: The statement of purpose and service users’ guide are well produced in large print, and contain all the required information. Prospective service users and their relatives are given a copy of both documents. The service users’ guide includes terms and conditions of residency, and details about items such as meals, telephone use, visiting, and bringing in personal possessions. Relatives of a recently admitted service user confirmed that they had received the necessary information, and that they were shown around the home and made to feel welcome. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 9 The manager (or deputy) carries out a detailed pre-admission assessment before confirming the placement. This is in addition to obtaining a joint hospital and social services assessment. The manager assesses all aspects of daily living, such as mobility, nutritional needs, personal care, nursing details and social care, and checks that the home will be able to meet all the assessed needs. The Inspector viewed three completed pre-admission assessments and noted that they contained lots of details. Any specialist equipment needed is put in place prior to admission. All service users are provided with a contract; and all have a copy of the terms and conditions of residency signed and agreed and filed in their care plan folders. Items which are not included in the weekly fee are clearly specified (e.g. hairdressing, chiropody). There is a trial period of four weeks, with a review held at the end of this time. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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): 7-11 The quality for this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Service users are confident that their health needs will be met. They receive kind and efficient care and their individual needs are met. EVIDENCE: The inspector viewed three care plans. These are set out in individual folders for each service user, with an index at the front for easy access of information. Service users have a detailed assessment on admission, to include their dependency needs, pain assessment, nutritional needs, mobility needs and continence care. The assessments are re-evaluated every month. Care plans are written according to the identified needs, and are also reviewed monthly. Each service user has a general risk assessment for their individual bedroom, checking that electrical appliances are safe; if the radiator cover or low surface temperature is effective; if they can manage a door lock (if they wish to hold their own key); and if they are safe to eat unaccompanied (if they wish to take meals in their own room). The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 11 Records included detailed continence assessments, and the risk of developing pressure sores. Skin condition is fully assessed on admission, and any wounds or bruises are entered on to body maps. Only one service user currently needed wound care, and the records showed a separate report for each time the dressings were changed, the healing progress of the wound, and the type of dressings used. Pressure-relieving equipment was clearly specified with the type of mattress or cushion in use. Photographs had been taken to show the healing process of the wounds, and consent had been obtained to take these. Consent is also obtained for flu vaccinations, chiropody, sharing a bedroom, yearly eye check ups, use of strap on a wheelchair for safety (after discussion with relatives and care manager), and use of bed rails. The service users’ representatives had signed consent where the service users no longer retained the capacity or ability to sign for themselves. Relatives are asked to help compile a previous life history of the service user, so that staff can relate to their different interests and family situations. Visits from other health professionals are clearly documented, and included GP visits, care managers, consultants, dietician, and speech and language therapist. Care staff are given directions at handovers for service users who need personal care, and they carry notebooks to record any changes seen, or any concerns. These are passed on to the nurse on duty, who writes a daily report for each service user. The reports were correctly signed, timed and dated, and included good content, giving a clear picture of daily health progress or deterioration, and any changes in mental state. Care staff complete fluid balance records and turn charts for service users who are really unwell. These had been well completed. Service users said that they are well cared for, the staff “are lovely”, and they do not usually have to wait too long when they ring the bell. One said they do not have to ring the bell very often, as staff anticipate their needs and are active in checking if everything is satisfactory. Medication is overseen by the deputy manager, and is mostly administered via a monitored dosage system. The providers are fully aware that the clinical room is too small, and building alterations include a significant increase in the size of this room. The alterations are due to commence at the end of November 2006. Medication, including controlled drugs, and creams and lotions, is stored appropriately, and good records are maintained for receipt and disposal of medication. Policies and procedures are written clearly and are easy to follow. Medication Administration Records (MAR charts) were all well completed. There were no service users self- medicating at this time. The manager has an excellent audit system in place for checking all aspects of administration storage and administration. This audit is carried out twice yearly. Hazard warning signs were seen where oxygen is stored or in use. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 12 Service users were well groomed and said they are treated with respect. Staff knock on their bedroom doors before entering. Service users get up/go to bed as they wish, and sit where they wish in the lounge/dining area, or their own rooms. Attention to detail was apparent, with hair styling, shaving, teeth cleaned etc. Staff were seen to interact well with service users, and to speak to them respectfully and with kindness. The home has a record of carrying out palliative care for service users with terminal illness. The manager, the deputy manager and one of the nurses have completed palliative care training (4.5 days) at a nearby hospice. The training has been passed down to other staff. The home has recently signed up to two special arrangements enabling continuity of care for service users at this difficult time. These are known as the “Liverpool Care Pathway” and the “Gold Standards Framework”. Local GP surgeries are happy to link in with this, and when service users are entered on the register, additional services can be accessed more quickly. The home works closely with the hospice, and a liaison nurse visits to give advice. Service users are enabled to stay in the home, in their own room and where they already know staff. Relatives are able to visit at any time, and staff are can help them at the start of the time of bereavement. A GP commented that “patient care is always of the first priority in this home.” The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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 the following standard(s): 12-15 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users have a sufficient variety of activities, and there are good community links. Food is well prepared, and there is a good daily choice to provide a nutritious diet. EVIDENCE: The home has a programme of activities provided every day, and this includes a twice weekly exercise session (armchair, leg exercises, ball games etc.). There is also an activities co-ordinator who carries out bingo, quizzes, reminiscence, sing alongs, etc.; an aromatherapist once per week; a hairdresser once per week; and other entertainment programmes (musical, carol singing etc.). Service users may be taken out in wheelchairs to the public park immediately opposite, or to the sea (at the end of the road), or out with relatives if possible. Some were already making arrangements to visit relatives at Christmas. The home will hold a big Christmas party with buffet and entertainment, when relatives are specifically invited. The service users help to The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 14 make Christmas cake and presentation boxes, so that these can be given as gifts to their families. The service users are informed of activities on a daily basis. It was found that giving them a printed programme was not very effective, as many forgot, or did not know which day it was. The activities and exercise staff are always willing to adapt the programme for any specific wishes. A record is kept for each individual service user for their daily activities – this may just be reading with them, giving them a manicure, or helping them to join in with organised activities. Visitors said that they are warmly welcomed into the home, and can join in with the activities if they want to. One service user said that doing the exercises twice per week has helped her to improve her mobility; the manager said that positive health benefits had been found for several with an increased activities programme. One has had medication for depression reduced since joining in, and another has had a reduction in pain relief, as the exercises have helped. There are regular communion and church services held in the home; and visits from different ministers (C/E and R/C) are arranged as appropriate. No service users have their finances managed by the home. If they are unable to manage these themselves, arrangements are made with their next of kin or their choice of advocate. Service users are encouraged to bring personal possessions in with them, and small items of furniture if they wish. A record is kept of these items. Meals can be taken in the lounge, dining area, or service users’ own rooms, according to choice. The main meal is at lunch, and there is a cooked dish available at tea. Service users are offered a choice, and the cook speaks to them individually the day before to ask what they would like. Fresh fruit and vegetables, and fresh meat, are delivered from local sources. The kitchen was in good order. Most kitchen furniture is now stainless steel. There are dedicated daily/weekly cleaning programmes. The Environmental Health Officer carried out a routine visit in September 2006, and made a recommendation (non - urgent) which was quickly met. All meals are prepared by cooks. Care staff prepare drinks mid-morning and mid afternoon, as they know what service users will like, and they then feed drinks to those who need assistance. Staff who prepare food/drinks have completed basic food hygiene training. Service users said that the food is very good. The Inspector viewed a copy of the menus, and these showed a good choice of food, providing a nutritious diet. The last staff meeting included a presentation by a senior nurse on management of nutrition and weights/BMI as a response to recent comments in the press about food in care homes. The staff have been proactive in the prevention of malnutrition. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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 the following standard(s): 16-18 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has an effective complaints process in place. Service users are protected from abuse. EVIDENCE: The complaints procedure is on display in the entrance hall, and is included in the service users’ guide. All service users are given a copy of this prior to admission to the home. Service users said they would talk to the manager or the nurse on duty if they had concerns/complaints. A complaints log is kept in a hard backed notebook for any day to day concerns/niggles – and shows the action taken to reassure or assist the service user as needed. Any serious complaints are recorded on a complaints form, and are followed up by the manager. There had been no serious complaints since the last inspection. The procedure includes information about Social Services, CSCI, Health Services, and the ombudsman, so that service users and relatives have a choice of where to apply for any help. Any complaints are thoroughly investigated, and a response is made within 28 days (and usually much sooner). Service users are enabled to take part in civic processes and voting, and postal votes are applied for unless service users prefer to visit the polling station. Service users are protected from abuse by robust recruitment procedures, a detailed induction programme, and Adult Protection training. The training The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 16 matrix showed that all staff had received this training during this year, and discussions with staff showed that they understood the recognition and prevention of different types of abuse. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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 the following standard(s): 19-26 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The premises are homely, and provide a suitable well-maintained environment. The planned alterations will enhance the facilities. EVIDENCE: The Inspector viewed most areas of the home, including most bedrooms, some bathrooms, en-suite facilities, the kitchen, laundry, sluice and communal areas. The home was very clean, and there was evidence of recent redecoration in many areas. This is an old building, and requires lots of ongoing maintenance. It was good to see that rooms and corridors had been redecorated in many areas, some carpets had been replaced, and there was some new furniture. The manager is ensuring that this existing building is kept in a reasonable The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 18 state, although alterations to several areas are shortly due to commence, and will mean further decorating to the areas affected. Two new bedrooms will be built on at either side at the front; the clinical room will be extended; the small quiet area above that will also be extended, creating a new quiet room for service users and relatives/friends. There will be alterations to some shared rooms, and they will become single en-suite rooms. A larger office will be created for the manager, the kitchen will be moved, and the lounge will be extended. So all these changes will improve life in the home for both service users and staff. Service users and relatives have been kept fully informed of proceedings, and are also aware that the manager has purchased the adjoining property. New plans are currently being drawn up to build a large addition to this home, and extra beds. The communal areas currently consist of a large lounge and adjoining dining area, and a small outdoor patio. These are suitably furnished and decorated. Bedrooms were seen to be personalised, and to have suitable furnishings and equipment. Most rooms have nursing beds, and toilets are fitted with raised seats, toilet surrounds, and grab rails as appropriate. Shared rooms have suitable screening for privacy. The home has assisted baths (including a Parker bath). There is a good variety of hoists for different room areas and different service users’ needs. The manager had recently purchased an additional hoist, which has an extra high weight-bearing facility for any overweight service users. The home is well ventilated and lighting and heating are satisfactory. Maintenance checks are carried out for water temperatures and chlorination. All radiators are fitted with guards, or have a low surface temperature. Carpets are cleaned on a daily basis as needed. The home now employs three cleaning staff per day, which has helped in keeping the building clean. There is a laundry assistant on duty every day to manage the laundry, and the cleaning staff also assist with this. The home has sufficient laundry equipment, including washing machines with a sluice facility. A red alginate bag system is used for soiled items. There are two separate sluices, and a new sluice disinfector has been fitted in one of these. The manager carried out a very detailed infection control audit (as provided by the Health Protection Agency), in October 2006. This was a comprehensive survey of every area in the home. The score came to a very satisfactory 93 . The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 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 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): 27-30 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staffing levels are satisfactorily maintained. The home has good procedures in place for recruiting staff, and for providing staff training. EVIDENCE: Staffing levels are satisfactorily maintained, and there have been some increases in numbers of staff per shift since the last inspection. The home has 1 nurse on duty for all shifts. The manager is in the home most days, and although she is supernumerary on most shifts, she actively takes part in the nursing duties of the home as well as management. She covers some nursing shifts as the allocated nurse, in order to retain her nursing skills. For some shifts there are 3 nurses in the building, as the manager, deputy manager and another nurse may all be on duty – especially if there is in-house training, or ongoing supervision taking place. The home has 5 care staff on duty in the mornings, and 3 in the afternoons. Another carer comes on duty from 5pm – 12mn, assisting service users with eating at teatime, and helping to put service users to bed. There are 2 care staff on duty at night, but another 3 care staff start work at 07.00, so all busy peak times are well covered. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 20 In addition to care staff, there is a cook on duty each day, 3 cleaners, a laundry assistant and an activities person. There is a part-time maintenance person, and additional contractors are employed for decorating etc. The home currently has 4 care staff who have completed NVQ 2 training, and who are going on to take level 3 (they have commenced this). This is 28.5 . Another 7 have commenced NVQ level 2, and if these all complete it satisfactorily, there will be 78.5 trained to NVQ 2 and above, which is a significant improvement. NVQ training is carried out in-house, with a trainer coming in to the home, and nursing staff as mentors. Recruitment procedures are well managed. The Inspector viewed 4 staff files, which were well compiled, and included the necessary information. The application form has been amended to include a complete working history, and exploring any gaps in employment. All staff have a Protection of Vulnerable Adults (POVA) check, and a Criminal Record Bureau (CRB) check (enhanced) before commencing employment; proof of identity on file and a recent photograph; 2 written references, a health questionnaire, and a statement regarding any outstanding criminal convictions/cautions. Nursing staff have their PIN numbers checked, and are required to provide their training certificates. Staff files viewed included comprehensive training records and yearly appraisals. Other supervision documents (2 monthly) are kept in a separate file. Nurses have clinical supervision sessions, to check subjects such as competency in leading a shift, medication administration and training other staff. The home uses a recognised induction training course, which is detailed, and signed for each item understood and put into practice. The induction takes approximately 6 weeks. A staff training matrix showed compliance with all mandatory training procedures. Fire prevention training, moving and handling, and prevention of adult abuse are updated for all staff every year. There was evidence for other mandatory training being up to date – first aid, basic food hygiene, infection control and COSHH. There are several staff who are trained as trainers in subjects such as moving and handling and prevention of adult abuse, so that they can pass on the training to other staff. Nurses are encouraged to develop their own nursing skills, and training was evidenced for subjects such as medication management, male catheterisation, syringe-driver training, administration of subcutaneous fluids, and palliative care training. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 21 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): 31-38 The quality for this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The manager is proactive in all areas of administration and management, and provides good leadership in the home. EVIDENCE: The manager is a level 1 nurse with a diploma in care home management, and she is completing a degree in rehabilitation (BSc. Hons.) She keeps her own nurse training up to date with other relevant courses and study. The home is working with “Essence of care” – organised by the NHS/PCT to promote good practice in nursing homes. She provides a good leadership presence in the home, and is always available for staff, service users, and relatives as needed. She carries out nursing duties as well as management, and leads the staff team in furthering their understanding, knowledge and skills. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 22 The staff said that there is always opportunity to chat informally at handovers, and staff meetings are held two to three times per year. The minutes showed that fifteen staff attended the last one. The manager carries out quality assurance surveys in the home twice per year, and audits the results. The questions include items such as: if service users find the home friendly, how they feel about visitors coming into the home and visiting arrangements etc. The audits were excellently arranged, and included a PIE chart to show the results. The manager arranges regular residents meetings to keep them informed of any changes in the home, including details of alterations inside the building, as well as progress with the plans for the extension. Eight service users attended the last meeting, and the minutes showed discussions included food, activities and building work. All accounts for the home are audited annually, and the accountant keeps a very strict check of all income and expenditure. The home is financially viable. No finances for service users are managed in the home. Service users have a lockable facility for anything they wish to look after themselves, otherwise they appoint a representative. The manager said that extra payments such as hairdressing and chiropody are paid for by the home, and then the relatives/representatives are billed for the extras. Staff supervision sessions are delegated between nurses, and are carried out five times per year, with a sixth meeting as a yearly appraisal. Nurses have practical clinical supervision sessions as well. Records in the home are kept locked away, except for care plans which are stored in the front office. The door can be locked if trained staff are not in the vicinity. Maintenance records, accident records, complaints records and care plans were up to date and well completed. Some handwriting is not always very clear, but was still readable. Policies and procedures are reviewed and amended as necessary every year, and had been done this year. The manager ensures safe working practices by keeping staff mandatory training up to date. She has implemented her own risk assessments for chemical products, as well as the leaflets which are provided. There is suitable locked storage for chemicals. Maintenance records were viewed for electricity, gas, fire and security systems, hoist and lift servicing, and PAT testing. The manager is proactive in carrying out audits for different areas. This includes accident/incident records, which are audited monthly, showing any patterns or risks, which can be diminished by a change of protocol. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 23 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 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 2 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 24 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 OP19 Regulation 39 (h) Requirement Ongoing requirement to keep CSCI informed about the proposed new building work, and supplying CSCI with a new action plan with timescales once the plans are approved. Timescale for action 14/05/07 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 OP19 Good Practice Recommendations To ensure there is an ongoing review of the premises, keeping décor and furnishings in a satisfactory condition while alterations are being made to the building. The Knoll Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Kent and Medway Area Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Nursing Home DS0000026103.V301615.R01.S.doc Version 5.2 Page 26 - 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. 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