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Inspection on 20/08/05 for The Knoll Nursing Home

Also see our care home review for The Knoll Nursing Home for more information

This inspection was carried out on 20th August 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The level of care in the home is good. Service users all looked clean and well presented. A visitor commented, "I am happy with the care here". There is a homely atmosphere with a friendly staff team. Service users commented, "the staff are always very happy", and "we get good care", and visitors commented, "the staff are marvellous", and "its very homely" Food served is nutritious and appetising. Service users commented, "the food is very good", a staff member said, "there are good choices of food and a varied diet", and a visitor commented, "I sometimes have a meal, the meals are very good".Staffs are well trained to perform their roles. Administration is up to date and relevant. Visitors are always made welcome. Visitors comments included, "I am always made welcome", and "its very good". The home copes well with death and dying and gives good support to family at this time. A visitor who had a recent bereavement said, "They were great, everybody was very kind and I got a lot of support" General comments included a service user who said "I`m happy here", staff members commented, "I would not be here if I were not happy with it", and "It`s a good care home", and visitors commented "I am very happy with the home, its absolutely brilliant", and "its better than anywhere else she has been".

What has improved since the last inspection?

The entrance hall, office, kitchen and staff room and one bedroom have all been redecorated, and new carpet has been fitted in some of the areas. A new sluice has been fitted. A new shelf, with built in dividers, has been fitted in the office for the storage of care plans. The MAR record sheets for medication administration are now fitted with reinforcement rings to avoid the danger of sheets falling out and being lost. Staff files are now stored at the premises rather than at the off-site office. The cleaning staffs have been working hard at reducing odour within the home and a significant improvement was noticed.

CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 196 Dover Road Walmer Deal Kent, CT14 7NB Lead Inspector Chris Randall Announced Inspection 20/09/05 at 09:20 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Knoll Nursing Home Address 196 Dover Road, Walmer, Deal, Kent, Ct14 7NB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 374679 01304 374679 Raj and Knoll Limited Mrs. Amita Patel Registered Care Home 28 Category(ies) of Older People x 28 registration, with number of places The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 11 of the 28 beds registered for nursing patients are also registered for the admission of residential clients 2. The 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 them leave the home 3. Service user under the age of 65 to be restricted to one whose date of birth is 09/04/1947. Date of last inspection 21/06/05 Brief Description of the Service: The Knoll Nursing Home is a large detached building, situated at the junction of the main road leading from Dover to Deal and a minor road, and is 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. The home is registered for 28 older people with 3 conditions of registration as listed above 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. 8 rooms have en-suite facilities. Outdoor space is currently limited to a small patio area with attractive planted pots which is accessible for service users to sit out in good weather. However, there is a large public park almost opposite The Knoll which families can use 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 extensive building work to link the two properties. Some structural alterations and refurbishment of the existing building will be undertaken as part of the new project. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and took 12 hours (7 hours in the home plus preparation time). The inspection took the form of a tour of the majority of the building, although rooms where personal care was being provided at the time were not inspected; speaking to most service users, 9 in some depth, 7 staff, 4 visitors and the manager; observation of an activities session; observation of interaction between service users and staffs, and of a meal being served; examination of medication storage and of various records. The home was generally clean. There was a nice atmosphere in the home, service users and staffs were all happy, and service users looked well cared for. The meal served was well presented and there was a choice of both main course and desert. Service users who chose to take part enjoyed the activities afternoon. Several improvements had been made to the home since the last inspection including some decoration and new carpets. Currently there are 24 service users accommodated in the home. One visitor commented, “if I ever have to come to a home I will come here”, and a service user commented, “I am happy here”. What the service does well: The level of care in the home is good. Service users all looked clean and well presented. A visitor commented, “I am happy with the care here”. There is a homely atmosphere with a friendly staff team. Service users commented, “the staff are always very happy”, and “we get good care”, and visitors commented, “the staff are marvellous”, and “its very homely” Food served is nutritious and appetising. Service users commented, “the food is very good”, a staff member said, “there are good choices of food and a varied diet”, and a visitor commented, “I sometimes have a meal, the meals are very good”. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 6 Staffs are well trained to perform their roles. Administration is up to date and relevant. Visitors are always made welcome. Visitors comments included, “I am always made welcome”, and “its very good”. The home copes well with death and dying and gives good support to family at this time. A visitor who had a recent bereavement said, “They were great, everybody was very kind and I got a lot of support” General comments included a service user who said “I’m happy here”, staff members commented, “I would not be here if I were not happy with it”, and “It’s a good care home”, and visitors commented “I am very happy with the home, its absolutely brilliant”, and “its better than anywhere else she has been”. What has improved since the last inspection? What they could do better: There were a couple of areas where some residual odour still remains but these are being addressed through the provision of new carpet and additional cleaning. The clinical room is still far from ideal and is very cramped, however it is anticipated once the new works have been completed and a new clinical room has been provided this problem will cease. Please contact the provider for advice of actions taken in response to this The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 7 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 H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, & 5 A thorough assessment process, trial visits, and provision of clear information ensures that prospective service users can be confident the home will be able to meet their needs. EVIDENCE: The statement of purpose and service user guide has been updated and now includes details of the proposed extension to the home, and an analysis of the service user survey. Each service user is issued with a contract/statement of terms and conditions within the home and this includes the room number, details of the fee, and gives details of what is not included within the fees. The manager visits prospective service users to complete a comprehensive assessment of needs prior to admission. For service users who are under the care management scheme a joint assessment is also obtained. These assessments are then used to form the basis of the plan of care. The manager will not accept new service users unless she is confident that the home can meet their assessed needs. Where additional equipment is required The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 10 to meet the needs of a prospective service user these are arranged prior to admission. All prospective service users are offered trial visits; some view the home and spend time with the other service users, and may stay for a meal if they choose; others come for respite care prior to admission; the first month of occupation is classed as a trial visit for all service users, giving the opportunity for them to decide if this is the right place for them and for the home to fully assess their ability to meet the service users needs. The home does not currently offer the facility of intermediate care, although they hope to include this service once the alterations and extensions are complete. A visitor commented, “we feel fortunate to have got her here”. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, & 11 Service users can be confident that their health and personal care needs will be met by the staffs at the home, and that they will be treated with respect. EVIDENCE: All service users have a comprehensive care plan, and details include records of professionals visits, accident incident records, pressure area charts & body maps, monthly weight record, a daily report sheet, various dependency assessments and risk assessments including moving and handling risk assessments. The care plans are reviewed monthly and updated if necessary between normal review dates. The physical and mental health care needs of service users are met by the nursing and care staffs of the home backed up by G.P’s and other specialists where necessary. One visitor commented, “she is not easy to care for but they do very well”. The nursing staffs deals with any pressure areas and the nurses have attended appropriate tissue viability training. There is sufficient equipment available in the home to ensure the promotion of tissue viability. Nutritional screening is The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 12 undertaken on admission and is regularly monitored and the weights of all service users are recorded monthly. Medication in the home is under the control of the registered nurses. The medication/clinical room is currently very small and cramped, however this will be remedied once the extension has been completed and the new medication room has been provided. The home uses the monitored dosage system for the administration of medication. Medication records seen were up to date and relevant and the home has introduced a system of applying reinforcement rings to the MAR sheets to avoid the danger of them falling from the folder and getting lost. The home has a drugs fridge and the temperature is recorded daily. Controlled drug storage and recording is all in order. The home does not have any homely remedies. Although Boots are investigating the possibility of disposal of unused medication, in order to comply with their duty of care the home has made an interim arrangement with the collector of their clinical waste. Service users privacy and dignity are respected and upheld. In shared rooms there are curtains to ensure privacy when personal tasks are being undertaken. Medical treatments are undertaken in the service users own bedrooms. Staffs treat the service users with respect. Service users comments included, “they treat me with respect and look after me properly”, and “the staff are all very nice, all polite and well behaved”, and a visitor commented, “I have never seen any of the staff being disrespectful” Care and comfort are given to service users who are dying, and to their families. Service users are able to die at home surrounded by their own belongings unless there is a medical reason for them to be transferred to hospital. Visitors are able to spend as much time with the service user as they wish, subject to the service users agreement. A visitor commented, “I stayed here for 2 nights, I was offered endless cups of tea and food, they were so good”. Another visitor commented, “Uncle always used to say he loved it here, when he was in hospital and dying the manager visited him there”. Staff always attend and send flowers to the funerals of deceased service users. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, & 15 Service users are able to exercise choice over all aspects of their lives. Visitors are made welcome, a wholesome and nutritious diet is provided, and suitable activities are available for stimulation of mind and body. EVIDENCE: The service users at the home have opportunity to take part in activities. An outside activities organiser calls once or twice a week. One of these sessions was witnessed and 9 service users had chosen to participate, it lasted for a good two hours and included poems, reminiscence, ball and balloon games, bingo, quizzes and music. In addition to these sessions there are twice-weekly music session, manicure afternoons, communion once a week, tea parties for birthdays and a group of service users had recently been out in a mini bus to visit Samphire Hoe and have an ice cream. One service user commented, “We have lady Fran for activities”, visitors commented, “they have a party the week before Christmas with residents and their families and staff and spouses”, and “she had a cake and they all sang happy birthday”. Visitors are made very welcome in the home and made various comments including “I am always made welcome”, “we always feel we can call in at anytime”, “I stayed here over Christmas, we had a nice Christmas meal”, ”they look after the relations as much as the residents”, and “I am always offered tea or coffee”. Service users can see their visitors in the lounge or their The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 14 bedrooms according to their wishes. One service user commented, “my son comes when he can, they always ask all visitors if they would like a cup of tea”. Either service users or their representatives deal with their own financial affairs and the home does not handle any service users monies. If service users wish to bring items of their own furniture or belongings into the home they are encouraged to do so. A balanced diet of wholesome and nutritious food, which is attractively presented, is served to service users. Hot and cold drinks are available throughout the day and night. The kitchen is clean and well organised, storage of food is appropriate and fridge and freezer temperatures are recorded. The cook provides home cooked fresh food for the majority of meals. The menu ensures that there is always a choice of meals available. Special diets are catered for; currently this includes diabetic, high protein, low carbohydrate, and soft diets. Soft diets are presented as separate foods, therefore giving the appearance of a normal meal. Meals can be enjoyed in the dining area, at tables in the lounge, or in service users own bedrooms and staff assistance is available whenever needed. Service user comments included, “The food is very nice, and plenty of it”, and “I think the food is good”, visitors commented, “I am staying for lunch today”, and “the food always looks good”, and a staff member said, “they always try to accommodate service users choices”. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 Service users can be confident that their complaints will be taken seriously, that their legal rights will be protected, and that they will be protected from abuse. EVIDENCE: The home has a clear complaints policy. The home records all complaints, however minor and there have been 7 minor complaints recorded since the last inspection. In each instance a record was also made of the actions taken to resolve the complaint. Service users who are able still participate in the electoral process. The home completes the Register of Electors information annually. The majority of service users have postal votes although sometimes family members take service users to the polling station. The home has good policies on the protection of service users from abuse, and whistle blowing. They also have the latest guidelines from Kent Social Services on adult protection. All new staffs are checked against the POVA list prior to employment and there have been no referrals to this list made by the home. Staff are all trained in adult protection and one member of staff is trained as an adult protection trainer ensuring that she can train all new staffs and keep all of the existing staffs up to date in this important subject. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, & 26 The accommodation is homely, regularly maintained, generally clean, and meets the needs of the service users EVIDENCE: The home is applying for planning permission to convert and link the adjoining property and to make extensive alterations to the existing building. An ongoing requirement has been added that CSCI be kept informed about this work and that once planning permission is obtained an action plan with timescales be produced to the commission. Once the planning permission is obtained considerable alterations will be made to the existing property, however in the interim period the manager has redecorated the hallway, kitchen, staff room, and office with new carpet being laid in some of these areas and in one bedroom. Further carpeting is on order for another 2 bedrooms and routine maintenance is ongoing. Although currently the outdoor space is limited to a small patio area this is kept tidy, The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 17 safe and attractive with lots of pots with a variety of plants. The outside area is accessible to service users. The communal area consists of an L shaped lounge/dining room; which accommodates two distinct sitting areas and a dining area. There are sufficient toilet and bathing facilities provided and these all have appropriate adaptations e.g. raised toilet seats, grab rails, bath with hoist, and ‘parker’ bath. The home has a variety of other hoists available to aid with moving and handling of service users. Individual moving and handling, and dependency assessments are undertaken on all service users, and appropriate equipment is provided to meet their needs. All parts of the home are accessible and there is a lift for access to the upper floors. The home still has one bedroom that accommodates 3 service users. There is awareness that this does not meet the National Minimum Standards but as the three service users chose to share some time ago this has been accepted at the current time. However should one of the beds become vacant this room will need to revert to a double room and there is a condition to this effect on the registration. All shared rooms have appropriate curtaining to enable personal tasks to be carried out in private. Many of the service users have brought in items of their own belongings or furniture to personalise their rooms. All rooms have appropriate furnishings, lighting and heating, and all are naturally ventilated. Water temperatures are checked regularly. The home is generally kept clean. There were 3 areas where an odour was noted, one currently unused bedroom that is waiting for a new carpet to be fitted, one other bedroom where a new carpet is on order and an area on the ground floor where it was identified that the odour was probably coming from the wheelchairs and not the carpet. The home intends to address the issue of the odour from the wheelchairs and a recommendation has been added that this is carried out. Visitors’ comments included, “its always clean” and “its always very clean”. Infection control procedures at the home are good. There is sufficient hand washing facilities provided. Gloves and aprons are used whenever necessary. The laundry area is clean and there are plenty of washing machines and tumble driers available with a spare of each stored in the garage for emergency use. There is a washing machine fitted with a sluicing facility for soiled laundry. There are two sluices; one on the ground and one on the first floor and a new sluice has been fitted in one of these rooms since the last inspection. Clinical waste is stored in a locked container and a contract is held for its collection. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 A properly recruited, well-trained, competent and caring staff team meets Service users needs. EVIDENCE: The staffing rotas and the number of staff on duty on the day of the inspection indicates that the home has sufficient staff to meet the needs of the service users. The current rota consists of 1 nurse and 4 care staff in the mornings plus 2 domestics and a cook. In the afternoon there are 1 or 2 nurses with 3 carers and overnight there is 1 nurse and 1 carer. The manager explained that when it is necessary to meet an increased need, extra staffs are employed on shift. Staff explained, “we have a 20 minute break in the morning”, and “we are provided with our tunics”. Currently only 4 of the 14 care staff (28.5 ) have achieved NVQ level 2 or above although 3 more are due to enrol on the course which, if they all complete and pass, will bring the total up to the minimum expected of 50 . A recommendation is made that this training is ongoing. Recruitment procedures are thorough. No new member of staff is employed until 2 written references and a satisfactory POVA first check have been received. Staff then work under supervision until the satisfactory enhanced disclosure is received. Nurses are checked against the UKCC register. All staffs are employed subject to the GSCC code of conduct and all receive copies of their terms and conditions of employment. Staff files are now being stored at the home rather than in the off-site office as previously reported. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 19 Evidence was seen in some of the nurses personnel files of recent training in best practice in medicine management, tissue viability, male catheterisation, catheter management, administration of flu vaccination, digital rectal examination and manual removal of faeces, COSHH, fire protection, abuse, subcutaneous fluid administration, and moving and handling instructors certificate. 6 staffs are now moving and handling trainers, which ensure that all staffs can be regularly updated in this important aspect of their roles. Recent training for care staff included moving and handling, fire, food hygiene, COSHH, First Aid, and Infection control. Staff comments included “there is lots of in house training”, and “we are all trained to use the hoists” Service users comments about the staffing included, “the staff are wonderful”, “the staff are excellent”, “the staff do their best – they look after us well”, and “the staff are very good”, and visitor comments included, “the staff are always very helpful and friendly”, “the staff always keep us informed”, and “there always seemed to be enough staff”. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37, & 38 A suitably qualified and experienced manager, good administration processes, and a healthy awareness of health and safety, ensure the service users safety. EVIDENCE: The manager is a first level registered nurse who holds a diploma in care home management and is undertaking a B.Sc (Hons.) degree in rehabilitation The manager undertakes a variety of training to keep her own practice up to date and in addition to the training noted above evidence was seen of attendance this year at courses in best practice in medication management of the elderly, COSHH, male catheterisation, subcutaneous fluid administration. The Knoll is one of the lead homes in Essence of Care, which is organised to promote good practice in nursing homes. This group was originally funded by the NHS but the homes are now organising it themselves to benchmark The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 21 quality. Currently they are looking at social needs of service users and how best to meet them. The ethos of the home is open and positive. The manager and her deputy are visible and approachable and communicate a clear sense of direction. The home operates good quality assurance procedures and quality questionnaires are circulated to all service users, via their families or representatives, with an analysis of the survey being attached to the service user guide. All policies and procedures are regularly reviewed. The financial procedures in the home are sound and it is financially viable. Insurance cover is at an adequate level and is up to date. The home does not handle any money for service users; families or representatives deal with this for them. For the few services that are not covered under the fees, hairdresser, and chiropodist the home will pay for the service and then invoice the financial representative. Newspapers are billed direct to the financial representative. All staffs at the home are supervised 6 times a year and the manager has her own networks to ensure that she can also receive clinical supervision as needed. All records kept in the home are up to date, relevant, and are appropriately stored for security and confidentiality. The home has a written health and safety policy. Accidents are recorded and are cross-referenced to a sheet on the service users care plan. Safe working practices are complied with, including training in infection control, moving and handling and fire safety for all staff. Staffs who deal with food all have basic food hygiene training and there is a member of staff trained in first aid on duty at all times. The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 2 3 3 2 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 3 The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 23 Yes - one ongoing 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 19.4 Regulation 39 (h) Requirement Ongoing requirement to keep CSCI informed about the proposed alterations and new building work, and supplying CSCI with an action plan and timescales once the plans are improved. (Original timescale not yet reached) Timescale for action 31/12/05 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 26.1 Good Practice Recommendations The wheelchairs, which appear to be creating an odour on the ground floor, should be cleaned and the odour eliminated to ensure that the home is kept free from offensive odours. Training should be ongoing to ensure a minimum of 50 of care staff are trained to NVQ level 2 or above. 2. 28.2 The Knoll Nursing Home H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU 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 H05-H56 S26103 The Knoll Nursing Home V243415 200905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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