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Inspection on 20/09/05 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 September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 home is in a secluded yet accessible setting with some of the rooms having attractive views across the valley and others overlooking the gardens. The communal areas are airy and spacious with large windows. Staff are welcoming and were seen to treat residents with respect. One resident said that since she had been admitted to the home she had `never looked back` and felt that the home had been a `good choice` and that the staff were kind and the food `marvellous`. The residents looked well cared for and those being nursed in bed looked very comfortable.

What has improved since the last inspection?

Some of the badly worn carpets have been replaced. National Vocational Qualification in care at level two was now being arranged for care staff with several due to start their training. The provider continues to work towards meeting requirements and recommendations.

CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX Lead Inspector Catherine Paling Unannounced Inspection 20th September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Knoll Nursing Home Address 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX 01274 619207 01274 620194 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) The Knoll Nursing Home Ltd c/o ADL plc Care Home 42 Category(ies) of Physical disability over 65 years of age (42), registration, with number Terminally ill (3) of places The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 December 2004 Brief Description of the Service: The Knoll is a detached, converted Victorian property. The home is located in a residential area close to local amenities and on public transport routes. A long driveway leads to the home and there are parking facilities to the front of the property. There are gardens surrounding the home that are accessible to the residents. The accommodation is over four floors although residents only use the ground and first floors. A passenger lift goes to all floors. There are thirty-nine bedrooms in total; thirty-six single and three shared rooms. Eleven of the bedrooms have en-suite facilities. There are four communal bathrooms; three showers and ten communal toilets. There are three lounges on the ground floor. One has a conservatory area and two of the lounges are also used for dining. The home is registered to provide personal care with nursing for residents over the age of 65 years. There are three beds registered to provide palliative care. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has to carry out at least two inspections of care homes every year. The inspection year runs from April to March and this was the first inspection visit for 2005/2006. Copies of previous inspection reports are available at the home or on the Internet at www.csci.org.uk. The last inspection of the home was on 21 December 2004. This was an unannounced inspection carried out by two inspectors who were at the home from 09.30 until 17.30. The main purpose of this inspection was to make sure that the home provides a good standard of care for the service users and to assess progress on meeting any requirements or recommendations made at the last visit. The methods used at this inspection included looking at care records; observing working practices and talking to staff, service users, relatives and to the manager. What the service does well: What has improved since the last inspection? Some of the badly worn carpets have been replaced. National Vocational Qualification in care at level two was now being arranged for care staff with several due to start their training. The provider continues to work towards meeting requirements and recommendations. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 6 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 DS0000019883.V251368.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. (Standard 6 does not apply) Information about the home is not readily available to residents or relatives. All residents have their needs assessed prior to admission to the home. EVIDENCE: There was no Statement of Purpose, Service User Guide or brochure available at the home on the day of the visit. The manager agreed that there was no information at the home that she would have been able to provide for any prospective clients. The manager said that these documents were being updated. Once updated these documents must be made available to residents, relatives and to the CSCI. Residents have their needs assessed before they are admitted to the home. Overall there was sufficient information in these assessments although some were more detailed than others. One resident had been asleep during the preadmission assessment and this had affected the accuracy of the assessment for example, the resident’s poor eyesight had not been recorded. Requirements and recommendations have been made. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 9 The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, and 10. Care plans are poor and the lack of appropriate records provides the opportunity for needs to be overlooked. Residents are treated with respect and their privacy is upheld. EVIDENCE: There were care plans in place for all the residents. The care plans were generic, pre-printed documents which rely on staff adding in specific personal information about the needs of the residents. There was little useful detail about the management of individual needs. A care plan for a resident who was falling did state that she did not use her nurse call and will call if she wanted help. There was no other information about how the risk of falling is managed other than stating that she falls and is unsteady. The effect of the standardised generic care plans is that the format does not encourage personal detail and any relevant information added was hard to extract. One resident with mental health needs was showing some aggressive tendencies. There was no information within care plans about any coping strategies for the staff. It was recorded in one plan that the community psychiatric nurse (CPN) should be contacted for advice and guidance. There was no information about whether this had been arranged. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 11 Personal hygiene needs were not specific about the precise assistance needed from staff, for example, the plan stated that the resident ‘will require a weekly bath/shower’. It was not noted which the resident would prefer and how they would get in the bath or shower, how many staff might be needed, and when the resident might prefer to have their bath or shower. The care plans were being evaluated briefly and it was suggested to the manager that a specific date be recorded for the review rather than the month to make sure that the review is actually monthly. Some relevant information identified at the care plan review did not always result in the update of the care plan and was potentially being ‘lost’. There was a range of risk assessments being carried out for all residents including for nutritional risk; risk of falling and for the risk of skin damage. Continence assessments were also carried out. It was not always clear how the level of nutritional risk had been calculated and the accuracy of the calculation was in doubt. One resident had been admitted with a very low body weight and it was also recorded that he had a poor appetite. There was no evidence that advice had been sought from the GP or the dietition. The information on the care plan gave staff only vague instructions for ‘regular encouragement with diet’ and to ‘monitor closely’ with no specific detail of how this risk is managed. There was no food diary for this resident. It was recorded in the daily records that his skin was becoming reddened and was at high risk of developing skin damage. There was no turn chart in place and the instruction in the care plan was ‘to monitor due to bony prominences’ without specific detail and instruction for staff. There was no detailed risk assessment for the bed safety rails in use. Daily records indicated that the resident had made many attempts to climb out of the bed with the safety rails in place. There was no indication that the risk of using the safety rails had been reviewed in the light of this. Residents who were spoken with said that the staff treated them with respect and a visitor said that the staff were ‘always kind’. Requirements and recommendations have been made. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13. Residents are encouraged to make some choices in their daily lives. There is a lack of stimulation at the home meaning that some residents are bored. EVIDENCE: Residents had mixed views about the activity provision at the home. One resident was content with her life at the home saying that since she had come to live at the home she ‘had never looked back’. Staff helped this resident to occupy her time knitting. Another resident said that she was bored ‘doing nothing from morning to night’. Social care plans had not been individualised resulting in little personal detail of how residents like to spend their time. Records of activities at the home were held centrally and indicated a limited range of activities at the home. At the time of the inspection a resident was having an aromatherapy massage. The aromatherapist visits the home twice a month. Residents had some choice about the times of rising and retiring. There were night care plans in place but daily records indicated that the information held The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 13 in these was not accurate or had not been updated in the light of changing needs. A regular visitor to the home said that she was always made to feel welcome and was able to make herself a drink when she visited. The visitor said that staff were always busy and rarely had time to do activities and also commented on how much the residents enjoyed a keyboard player who visits the home once a fortnight. A requirement has been made. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Complaints are dealt with appropriately. Overall residents are protected from abuse but staff need robust procedures with further training and guidance to make sure that residents continue to be protected. EVIDENCE: The complaints procedure was displayed at the home on the notice board at the entrance but was obscured with other notices. There was a book for relatives to record concerns, kept by the signing in record. It was suggested that there might be a reluctance to record concerns in a book that could be accessed by others. The policy and procedure file did not include a copy of the complaints procedure. A record was kept of complaints received at the home, including verbal complaints. Records evidenced the action taken by the manager to address concerns. The adult protection procedure at the home does not refer to or link into the local authority multi agency procedures. There are no contact numbers provided for staff telling them where they could get advice. Some staff have recently accessed training on adult protection. After discussion with staff the manager was advised that she must assess the quality of the training to make sure that it is pertinent and reflects the local authority procedures. The CSCI and the adult protection team are currently investigating a complaint at the home with the cooperation of the provider. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 15 A requirement has been made. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: None of these standards were assessed at this visit. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Overall there were sufficient staff to meet the needs of the residents. Training was being provided to staff to make sure that they are competent to do their jobs. EVIDENCE: On the day of the visit there was a shortage of staff due to staff sickness. The manager was in charge of the shift and despite being a member of staff down the home was calm with no sense of the pressure the staff were working under. One qualified member of staff was on annual leave and the manager was rostered to work seven days during that week. The care staff were supported by some domestic staff although they were expected to carry out some non-caring duties such as clearing tables and stacking the dishwasher. A training audit had been done indicating that twelve carers have completed TOPPS induction with six having completed the foundation course. Mandatory training was being carried out for staff with additional topics such as palliative care and adult protection. Care staff are also undertaking NVQ training with four staff already working towards level two and a further three or four carers were to be enrolled soon. One member of staff who had recently commenced at the home referred to an induction list but said that she had not had to provide any written evidence of her learning. Recommendations have been made. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 18 The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 37. Although the manager works with staff and provides ‘hands on’ leadership she now needs to develop the policies and procedures to guide and support staff in their work. EVIDENCE: The manager has made application to become registered with the CSCI and this is being processed. She is an experienced nurse although this role is her first experience as manager of a care home. The manager is currently undertaking the Registered Managers Award. There is an established system of audits as part of the monitoring of the home. These include audits and regular checks of the kitchen, care plans, the medication provision and accidents to residents. An annual audit of the views of residents and their families is done. The information was collated but had not been made available to residents and their relatives. It was recommended that this be done in the interests of openness. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 20 There was an ‘Essential care’ policy and procedure file containing a range of information for staff. The document seen was a mix of two formats and many were undated and did not reference any good practice documents or research. The policies were not all indexed with pages not numbered or the policies dated. Overall there was a lack of specific instruction for staff. The manager said that she was not familiar with the documents. Staff do not have access to detailed policies and procedure to support them in their role in meeting the needs of residents. A recommendation has been made. The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X 2 X The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4 Requirement Timescale for action 01/12/05 2 OP1 5 3 OP7 15 4 OP8 12 The registered provider must make sure that the Statement of Purpose is updated and made available to residents and their representatives. A copy must be provided to the CSCI. The registered provider must 01/12/05 make sure that the Service User Guide is updated and includes a recent copy of the inspection report, the complaints procedure and residents views of the home. (previous timescale of 30/04/05) Care plans must set out in detail 01/02/06 the action which needs to taken by nursing and care staff to ensure that the health, personal and social care needs of the resident are met. Care plans must be drawn up with the involvement of the resident and agreed and signed by the resident wherever capable and/or their representative. The registered person must 19/12/05 make proper provision for the health and welfare needs of the residents to be met. A review must take place of the DS0000019883.V251368.R01.S.doc Version 5.0 The Knoll Nursing Home Page 23 5 OP9 13(2) 6 OP12 16(m)(n) 7 OP18 12(1)(a) 13(6) nutritional risk assessment currently used to make sure that there is accurate identification of those residents nutritionally ‘at risk’. Records must demonstrate clearly how that risk is to be managed. The registered provider must 05/12/05 ensure that there is a policy and that staff adhere to the procedures for the receipt, recording storage administration and disposal of medicines. (previous timescale 30/04/05) The registered provider must 09/01/06 consult residents about their social interests and about the programme of activities arranged for them. Facilities must be provided for recreation taking into account the needs and abilities of the residents. The provider must ensure that 09/01/06 the home develops and implements an adult protection procedure which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. The Local Authority Multi- agency procedure must also be available to staff. Staff must receive relevant and informative training to equip them with the knowledge to recognise and act appropriately to protect residents. All threadbare carpets must be replaced. (previous timescale of 23/12/04) The registered provider must make arrangements to ensure that there are adequate toilet and bathing for all residents. (previous timescale of 24/12/04) The registered provider must ensure that all residents DS0000019883.V251368.R01.S.doc 8 9 OP19 OP21 23(2) 23(2)(j) 09/01/06 06/02/06 10 OP24 12(4)(a) 06/02/06 Page 24 The Knoll Nursing Home Version 5.0 11 OP28 18(1)(a) bedroom doors are fitted with an appropriate lock which allows staff to gain access in an emergency. (previous timescale 31/05/05) The registered provider must 31/12/05 ensure that the minimum ratio of 50 trained members of care staff is achieved by 2005. 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 OP3 Good Practice Recommendations The manager should make sure that all pre-admission assessments are carried out thoroughly so that the resident can be assured that their needs can be met at the home. The manager should consider the use of food diaries for those residents nutritionally at risk’. A review of the staffing numbers and skill mix of qualified and unqualified staff should take place to ensure that these are appropriate to the assessed needs of the service users, the size, the layout and purpose of the home, at all times. The number of staff and hours in respect of service user needs should be based on guidance recommended by Department of Health. Care staff should provide written evidence of their induction training. The information collated from the annual audit of residents and their relatives should be made available to all interested parties. The manager should be familiar with the homes policies and procedures. Staff should have access to them, to support them in their work. 2 3 OP8 OP27 4 5 6 OP30 OP33 OP37 The Knoll Nursing Home DS0000019883.V251368.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 DS0000019883.V251368.R01.S.doc Version 5.0 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. 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