Inspection on 21/05/08 for The Knoll Care Home

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Knoll Care Home 24/05/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 33 Preston Road Yeovil Somerset BA21 3AE Lead Inspector Justine Button Key Unannounced Inspection 21st May 2008 10:00 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 DS0000066156.V363129.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 DS0000066156.V363129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knoll Nursing Home Address 33 Preston Road Yeovil Somerset BA21 3AE 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) 01935 421822 The Knoll Nursing Home Limited Mrs Tricia Susan Oliver Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 29. 24th May 2007 Date of last inspection Brief Description of the Service: The home is a converted house with a purpose built extension, situated a few minutes walk from the centre of Yeovil. Accommodation is on two floors. All the bedrooms are single occupancy. There are an adequate number of adapted bathrooms. There are two reception rooms and a conservatory area. There is a small dining area although this cannot accommodate all the people who live at the service. There are well-maintained gardens and patio area, which can be seen from the two main sitting areas. The home provides general nursing care for older people and can offer personal care for three people. The proprietor lives on the premises and has day-to-day contact with the service users. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out over one day by one inspector. The inspector would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The home completed an Annual Quality Assurance Assessment, AQAA, which has yet to be received by us, the CSCI. A number of service user surveys were sent to the home. To date none of these have been returned to us. The content of the Comment cards will be included in the next inspection report. The inspector was able to see and observe staff interactions with many residents, meet several relatives, discuss care issues with staff and discuss the management of the home with senior staff. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were care and support plans as part of the case tracking process, medication administration records, maintenance records, the home’s Statement of Purpose, staffing rosters, menus, the home’s complaint’s file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The Knoll is a home, which has a history of providing a poor service to the people who live at the home. In October 2007 a new manager was recruited. Since this time the care and support afforded to people living at the home has improved. Some issues have been raised in the period between October 2007 and the present date. These concerns relate to the prevalence of pressure damage and general concerns regarding to the general care and support afforded to people. These concerns have been shared with social services and a number of meetings have been held to discuss these concerns and to ensure the safety of the people living at the service. In addition we have conducted number of visits to the home to monitor the progress made. The outcome of these visits is included in the body of this report. Considering the relatively short time span the manager and staff have made some significant improvements although the manager agreed during the The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 6 inspection that these need to continue over the next few months to ensure that the quality rating continues to improve. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: What has improved since the last inspection? During 2007 concerns were raised with regard to care and support afforded to people living at the home. This included the number and prevalence of pressure ulcers and skin damage. Since the last key inspection staff have worked hard at improving the standards of care such that the incidents of pressure damage has reduced. This includes a regular change of position. The care plans and documentation detailing the progress and treatment of any existing wounds or pressure damage has improved. This allows for the progression and the treatment of the wound to be assessed. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 7 The provision of diet and fluids has improved with all people now receiving a diet according to their assessed needs. Health care needs are now met with evidence that staff are supporting people to complete oral hygiene. The provision of social and recreational opportunities has improved. People now have the opportunity for social stimulation both within and outside of the home. The home now has procedures in place to reduce the risk of harm or abuse to the people living there. Robust procedures are followed for staff recruitment which include checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA). Then induction procedures for new staff have been updated and reviewed. These are now in line with expected standards. Staff training is organised although some of the training has yet to be completed. An increasing number of staff are now completing an NVQ. Upper floor windows and wardrobes are now secure reducing the risk of accidents to people living at the home. What they could do better: During the inspection it was noted that a number of bed rails had not been adequately maintained. This could pose a risk of injury to people who use this equipment. The home does not currently provide all people with nursing needs with an adjustable height bed. This could increase the risk of back injury to staff. The care planning process although improved since the last inspection requires continued development to ensure that the plans adequately reflect the needs of the individual and provide clear guidance to staff on the care needs of people living at the home. People lving at th ehome and/or their representative need to be involved in the development and review of the plan of care. This will ensure that care and support is delivered in the manner in which the individual would like and takes into account their likes and dislikes. The management of medication needs to be improved to ensure that all hand transcribed entries on the Medication Administration record are checked by two people. Creams and lotions prescribed by the GP need require a signature on the Medication Record when they have been applied. Not everyone at the home has the opportunity of eating their meals at a table due to the lack of dining space available. The management need to continue to consider ways of achieving this. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 8 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 summary of this inspection report can be made available in other formats on request. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 9 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 DS0000066156.V363129.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Standard 6 is not applicable in this home Quality in this outcome area is Good . This judgement has been made using available evidence including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. The home ensures that people are appropriately assessed before a placement is offered. All people living at the home have copy of the terms and conditions of their stay The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which details information about the home and services offered. This was reviewed and up dated in January 2008 and reflects the current managerial arrangements at the home All information, including a copy of the home’s last inspection report by the Commission, is displayed in the main reception area of the home. The terms and conditions of stay for the home have been updated and a copy of these was seen at the inspection in February 2008. These have been given to all people living at the home and will be used for all future admissions. We have sampled six care plans at this inspection and the random inspection in February 2008. We were able to see evidence that people are appropriately assessed by the home before a placement is offered. Care plans contained preadmission assessments and assessments from other healthcare professionals had been obtained where available. People who had recently moved in to the home and relatives confirmed during the inspection that they were able to visit the home prior to moving in order to ensure that home could meet their individual needs. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s care planning processes require additional development. Care plans need to promote a person centred approach to care and give clearer guidance to the staff on the needs of the individuals living at the home. People who live in the home have access to appropriate healthcare professionals. Healthcare needs are met in full including care in oral hygiene and the care and treatment of wounds and pressure sores. The home does not follow the correct procedures for the management and administration of resident’s medication. Staff interact with residents in a kind and respectful manner. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 13 EVIDENCE: The care planning process was reviewed both at this inspection and the random inspection which was conducted in February 2008. In the random inspection three care plans were viewed. At this inspection it was reported “The care and support plans for three individuals were viewed during the inspection. The care plans in use require additional development to ensure that they reflect the care needs of the individuals living at the home. One individual had been admitted to the home with vulnerable skin. A risk assessment for mobility and pressure risk had been completed. This however had not been reviewed by the staff so it was difficult to ascertain if care needs had changed or if the care being given was appropriate. A pressure wound for this individual had developed and a wound care plan and photographs were in place. For this individual a steady weight loss over several months had been recorded however there was no evidence to demonstrate that monitoring of this individuals dietary intake had or was in place. The care plan for this nutrition had not been reviewed since December 2007 despite the recorded weight loss. There was no evidence of the individual or their relatives being involved in the development of review of the plan of care. For the second individual who has type two diabetes there was no record of blood sugars being taken at any time. The care and support plan or nutritional assessment did not reflect the diabetes and therefore did not given clear guidance to staff of the needs of this individual. The individual had had previous issues with weight loss. A care plan had been developed which stated that the individual should be weighed weekly. Staff had not completed this. If the weekly weights were no longer required then the care and support plan should have been reviewed to reflect this. The individual had experienced previous pressure damage. This had now healed and a detailed care plan was in place to reflect the care that was now required. On viewing the individuals bedroom however cream was observed. There was no evidence in the plan of care for the use of this cream nor was this medication written on the Medication Administration Record. There was evidence for this individual that a relative had been consulted with regard to the development and review of the plan of care. The third individual, according to the preadmission assessment, had dementia, confusion and recurrent falls. On viewing this individuals bedroom it was clear the windows could be opened to the fullest extent and that the wardrobe was not secured to the wall. There was no environmental risk assessment in place The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 14 to reflect these issues. This may compromise the health and safety of this individual.” An additional three care plans were viewed at this inspection visit. The care plans viewed showed some signs of improvement particularly with regard to those people who had pressure damage. The care plans for the tissue damage were now in place and reflective of the care required. It should be noted that the incidents of pressure ulcers developing at the home has fallen over recent months. This demonstrates that the care and support afforded to people has improved and that the home is meeting needs more effectively. The plans viewed however continue to need additional development to ensure that they are reflective of the current needs of the people living at the home. This requires the plans to be reviewed on or at least a monthly basis. This review process should be completed more frequently if the individuals condition dictates this. Discussion took place with the manager who agreed that the care plans needed additional development. The manager stated that a new care planning system was due to be introduced at the home. In addition the manager has been completing training with staff to ensure that they are aware of their legal accountability with regard to care planning process and to ensure that all staff complete the plans consistently. It is hoped that improvements to the care planning process will be seen at the next inspection visit. During the inspection it was noted that all people had a regular change of position. This helps in the prevention of pressure damage and is a marked improvement on the findings of previous inspections. At this inspection all people had access to fluids and appropriate meals and snacks. Oral hygiene needs had been met with toothbrushes and toothpaste showing evidence of recent use. The care plans showed that people living at the home have access to other health professionals including GP, dentist and chiropody. Advise given by these individuals was seen to be incorporated into the plan of care. The homes procedures for the management and administration of medication was examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. As the MAR are pre-printed there are occasions when the GP may change the dose required in between the new MAR starting. In these cases staff should rewrite the prescription in full on the chart. This should be signed by two staff members to reduce the risk of the incorrect dose being given. This was seen for three people who had required drug changes. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 15 Some creams in use, seen in service user bedrooms, had not been marked with an expiry date nor had the MAR chart been signed to confirm that the creams had been applied as per the Prescription. Some creams and lotions seen in bedrooms did not relate to the individual to whom they had been prescribed. People living at the home who were able to express a view were very positive about the care they received. Staff interactions with service users were noted to be very warm, professional and respectful. Interventions were observed to be ‘unhurried’. Staff were heard explaining interventions to service users before carrying out. Service users appeared relaxed and comfortable throughout the day. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People have the opportunity for social stimulation in line with their preferences. People are supported to exercise choice over their lives. Meals are freshly cooked at the home and choices are offered. EVIDENCE: Care plans examined contained good information regarding individuals’ social history. It was apparent that family members had been involved in providing information about their relatives life and past interests. We were able to see that the home offers a range of activities both in and outside of the home. The majority of care plans contained an activity sheet which provided details about the activity offered and the outcome for the individual. This was lacking in some care plans and staff had recorded information in the daily record The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 17 sheet. It is recommended that a consistent approach is taken and that separate activity records are maintained. During this inspection we observed people moving freely around the home and accessing their bedrooms as they chose. The atmosphere was relaxed, people were ‘coming and going’ as they chose and staff confirmed that this was a regular occurrence. The home has recently employed an activities co-ordinator who was not on duty for this inspection. The activities organiser however was available on a previous visit to the home and discussed with us the improvements that have been made to the activity provision at the home. This has included structured activities such as flexersice weekly, bingo arts and crafts. The home has a library service and ‘shopping trolley’ which enables people to purchase such things as confectionary and toiletries. New garden furniture has been purchased which has enabled people the opportunity of sitting in the garden during the warmer weather. Staff confirmed that people were supported to make choices about their life. The care plans examined however contained limited evidence of peoples’ preferences regarding waking, going to bed or food and drink . The home welcomes visitors at any reasonable time in line wish the wishes of individuals. We met with some visitors during this inspection. The homes’ visitors book identified a number of visitors to the home at other times. We were able to see lunch being served at the home. Meals are prepared and cooked in the home’s kitchen. Catering staff are employed. Menus are now on display in the home. The meal looked wholesome and plentiful and staff were heard offering a choice of meals to people. The home currently has limited dining tables available however the provider is planning an extension in the future that will include an increase in the dining facilities. The limited tables that are available were attractively laid with condiments available. Refreshments appeared plentiful and people were able to choose from a selection of cold or hot drinks. The home is able to accommodate any specialised dietary requirements including for those individuals who require a soft diet or those who require a diet high in calories or protein due to tissue damage or weight loss. staff members were observed sitting with people and assisting them in an unhurried and respectful manner. The lunch time experience appeared pleasant and relaxed. People spoken with told us that the food was ‘very good’ and that there was ‘plenty to eat and drink’. During the afternoon further refreshments and cake were offered. Drinks were made available throughout the day. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place. The home has systems in place to reduce the risk of harm or abuse to the people living there. EVIDENCE: The home has an appropriate complaints procedure which is in the process of being updated to reflect the Commission’s revised contact details. The complaints procedure is clearly displayed within the home. There is also a ‘suggestion box’ clearly displayed in the reception area of the home. Since the last inspection the Commission has received a number of complaints and concerns regarding the level of care and support provided at the home. These complaint have been investigated with the full cooperation of the home manager and provider. Since the employment of an experienced and stable management structure improvements at the home have been seen although these need to continue over the next few months. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 19 We spoke to two staff both of whom confirmed that they were aware of the home’s whistle blowing policy and would feel confident in raising concerns if they had any. The staff members confirmed that they were aware of what to do if they, a person using the service or their relative/advocate had concerns about the home. ‘The complaints procedure is clear and there is a whistle blowing policy’ It could not be confirmed at this inspection that all staff had received training in abuse awareness although this is planned to take place over the next few months and all staff are currently completing the common induction standards which contains information on abuse awareness. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained in the majority of areas (see standard 38 for additional information) The home provides an adequate environment and is fit for purpose although on going decoration and up grading will be required. The home is clean and tidy with no malodours. The home should consider increasing the amount of height adjustable beds to meet the needs of the people living at the home. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 21 EVIDENCE: A tour of the building was conducted during the inspection. The home was clean and tidy on the day of the inspection. The bedrooms seen showed a degree of individuality with personal possessions being evident. There are two communal lounges and a small dining room. All areas were well used by people living at the home during the inspection. The gardens were pleasant and well maintained. The inspector observed that some work has been undertaken to improve the environment of the home. At the last inspection a number of the bedrooms had been decorated. This has included the splitting of the double rooms to make them single occupancy. At the random inspection which was conducted on in February 2008 it was reported that new furniture for the home has been ordered in addition the lounge area have been redecorated and upgraded. This has had a positive effect on the overall feel of the home. At this visit the new furniture was in place. People living at the home and relatives stated that they like The Knoll because of its homely feel. The provider, Mr Ghuman has submitted plans to the local planning department for an extension. Following the extension all communal areas will be redecorated. The home takes appropriate steps to reduce the risk of the spread of infection. Hand washing facilities are appropriately sited throughout the home and staff have access to protective clothing. Grab rails, ramps and nurse call points are appropriately sited throughout the home. Recent purchases now ensures that the home has an adequate number of mobile hoists and stand-aids. Moving and handling belts and slide sheets are also available. The home has a good supply of adjustable beds although not everybody who has nursing requirements has this equipment. This could compromise the health and safety of staff when nursing people in bed. It is recommended that risk assessments are completed for all people who do not have an adjustable bed to ensure that this equipment is provided for any person who spends significant periods in bed and those who require staff intervention, such as help with changing position, when in bed. At the random inspection conducted in February 2008 it was identified that a number of the upper floor windows and the wardrobes were not secure. This may place people living at the home at risk. At this inspection a tour of the building including some of the bedrooms was conducted. At this inspection it was noted that all the upper floor windows and wardrobe are now secure. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. This is a new staff team who are in process of developing. Although it could not be confirmed that all staff have received the necessary training skills and or competencies all necessary training has been arranged over the coming months. Staffing numbers at the home are adequate to meet the needs of the people living at the home. People are protected by the homes recruitment procedures EVIDENCE: Since the last key inspection the manager has reviewed the induction of new staff. A system has now been developed which includes all areas detailed in the Skills for Care Common Induction Standards. These standards are designed for people entering social care, and those changing roles or employers within adult social care. They are designed to be met within a 12week period, and were developed to reflect recent changes to the NVQ The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 23 requirements and the General Social Care Council Code of Practice. The General Social Care Council is currently consulting on the requirements for registration for social care workers. All staff at the home are completing this induction to ensure that all staff have a basic level of understanding and standards from which to work and any other training will be built upon this. Individual staff training is being reviewed by the home manager currently. NVQ training is being organised with four staff commencing the award the day following this inspection. The home currently supports four staff on an apprenticeship scheme. NVQ for cooks, housekeeping and ancillary staff is in the process of being organised All the Registered Nurses are newly employed at the home. Additional clinical training has been organised for these staff. A staff training plan was seen. This plan details the training organised for the next twelve months and will build on the common induction standards which staff are currently completing. An outside company has been paid to provide 24 staff places on abuse awareness, 1st aid, health and safety , infection control, moving and handling, fire training, dementia care, medication, MRSA and acquired infections , Palliative care and managing challenging behaviour. The manager has also set up regular training sessions held on a Wednesday afternoon for staff to attend. These training sessions include reviewing any critical incidents and improvements that could be made to the care and support provided and other areas such as nutrition and care planning. The new manager has reviewed the staff files for existing staff. These had previously not been satisfactory. Any required information and/or checks for these staff have now been obtained The home’s procedures for new staff recruitment were examined. Records relating to two staff recently employed were viewed and there was evidence that the home was following robust recruitment procedures which also included appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA). The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes manager has been in post less than six months and has made some significant improvements to the service and the care and support afforded to people living at the home. A system of staff supervision has been developed although this has yet to be extended to all staff System of monitoring health and safety and taking any required action are not adequate and may put people at risk. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mrs Oliver has been employed at the home since October 2007. Mrs Oliver has had vast experience in elderly nursing care. Mrs Oliver has been registered previously under the Care Standards Act 2000 in respect of another nursing home in Buckinghamshire. Her qualifications and training include: Registered Nurse RN2 on the NMC register Registered Nurse in Mental Health RNMH on the NMC register ENB 993 in Nursing Care Healthy Eating with Diabetes Current Challenges Influencing Best Practice when Caring for the Elderly Clinical Supervision Registered Managers Award 2006 Train the trainer in POVA Mental Capacity Act 2005 All mandatory training End of Life Conference CSCI 2007 Mrs Oliver, at her interview to become registered with us, discussed the way she is involved in Quality Assurance and Monitoring and auditing of the service. She understood the need to involve service users, families, visitors, staff and other stakeholders within that. Mrs Oliver also demonstrated a good understanding of equality and diversity and the need to promote this within the home. She understood the need for individual social and cultural needs profiles for service users and that all service users would be treated individually in line with their ability, preferences, needs and expectations. Mrs Oliver had a good knowledge base of equalities legislation and her role under this, stating: everyone should be given a fair deal and equal opportunities, and non-discrimination must be promoted. Mrs Oliver has demonstrated during both this and the random inspections visits to the home a strong commitment to improving standards of care and services at the home. Staff and relative meeting are now organised on a regular basis. Minutes of these meeting are kept A system of staff supervision has been developed. This includes a new supervision sheet. Staff supervision has not been completed for all staff. The manager stated that this was due to the relatively high number of new staff. Once these staff are comfortable in their role Mrs Oliver hopes to delegate some of the supervision responsibilities to the senior staff at the home. This would ensure that all staff supervision. Mrs Oliver stated that she does meet with all new staff 3, 6 and 12 weeks after commencing employment. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 26 During the inspection a tour of the building was conducted. A number of people require the use of bed rails. Bed rails, also known as bed side-rails, cot-sides, safety sides, and bed guards, are used extensively in the health and social care sectors to protect vulnerable people from falling out of bed. There are several causes of injury involving bed rails, the most serious being as a result of entrapment by the head or neck. This may lead to death from asphyxiation. Injuries also arise from a patient attempting to climb over the rails, or when a restless person strikes their head against the rails. A number of bed rails used at the home were seen to be wobbly and had gaps. This could pose an entrapment risk thus placing people at risk. The Health and Safety have published clear guidance on the safe use of this equipment. This guidance can be found at Medical Device Alert MDA/2007/009 – Bed rails and grab handles. The management need to ensure that they review the current system of checking and maintaining bed rails in view of this guidance. In addition the management should ensure that all employees who are responsible for selecting, fitting and checking bed rails have received adequate training. Other staff, such as care assistants and domestics who make beds and help clients in and out of bed, also may remove and replace bed rails. These employees should also be given information and instruction in the correct fitting and adjustment of bed rails. (Equipment suppliers may be able to provide training on use of their equipment). A review of policies and procedures was completed during this inspection. These were found to be satisfactory. The whistleblowing policy however should be to detail that whistleblower can contact Social Services or us at any time. The home has a fire risk assessment. This was reviewed November 2007. Other maintenance records were viewed including • • • • • • Portable Appliance Testing was completed on the 03/03/08 Gas safety certificate was issued on the 17/04/08 Nurse call bell system has been serviced this year. The environmental Health Officer visited the home on the 28/02/08 and was satisfied with the service provided by the home. The home has a waste disposal certificate which was issued on the 09/10/07 A lift servicing agreement is in place. This ensures that the hoists and passenger lift are serviced twice yearly. The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 27 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 1 The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 (1) Requirement It is required that a system be developed which ensures that service users or their representatives are involved in the development and/or review of their care plan. This requirement is outstanding from previous inspections. Previous timescale 23/01/08 2 OP38 13 (4) (a) (c) It is required that the management ensure that illfitting bed rails do not compromise the health safety and well being of people living at the home. This requirement is outstanding from previous inspections. Previous timescale 23/01/08 It is required that all prescribed creams and lotions are marked with a date of opening and that these creams are administered only for the individual to whom they are prescribed. The person applying the cream should sign the Medication Administration Record DS0000066156.V363129.R01.S.doc Timescale for action 23/08/08 30/07/08 3 OP9 13 (2) 30/08/08 The Knoll Nursing Home Version 5.2 Page 29 4 OP7 15(2) It is required that the service user plans are reviewed to ensure that the plans adequately reflect the current care needs of the individual and provide clear guidance to staff including weights, nutritional and fall risk assessments. 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP15 OP30 OP24 OP36 Good Practice Recommendations It is recommended that the home continue to investigate the possibility of increasing the dining space at the home to allow people the option of sitting at a table for meals. It is recommended that staff training is given in line with the planned and current training plan. It is recommended that height adjustable beds are provided for all people receiving nursing care. It is recommended that the system for staff supervision continues to be developed to encompass all staff working at the home The Knoll Nursing Home DS0000066156.V363129.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000066156.V363129.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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