Inspection on 22/02/07 for The Knoll Nursing Home

This inspection was carried out on 22nd February 2007.

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.

Other inspections for this house

The Knoll Nursing Home 04/02/09

The Knoll Nursing Home 08/08/07

The Knoll Nursing Home 31/08/06

The Knoll Nursing Home 07/02/06

The Knoll Nursing Home 20/09/05

The Knoll Nursing Home 21/12/04

The Knoll Nursing Home 23/08/04

The Knoll Nursing Home 16/04/04

The Knoll Nursing Home 26/02/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX Lead Inspector Nadia Jejna Unannounced Inspection 22nd February 2007 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 DS0000019883.V324473.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 DS0000019883.V324473.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knoll Nursing Home Address 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX 01274 619207 01274 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.V324473.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2006 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 areas to the front of the property. There are gardens surrounding the home and sitting areas have been provided that are accessible to 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. Information about the services provided by the home in the form of a Statement of Purpose and Service User Guide is available from the home to current and future service users. The pre inspection questionnaire said that the weekly fees are £384.44. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two visits were made on 22nd February and 1st March 2007. The home did not know that this was going to happen. Feedback was given to the manager at the end of the visits. This was the second visit since 1st April 2006. An inspection carried out in August 2006 highlighted serious concerns that residents’ needs were not being met. The main problems were around: * Not enough staff on duty to meet the needs of residents’ living in the home. * Staff had not been given appropriate training to properly understand and meet residents’ health and specialist care needs, for example dementia. * Not enough written information for staff about residents care needs and how to meet them. The providers were made aware of these concerns and that the CSCI had carried out a management review in a letter dated 3rd October 2006. They were told to forward an improvement plan showing how they would meet the twenty-five requirements that had been made. It was made clear that if improvements were not made further action would be taken which could include legal action. An improvement plan was not sent at this time. The directors of the home met with the CSCI in November 2006 and gave reassurances that improvements had been made. The operations manager met with the inspector in December 2006 to discuss changes that had been and still needed to be made. They sent an improvement plan in January 2007, which showed that all requirements would be met within agreed timescales. The purpose of this visit was to look at what improvements had been made and make sure that the home was being managed for the benefit and well being of the residents. Information about what policies and procedures are in place, when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, and staff details and training provided was requested and received in February 2007. The document used is called the pre inspection questionnaire (PIQ). During the visit residents’ visitors and staff were spoken to. Other records in the home were looked at such as staff files, complaints and accidents records. What the service does well: The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 6 Care is provided in a clean, tidy home. Some of the rooms have attractive views across the valley and others overlook the gardens. The communal areas are airy and spacious with large windows. Residents are able to bring in their own possessions to personalise their rooms and make them more homely and ‘theirs’. Information from residents said that they got the care and support they needed, their privacy was respected, they enjoyed the meals and that they were satisfied with the services provided. They said they knew who to speak to if they were unhappy and that they were confident that if they spoke to the manager they would be listened to. Visitors can come to the home at any time. They said that the home had friendly, welcoming atmosphere and the staff kind and friendly. They were satisfied with the services and care provided to their relatives and said that staff kept them informed of any changes. What has improved since the last inspection? The manager was ‘acting up’ covering for the manager who had left. She has been confirmed as the manager for the home and will be making application to become registered with the CSCI. Comments from residents and visitors said that they had seen changes for the better since she took over. One person wrote to the CSCI to say this and added that their relative had been very well looked after, it was a caring home and the staff were dedicated and hard working. The Statement of Purpose and Service User Guide has been revised. Copies are available on request, displayed in the reception area and placed in all residents’ rooms. A new chef has been employed and together with the manager a new four weekly menu has been put in place and steps have been taken to enrich foods for residents at risk of losing weight. Snacks like home baked cakes, fruit and ‘smoothies’ are being provided. The main meal is now being given at lunchtime. Following a visit by the fire safety officer work has been carried out to meet recommendations made in the report. Quotes have requested to replace worn carpets and rooms are redecorated when they become empty. Staffing levels through the day have been increased. Information from residents, visitors and staff said that this had had a good effect and residents needs were being met by people who were not stressed and rushing to get to the next task. During the visit buzzers were answered promptly and people were not waiting a long time for staff to attend to them. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 7 The manager has had advice from the environmental health officers and an infection control audit has been carried out. As a result changes have been made to some of the hygiene and cleaning systems in the home in order to reduce the risk of cross infection. 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 summary of this inspection report can be made available in other formats on request. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given enough information about the home to decide whether or not it will meet their needs. EVIDENCE: A new Statement of Purpose and Service User Guide was displayed in the reception area with a copy of the most recent inspection report. There is a notice saying they can be provided in large print on request. Copies have been put in all residents’ bedrooms. The manager carries out pre admission assessments before arrangements are made for a resident to come and live at the home. One for a resident due to be admitted the following week was looked at. This showed that the relatives had visited to look around, been given copies of the homes brochures and that the individuals needs had been identified along with specialist equipment needed such as a pressure relieving mattress. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 10 The relative of a lady who had been in the home for two weeks said that they and their family had visited to look round and been given all the information they needed before they decided it would be the right place. The pre admission assessment had enough detail for the home to know whether or not they could meet their needs. The resident and their relative said that they were satisfied with the care and attention they had received. Information from residents and relatives surveys said that: • Contracts were in place. • They had been given enough information about the home and the services provided. • They were satisfied with the care provided. A letter was received from a relative who wanted to say how well the staff have looked after their relative and that things have improved over last few months since the manager came in post. They said it is a very caring home with a good staff team who are dedicated and hard working. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents care needs are assessed and identified but the care plans and records kept do not provide staff with detailed guidance about how to meet or show what action has been taken to monitor changing needs. There is a risk that care needs will not be met. EVIDENCE: The nurse in charge said no formal training about care planning had been provided since the last inspection. They had been given guidance by the operations manager and each nurse had been allocated a number of care plans that they were responsible for and had to keep up to date. The manager said that she knew the care plans still need a lot of work to make them more detailed and individual to residents needs. She said somebody from the organisation is going to provide training to staff. The provider must make sure that training is provided by people who are qualified and competent The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 12 to do so and that the guidance given is up to date with current practice around person centred care planning. Three care plans looked at showed that no changes to the level of detail had been made. Most identified needs had a care plan in place. But the information and guidance provided was not detailed or individual and could have been about any other resident in the home. In other instances information was not correct or had been missed. For example: • • • Personal care plans had no information about what the resident could do for themselves, how they liked to be helped or when they liked to have a bath. Plans about communication, one said the resident might not be able to communicate effectively but they were able to talk to me, their relatives and staff with no problems. The care plans for eating and drinking had no information about individual’s preferences, likes and dislikes with food and drink. The plan for a resident who has lost weight and is very frail showed that the dietician had been involved but the advice given was not incorporated into the care plan. The plan said that a food diary was to be kept but this does not happen. The nurse in charge said that records of food intake were not kept because staff were not filling them in properly. The importance of monitoring at risk individuals’ intake of food and fluids was stressed and the need to be able to evidence what they are doing to help residents maintain and gain weight. The nurse in charge said that they were concerned about residents losing weight and had contacted GP’s for support, advice and referral to the dietician. Missing care plan information about pressure care area care for one resident with limited mobility and very frail. Care plans for residents with dementia have not improved and still do not show what type of dementia they have, how it affects them or what staff can do to help them. • • Daily care records are still not being completed on a daily basis. In one care plan an entry had been on the day of admission 10.2.07, then there were two undated night entries and the next dated comment was 14.2.07. On the day of the visit 22.2.07 the last entry seen had been made on 18.2.07. Residents are being nursed/seated in ‘bucket’ type chairs. It was pointed out at the last inspection that risk assessments must be in place for using these and the consent of the resident and or their relative obtained. The manager said she was going to contact the falls prevention team for advice and support. Problems with the administration of medications were found at the last inspection. Staff have not had training or updates around safe practice when The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 13 dealing with medications. The manager said she has found a training provider for this and is waiting for dates to be confirmed. The medication policies and procedures have been revised by the organisation. The policy was not dated and is still not to the Royal Pharmaceutical Guidelines. Examples of areas not covered by the policy include: • The full process to follow when ordering repeat prescriptions. • How to deal with drug hazard and alert notices. • Storage and administration of oxygen. • Dealing with controlled drugs. • What to do if there is an error/mistake made when administering medication. Information from residents and relatives surveys said that: • They got the medical support they needed. • They usually got the care and support needed from staff. • Staff would listen and act upon what they said. • Relatives said they were kept informed about changes and other important matters regarding their relative’s care. • Their privacy was respected. Visitors and other healthcare professionals could see residents in their own rooms. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are helped to stay in contact with their family and friends and visitors are welcomed to the home at any time. But there is a risk that residents social care needs will not be met because of the poor provision of social activities. EVIDENCE: Residents are able to make choices about their day-to-day lives. They are supported in maintaining contact with their family and friends. Visitors were in and out of the home throughout the day. They said that they were welcomed by staff and drinks offered if staff had time or they could go to the small kitchenette area and make their own. It was clear that there were good relationships between residents, visitors and staff and the home had a nice, friendly atmosphere. One of the survey cards returned said that the ‘home was more welcoming, homely and friendly under new manager’. One of the care plans looked at had no social/life history. The social care plan for a recently admitted resident with not individual to them and did not show what they liked to or how they preferred to spend their time. The manager The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 15 said that new documents are being used to record residents social and life histories and will be included in the care plans when done. There are still no regular planned activities in the home even though an activities organiser is employed and they attended a training session in October 2006. Many of the house activity sessions that take place are still with a small number of the more able residents. The manager said that another care worker has been helping to plan trips out and a group of residents will be going to the theatre in March. A notice was displayed in reception of planned religious services to be held in the home over next few months. It invited visitors to come and join in. A new chef has been at the home for a few weeks. He and the manager have talked about nutrition and what can be done to enrich meals for people at risk of losing weight. They have got information nutrition in the frail elderly. Full fat milk, yoghurts, cream and butter are being used to enrich meals and blended foods. Snacks such as home baked cakes and smoothies are being provided. A four weekly menu has been put in place. This is due to be revised. The chef said he will talk to residents and their relatives about their likes before doing it. Residents said that they enjoyed the meals and food provided and that it was better now with the main meal at lunchtime and a light tea. Some said that the meals appear to have improved. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe living in the home and are confident their concerns will be listened to. But there is a risk that allegations of abuse may not be reported to the appropriate people and therefore not investigated properly by specialists in the area of adult protection. EVIDENCE: The adult protection procedure was looked at. It must be revised as it does not guide staff to report alleged/suspected abuse to the police or the adult protection unit depending on what the allegation is. It states that the manager will investigate the allegation and then report to other agencies if needed. Doing this would delay and hinder an investigation by the agencies properly trained to investigate such allegations. As stated in the section about health and personal care, policies and procedures must be written by people qualified and competent to do so and that must reflect current good practice, changes in relevant legislation and professional guidance. The manager has got a copy of the local authority adult protection procedures and said she would make sure staff read them. Not all staff have received training about abuse and adult protection but dates have been arranged and two had been on a course the day before this visit. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 17 Staff said they would not hesitate to report actual or suspected abuse to the person in charge or the manager. But they did not know they could report to other agencies such as the local adult protection unit or CSCI. The complaints procedure was displayed on the notice board by the main entrance door. There have been two complaints since the last inspection about care related issues. The manager has investigated and responded to the complainants. Records kept showed that they were satisfied with the outcome. Information from resident’s surveys said that they: • Knew who to speak to if unhappy • Knew how to make a complaint • Were confident to approach manager Information from a relatives survey from said that they were aware of complaints procedure and had not needed to make a complaint The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 18 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, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is provided to residents in a clean, tidy home. EVIDENCE: The home was clean and tidy and there were no smells. Residents said that their rooms were kept clean. They were happy with their rooms and it was clear that many of them had brought in their own belongings to make them more homely and ‘theirs’. Following the last visit and report from the fire safety officer the operations manager invited him back to review progress. Most of the work has been carried out and they have agreed to prioritise dealing with making smaller fire compartments first and other works can wait until this has been done. Following an outbreak of a viral infection affecting residents and staff there had been a visit by environmental health officers. A number of good practice The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 19 recommendations were made which have been made. These included making sure cleaning equipment was colour coded for different areas and tasks, new thermometers for checking food and freezer temperatures. The manager had been given an infection control audit to carry out by the environmental health officers and said she had kept a copy in order to do one every six to twelve months. A new washing machine had been put in the laundry but due to electrical problems it was not working. The manager said it was being dealt with. The laundry floor still needs to repaired or replaced. The home has two sluice disinfector machines for cleaning commodes and urinals but one of them was out of order. The manager said quotes to repair the machine had been received and sent to head office. A maintenance person works at the home and as well as doing minor repairs they redecorate bedrooms as they become free before somebody else moves in. If the potential resident has a colour preference they will be taken into consideration. The operations manager and manager have been getting quotes to fit new carpets where they are needed and hope to have this work done in the near future. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty for the number and needs of residents in the home at this time but there is a risk that needs will not be met because staff have not had appropriate training. EVIDENCE: The manager has increased the staff numbers on duty. They now have one nurse and five carers on morning shifts, one nurse and four carers on afternoon/evening shifts and one nurse with two carers at night. Staff, residents and visitors said that this had had a good effect and residents needs were being met by people who were not stressed and rushing to get to the next task. During the visit buzzers were answered promptly and people were not waiting a long time for staff to attend to them. The manager was aware that she will need to monitor resident’s needs and dependency levels and increase numbers of staff on duty if needed. The size and layout of the building must also be taken into consideration. But there are still only two permanent nurses including manager to cover day shifts. The manager is hoping to recruit more nursing staff. She said that at times agency nurses will be used but they use the same agency and ask for same staff to be supplied wherever possible. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 21 If there are no kitchen assistants at mealtime care staff are still being taken off the floor to help. The manager is looking to recruit more kitchen staff to make sure that care staff are not taken from their duties to work in the kitchen, She also hopes to increase night staff levels to four as and when more residents are admitted. Staff said that training has been talked about but not much formal training had been given since the last inspection. One had not had a moving and handling update for three years. Fire safety training has been given to all staff by somebody from another home in the group who is a qualified fire safety training facilitator. The manager is very aware that staff have not received all the training needed in order to maintain the health, safety and welfare of the residents and themselves or the specialist needs of residents. She is in the process of looking at staff records so that she knows who needs what training and make sure they receive it. She has arranged for some of the staff to start a distance learning courses about infection control and dementia. She is looking for other appropriate training courses. Advice was given that induction training for new employees must be equivalent to the Skills for Care common induction standards. Some of training given in the past has been provided by a member of the organisation. For example they have done health and safety training but records do not show what was covered during the training or if they were qualified to do so having attended an appropriate train the trainers course recognised by the Health and Safety Executive. The manager was advised to make sure that training was given by people who are qualified and competent to do so. Two staff files were looked at. One showed that there was only one reference on file and the carer had started to work before the POVA (Protection of Vulnerable Adults) first or enhanced CRB (Criminal Records Bureau) check had been received. The manager was made aware that all pr employment checks must be in place before people come to work in the home. The manager and the recently employed administrator are going to review all the staff files to make sure that they contain all the required information. The manager said that interview records are now being kept and that a section has been added to explore any reasons for gaps in a person’s employment history. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 22 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, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being run and managed in the best interests of residents. EVIDENCE: The manager has been running the home with support from the operations manager since the last inspection at the end of August 2006. Before then she had been the deputy nurse manager. She worked in nursing homes caring for the elderly for a number of years. She will be making application to become registered with the CSCI and knows that she needs to successfully complete a management qualification equivalent to NVQ level 4. The operations manager met with CSCI in December 2006 to discuss the running of the home and what action had been taken to meet requirements made at the last inspection and improve quality of services provided to The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 23 residents. An improvement plan was given to the CSCI, which if followed showed that all requirements would be met within agreed timescales. Some of the timescales have been achieved but there is still a lot of work to be done. It was clear that the manager and staff have worked hard to implement changes where these can be done in house they have been. Other areas for improvement that require a financial outlay are being considered by the organisation. Residents, visitors and staff said that the manager was open approachable and supportive. The last residents and relatives meeting was in September 2006. From looking at the minutes the manager was very open with those present about the poor outcome of the last inspection and what needed to be done as a result. She is planning another in the near future. Information from relatives and a letter sent to CSCI said how things had improved at the home since the manager took over and that there was a good staff team of hard working, dedicated staff. The most recent staff meeting was in January 2006 and they discussed staffing levels and training. The manager said one would be held soon to discuss the outcomes of this inspection. The manager has done 1 to 1 sessions with nearly all the staff and intends to provide this at least six times a year. She has not had training on how to provide staff with supervision and appraisals yet. The PIQ stated that all required safety and maintenance checks were carried out and kept up to date. Quality assurance systems are in place and audits are carried out at regular intervals. The last residents survey was done in October 2006 and the result shave been included in the Service User Guide. Comments made about services provided will be discussed at the next residents meeting. The manager said that the home does not look after any monies for residents. The resident or their relatives look after all financial matters. Accident records are kept but they would benefit from additional information about what happened, who saw it happen or when the resident was last seen and by who, what injuries were sustained, what action was taken and what the outcome was. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 24 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 2 The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 25 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 Requirement Care plans must set out in detail the action which needs to be 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. Timescales of 01/02/06 and 04/12/06 not met, it was agreed to extend this timescale. The registered person must make sure that appropriate records are kept. If it is policy to maintain daily reports about residents steps must be taken to make sure that they are kept. 2. OP8 12, 13 Steps must be taken to make 30/06/07 sure that appropriate professional advice and support is requested for residents at risk of losing weight. Accurate records monitoring dietary intake must be kept to show how the DS0000019883.V324473.R01.S.doc Version 5.2 Page 26 Timescale for action 31/08/07 The Knoll Nursing Home risk is being managed. The moving and handling assessment should provide more detail about what types and size of equipment are to be used. Written agreements and consents must be in place when forms of restraint, such as the use of Kirton chairs are used. A thorough risk assessment must be carried out before considering their use. The timescale of 06/11/06 was not met. It was agreed to extend this timescale. 3. OP9 13 The registered provider must ensure that there are detailed policies and procedures for the receipt, recording, storage, handling administration and disposal of medicines. These must be in line with the Royal Pharmaceutical Guidelines and reflect current good practice and legislatory requirements. Systems must be in place to make sure that staff adhere to these policies and procedures. Staff dealing with medication must receive appropriate, certificated training. Timescale of 01/09/06 not met. 4. OP12 16 The registered provider must 30/06/07 make sure that residents are consulted about their social interests and a suitable programme of activities arranged for them. The needs and abilities of residents must be taken into account. 30/06/07 The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 27 Timescale of 29/05/06 and 04/12/06 not met. 5. OP18 12 The provider must make sure that the adult protection policy and procedure complies with the Public Disclosure Act 1998, the Department of Health Guidance No Secrets and reflects the local authority adult protection procedures. All staff must receive relevant and informative training to equip them with the knowledge to recognise abuse and act appropriately to protect residents. Timescale of 29/05/06 and 18/12/06 not met. 6. OP19 23 The registered person must make sure that works recommended after the fire safety survey are carried out within the timescales agreed with the fire safety officer. The registered provider must ensure that all residents’ bedroom doors are fitted with an appropriate lock, which allows staff to gain access in an emergency. Timescale of 31/05/05 and 02/01/07 not met. It was agreed to extend this timescale. 8. OP26 13 The laundry floor must be repaired or replaced to allow for effective cleaning. Timescale of 06/11/06 was not met. The sluice disinfector must be The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 28 30/06/07 31/12/07 7. OP24 12 30/09/07 30/05/07 repaired. The second washing machine must be installed and pout into use. 9. OP28 18 The registered provider must make sure that at least 50 of care staff are qualified to at least NVQ level 2. 31/12/07 10. OP29 19 The provider must make sure the 01/03/07 recruitment procedures used are robust enough to protect residents at all times. This must include making sure that two written references and satisfactory POVA first disclosure are in place before agreeing to employ new staff. This must be subject to receiving satisfactory enhanced CRB disclosure. Timescale of 30/11/06 has not been met. 11. OP30 18 The provider must make sure there is a training programme in place. This must make sure that staff have the knowledge and skills to maintain the health, safety and well being of residents and themselves as well as training around specialist healthcare needs of residents such as dementia, stroke etc. Training must be provided by people who are qualified and competent to do so. Training records must be able to show who provided the training, what the course content was and whether or not an assessment of what staff had learned had been carried out. Induction training must be to 30/08/07 The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 29 Skills for Care common induction standards. Records must be kept to show that staff have completed this. Timescale of 29/12/06 has not been met. 12. 13. OP31 OP31 9 9 The manager must application to CSCI to become registered. The manager must achieve a management qualification equivalent to NVQ level 4 30/04/07 30/04/09 14. OP33 24 Policies and procedures must be 30/08/07 produced by people who are qualified and competent to do so and they must reflect current good practice and relevant, up to date legislation. They must be reviewed regularly and made available to staff to make sure that they have access to relevant and accurate information. Timescale of 18/12/06 not met. 15. OP38 13 and 17 Detailed accident records must 30/05/07 be kept which provide clear information about what happened, who saw it happen or when the resident was last seen and by who, what injuries were sustained, what action was taken and what the outcome was. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 30 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 OP36 Good Practice Recommendations People providing supervision to staff must receive appropriate training to help them to do so. The Knoll Nursing Home DS0000019883.V324473.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 DS0000019883.V324473.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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