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Inspection on 07/02/06 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 7th February 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The 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. Visitors are made welcome at the home and one said that there has been an improvement at the home with the current manager. Another visitor said that the home does not smell anymore. One resident said that they could please themselves about getting up and going to bed. Overall residents also said that they thought the food is good at the home. Recruitment practices for new staff are safe.

What has improved since the last inspection?

The manager has worked at the development of the care plans and a new format has been identified which will reflect individual care needs.

CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX Lead Inspector Catherine Paling Unannounced Inspection 09:45 7 February 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 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.V276830.R01.S.doc Version 5.1 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 Ms Ann Ellerby 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.V276830.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2005 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.V276830.R01.S.doc Version 5.1 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. This was the second 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 20 September 2005. This was an unannounced inspection carried out by two inspectors who were at the home from 09.45 until 14.15. 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 and other records; observing the lunchtime meal and talking to staff, service users, visitors as well as to the manager and her deputy. What the service does well: What has improved since the last inspection? The manager has worked at the development of the care plans and a new format has been identified which will reflect individual care needs. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 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.V276830.R01.S.doc Version 5.1 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.V276830.R01.S.doc Version 5.1 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): EVIDENCE: None of these standards were assessed at this visit. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 9 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 9. The new care plan format will provide clear and detailed instructions for staff and evidence of the care provided. There are safe medication practices in place. EVIDENCE: The manager advised that work is ongoing with regard to the identification of a more appropriate nutritional risk assessment tool. One set of records indicated that nutritional needs are being addressed by means of dietetic referral and the introduction of a food diary for one resident. Some work has taken place regarding a major review of the care planning format and one example was available which was a great improvement on the previous generic care plans in use at the home. The example seen contained good personal and specific detail about care needs. Discussion took place with the manager about the development of these documents. There are written medication procedures in place including one to address selfmedication practices. There is a resident at the home who looks after and administrates his own medication. A risk assessment has been carried out and The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 10 there is a written agreement. Monitoring systems are in place to make sure that this arrangement continues to be in the best interests of the resident. The deputy manager takes the lead in the ordering and overseeing of medication administration. She also carries out regular audits of medication administration which make sure that any anomalies are detected promptly. There are a number of GPs who attend the home and contact details are clearly available to staff together with details of the arrangements with the supplying pharmacist. The pharmacist who serves the home has also conducted a detailed audit on behalf of the GPs as part of an overall review of residents’ medication. The deputy manager advised that she intended to draw up a list of homely remedies in agreement with the pharmacist and GPs. A policy and procedure would need to be developed in conjunction with this. There is a procedure for oxygen administration and it was recommended that current practices be reviewed to make sure that this policy is adhered to. Oxygen must be prescribed and the manager should therefore formalise any agreements with GPs for emergency administration of oxygen. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 11 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): 14 and 15. Overall residents can exercise choice over their daily lives although staff need to make sure that they do always offer and encourage choices. Overall residents were satisfied with the food. However menus were not followed and there was no record kept of the food served so it was not possible to establish whether a varied and nutritious diet was being provided. EVIDENCE: Overall comments from residents and relatives suggested that residents were able to choose what time they went to bed and got up. However one resident said that they went to bed at 7pm every night but that they would like to stay up a little later. This resident did not ask to stay up, as they ‘didn’t want to be a trouble’. This was discussed with the manager and it was recommended that staff be reminded that choice of bedtimes should be determined by the resident. There were several very positive comments made regarding improvements at the home since the new manager took up her post. One visitor said that her friend used to sit all day in a wheelchair but now she sits in a recliner and is much more comfortable. Another said that the home does not smell anymore. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 12 There were mixed comments about the food. Overall comments were positive although some said there was a lack of choice and variety. There is a four-week menu in place, which indicated choice at each mealtime. However, the cook said that the menus were not followed and that no choice was offered. No record is kept of the meals actually served. The cook in charge of the kitchen, who was off duty at the time of this visit, is currently revising the menus. Although there was a cleaning schedule in place the kitchen was not clean at the time of the visit and some items of dried goods were out of date. The manager was provided with detail of these issues at the time of the inspection. The lunchtime meal was observed. Tablecloths were not used and there were no condiments on the tables. Juice was served in plastic beakers and tea was provided in cups without saucers. The sandwiches, buns and biscuits were served without tongs and were therefore handled by the staff serving the meal. It was recommended to the manager that the management of meal times be reviewed to make sure that staff followed appropriate procedures when handling food. There were also opportunities for residents independence to be encouraged and maintained for example milk and sugar could have been provided on the tables rather than staff serving it from the trolley. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 13 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): 18. The continued lack of detailed in-house procedures could place residents at potential risk of abuse. EVIDENCE: The adult protection procedures have yet to be revised and made available to staff. The manager was advised that these procedures should clearly link into the local authority multi agency procedures. In the absence of these procedures there are no contact numbers provided for staff telling them where they could get advice. The whistle blowing policy was displayed on the staff notice board. The manager advised of a very recent adult protection issue at the home. She had taken appropriate action once she had been made aware of the incident. She was also advised to liaise with the adult protection unit for further advice. Full and detailed information regarding any investigation and the outcome must be shared with the CSCI. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The systems currently used for the disposal of clinical waste create a potential risk of cross infection. There has not been any further refurbishment of the environment. EVIDENCE: The manager advised that the environmental issues raised at previous inspections have not yet been addressed. There was no provision for the disposal of clinical waste in the toilets with no gloves, aprons or plastic bags provided in these areas. This means that staff have to go between toilets and the sluice to get the equipment they need. Staff were seen wearing aprons to take residents to the toilet but these were not then removed before entering the dining room and came into contact with dining tables and chairs. Two care workers on duty said that they had not had any training in infection control. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 15 The laundry assistant does wear protective clothing but said that these were disposed on in the normal waste bin rather than a clinical waste bin. The laundry area was dirty as the removal of a window had resulted in leaves and dirt being blown in from outside. This needs to be addressed so that this area can be properly cleaned. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 16 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, 28 and 29. Staff shortages and sickness meant that there were insufficient staff on duty at the time of the inspection with residents having to wait an unacceptable time for their morning medication. Recruitment was ongoing and there were good recruitment procedures in place to protect residents. EVIDENCE: There were insufficient staff on duty at the time of the inspection. The manager advised that staff shortages were currently being experienced on all shifts. She had covered the previous night shift and had remained on duty to try to get agency cover for last minute sickness. The morning drug round was still in progress at midday and the deputy manager said that this was not unusual. She did say that any residents on antibiotic therapy would be given their medication first. However, this does suggest that nurse staffing levels may need to be reviewed for the morning shift. There is ancillary support for the staff. However, cleaning staff are provided for only six days a week and for mornings only. Laundry staff work five days a week. One member of staff has completed National Vocation Qualification (NVQ) in care at level 2. A further six carers have recently registered to undertake this training. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 17 Personnel files were looked at with regard to recruitment practices which were found to be satisfactory with the appropriate checks being carried out and written references obtained. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 18 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, 35 and 38. The home is well managed and the interests of the residents are safeguarded. EVIDENCE: The registered manager is undertaking her Registered Manager’s Award, which she is due to complete in July 2006. There is a policy at the home not to handle any monies on behalf of residents. However there is one resident who does have some support from staff in managing her personal allowance and staff do some shopping for her. There were good records kept of this arrangement including two signatures and receipts for all transactions. In the interests of clarity it was recommended that the layout of the record be revised. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 19 The fire safety officer has carried out a recent inspection at the home and a number of issues were raised in his report. A response with timescales has been requested from the manager. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 20 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO 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 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. (previous timescale of 01/02/06 not met) The registered person must make proper provision for the health and welfare needs of the residents to be met. A review must take place of the 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 consult residents about their social interests and about the DS0000019883.V276830.R01.S.doc Timescale for action 26/06/06 2. OP8 12 26/06/06 3. OP12 16(m)(n) 29/05/06 The Knoll Nursing Home Version 5.1 Page 22 programme of activities arranged for them. Facilities must be provided for recreation taking into account the needs and abilities of the residents. 4. OP18 12(1)(a)1 3(6) The provider must ensure that 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. 5. OP15 16(2)(i) The manager must produce menus that are adhered to by the catering staff to make sure that a wholesome, nutritious and varied diet is provided to 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 bedroom doors are fitted with an appropriate lock which allows staff to gain access in an emergency. (previous timescale 31/05/05) A review of the staffing numbers DS0000019883.V276830.R01.S.doc 29/05/06 08/05/06 6. OP19 23(2) 05/06/06 7. OP21 23(2)(j) 03/07/06 8. OP24 12(4)(a) 05/06/06 9. OP27 18(1)(a) 24/05/06 Page 23 The Knoll Nursing Home Version 5.1 10. OP28 18(1)(a) and skill mix of qualified and unqualified staff must 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. The registered provider must 03/07/06 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. 2. 3. Refer to Standard OP30 OP15 OP26 Good Practice Recommendations Care staff should provide written evidence of their induction training. The manager should make sure that there is an effective kitchen cleaning programme in place. The manager should review infection control practices with staff and consider additional training in control of infection for all designations of staff. The Knoll Nursing Home DS0000019883.V276830.R01.S.doc Version 5.1 Page 24 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.V276830.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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