Inspection on 18/01/06 for The Knolls Care Home

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Knolls Care Home 08/05/07

The Knolls Care Home 27/10/06

The Knolls Care Home 18/07/06

The Knolls Care Home 27/06/05

The Knolls Care Home 16/11/04

The Knolls Care Home 16/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Knolls Care Home Plantation Road Leighton Buzzard Bedfordshire LU7 3JE Lead Inspector Katrina Derbyshire Unannounced Inspection 18th January 2006 15:15 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 Knolls Care Home DS0000058804.V279299.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 Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Knolls Care Home Address Plantation Road Leighton Buzzard Bedfordshire LU7 3JE 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) 01525 380600 01525 851847 office@theknolls.co.uk Integrated Nursing Homes Limited Mrs Dawn Bishopp Care Home 56 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (56), of places Physical disability over 65 years of age (10) The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The home can accommodate a maximum of 56 people. The home can accommodate up to 56 people in the category old age (OP). The home can accommodate up 10 people over 65 years in the category of physical disability (PD(E)). The home can accommodate up to 10 people over 65 years in the category of dementia (DE(E)). Service users in the PD(E) category must only be accommodated in the 10 rooms designated and assessed as suited for service users. A suitably qualified registered nurse must, at all times, be in post to support Mrs Bishopp in clinical areas. 27th June 2005 Date of last inspection Brief Description of the Service: The Knolls is registered to provide social care and nursing care for fifty-six older people, ten of whom may also have dementia and ten of whom may also have physical disabilities. Integrated Nursing homes Ltd has been the registered proprietor for the last two and a half years. The building consists of a large original period house that has undergone structural alteration to extend the accommodation. The home has thirty-eight single rooms and nine shared rooms all with en suite facilities. Lounge and dining facilities are situated on both floors. Access to the first floor is via the stairs or shaft lift. The property has a semi-rural location to the north of Leighton Buzzard and neighbours the local golf club. The town provides a wide range of shops and other amenities but transport is required for resident’s to get there. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 18th January 2006. The Acting Manager Mrs. Angela Sheldrick was present throughout the inspection alongside the previous Registered Manager Mrs. Dawn Bishopp. Many of the areas within The Knolls were visited and the inspector spent time with many of the residents’ in the lounge areas of the home. The care of four residents’ was examined in depth by looking at their records and interviewing the residents’ and staff who look after them. Observations of care practice and communication between the residents’ was also made at the inspection. The focus of this inspection was to look at the core standards not assessed at the inspection in October 2005 and to follow up on previous requirements. What the service does well: What has improved since the last inspection? Access to chiropody services have greatly improved over the past few months, residents if they need to can now see a chiropodist on a regular basis; this has improved the standard of healthcare to the residents. Area management of the home have also carried out monthly visits to the home and looked at the standard of care the home offers during these times. A report has also been written about these visits and the action the home needs The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 6 to take to make things better. By looking at the running of the home on a monthly basis they have been able to pick up in areas that need to improve quickly, and this has been better for the residents. The home has also introduced two sittings at lunchtime; they have done this, as there are a limited number of spaces for dining. In introducing this system there is sufficient space for all residents if they choose to sit in a dining area to eat their meal. The home just needs to make sure that they up-date their records so everyone knows that this is now available. 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 Knolls Care Home DS0000058804.V279299.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 Knolls Care Home DS0000058804.V279299.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): 1 The homes statement of purpose does not contain up-to-date information therefore is not sufficient for prospective residents to be clear about the services the home can offer. EVIDENCE: The homes statement of purpose was noted to require amendments in order for the document to contain accurate information on the services the home could offer. Details that required updating included the Manager of the home and their qualifications alongside two sittings at lunch, the remaining information was satisfactory. The Knolls Care Home DS0000058804.V279299.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 The health needs of residents are well met with evidence of multi disciplinary working taking place. Care planning in the home is not sufficient to ensure continuity of care for the residents to meet all their needs. EVIDENCE: Care plans were examined within the individual records of resident’s; a plan of care was in place for most of the assessed needs of the residents. However the content and the way in which some care plans had been written were not sufficient to provide clear guidance to staff, on the care that they should provide. One resident for example required nursing intervention for a wound, entries relating to this had been written across three care plans resulting in conflicting information and no clear guidance on the actual dressing that needed to be undertaken by the nursing team. Access to healthcare was noted to be managed well, documents within the care records showed that residents had regular access to health services. The frequency of chiropody services had increased since the last inspection, this The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 10 now occurred every 6 weeks. Residents also continued to attend hospital appointments supported by the homes staff. The Knolls Care Home DS0000058804.V279299.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 & 15 Meals at the home are of a good standard and provide a nutritious and varied diet for the residents. EVIDENCE: Menus were displayed on notice boards within the communal areas of the home; these showed that a choice was available to residents at meal times including a cooked breakfast. Menus also showed that fruit and vegetables were provided alongside a varied amount of protein and carbohydrates. Several residents said how much they enjoyed their meals one resident said “ the food is always lovely”. However staff still need to make sure that when they are assisting a resident to eat their meal that they do not stand over them, this practice was observed on two occasions at the evening meal. Residents through discussion confirmed that since moving into the home they had continued to be able to vote in elections, maintain close relationships and make daily choices for example the clothes that they wear and the food that they eat. Staff when questioned were very clear on the rights of the residents; during their induction to the home they had been advised via training and the policies of the home that residents must at all times be offered the opportunity to make decisions. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 12 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 policies and staff knowledge on the protection of vulnerable adults is good and protects residents from abuse. EVIDENCE: The homes policy on abuse and the protection of vulnerable adults was examined, information available was clear giving sufficient guidance to staff on the types of abuse including emotional and physical. Reporting procedures were also available from the local guidance in the protection of vulnerable adults. Staff and their training records confirmed that they had attended a training session in this subject, through questioning staff demonstrated a good level of their responsibilities in this area. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 13 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): 20 & 26 The home is well maintained, clean and tidy providing a pleasant environment for the residents. EVIDENCE: Several areas in the home were seen including communal areas and individual rooms, all were clean, tidy and free of odours. Staff rotas showed that a team of housekeeping staff were employed to ensure the home was cleaned on a daily basis. Clinical waste was seen to be disposed of within the home using a suitable dispensing system and clinical waste removal from the home is also under contract. A previous requirement relating to dining room space has now been met; the home has now introduced a system whereby there are two sittings at lunchtime therefore adequate dining space using this system is available. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 14 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, 29 & 30 Systems in place for the recruitment of all staff are not sufficient to protect residents. EVIDENCE: Staff files were examined to inspect recruitment practices of staff in the home. Several files contained the required information including references and a completed application form, however one file was seen not to have followed the homes own policy on the recruitment of staff. Management confirmed that where staff had been secured via an agency them certain aspects of the homes policy had not been followed. A requirement is made following this inspection that all staff should be appointed in a consistent manner and documents must be completed for all appointments. Staff had undertaken a variety of training and through discussion they confirmed that the home had supported them in doing so. Training records however need to be clearer so that all training undertaken is recorded alongside the date and duration of the course. Throughout the inspection several staff and many residents commented that at certain times throughout the day they felt that more staff were needed. One staff member said “ its hard sometimes we really need more staff early in the morning, we just don’t have enough time”. This was discussed with the management at the time of inspection, and a requirement is made following this inspection that a review of staffing levels is undertaken by the home. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 15 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): 33, 35 & 38 Health and Safety within the home requires improvement to ensure the safety of residents. EVIDENCE: Previous requirements relating to a cupboard containing cleaning products being left unlocked and exposed radiators and pipe work were followed up at this inspection, the cupboard was noted again to be unlocked with the key left in the lock and the radiators in certain areas in the home remained uncovered. Monthly visits by senior staff were now being carried out, reports of these visits were seen and they were clear in the areas that had been reviewed. Recommendations following these monthly reviews had been made and identification of the responsible staff member had been made. The home was noted to manage a small sum of money on behalf of several residents, items purchased with this money included newspapers and The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 16 hairdressing. Balances checked were seen to be correct and an individual record of expenditure was maintained. However the home should maintain an actual receipt of any purchases and this should be kept with the resident’s records, this was discussed with the management at the inspection. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 17 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 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X 3 X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 schedule 1 Requirement The statement of purpose must be up to date and contain the correct information on the management of the home and any changes in the service provided. Care plans must be clear in their content to instruct and guide staff in the care that they are to provide. They must be accurate and up to date. The home must undertake a review of staffing numbers and skill mix, to ensure sufficient staffing is available in the home and share their findings with Commission for Social Care Inspection. The home must follow its own policy for the recruitment of staff in all cases. Comprehensive staff training records must be maintained to show the date and duration of training undertaken. Receipts of all expenditure must be maintained with the resident’s financial records. The cupboard in the corridor of DS0000058804.V279299.R01.S.doc Timescale for action 15/03/06 2. OP7 12(1)(a), 15(1)(ad) 12(1)(a), 18(1)(a) 31/03/06 3. OP27 30/04/06 4. 5. OP29 OP30 12(1)(a), 19 12(1)(a), 18 12(1)(a), 17, 20. 13(4)(c) 15/03/06 30/04/06 6. 7. OP35 OP38 30/04/06 31/03/06 Page 19 The Knolls Care Home Version 5.1 8. OP38 13(4)(c) the unit for the care of those with dementia must be secured to prevent service users from accessing cleaning products. (Previous requirement not met) Exposed radiator surfaces and 30/04/06 pipe work that pose a risk of accidental burn must be covered. (Previous requirement timescale not met) 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 OP11 OP36 OP15 Good Practice Recommendations Care plans should include service users preferences for last rites and similar and indicate whether funeral arrangements are for burial or cremation. Supervision should be provided at least six times each year. Staff should not stand over service users to feed them. The Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Knolls Care Home DS0000058804.V279299.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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