CARE HOMES FOR OLDER PEOPLE
The Knolls Care Home Plantation Road Leighton Buzzard Bedfordshire LU7 3JE Lead Inspector
Katrina Derbyshire Unannounced Inspection 18th July 2006 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Knolls Care Home DS0000058804.V304975.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 Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 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 Vacant 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.V304975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 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. The home is permitted to accommodate one named service user (Application No. V000032333) under the age of 65 in the categories of PD only. 7th July 2006 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 fees for this home vary from £575.00 per week for residential placements, to £675.00 per week for nursing placements. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. A random inspection carried out on 7th July 2006 raised serious concerns surrounding the recruitment of staff, meeting the nutritional needs of residents and the standard of monitoring systems for residents at risk of weight loss. In view of the notable decline in standards at this home between the inspection on 18th January 2006 and the inspection on 7th July 2006 a decision was taken to carryout a key inspection swiftly, to follow up on the homes progress since 7th July 2006 and to assess the remaining key standards. The Acting Manager was present throughout the inspection alongside an Area Manager and Commercial Manager for part of the inspection. During the visit the inspector spent time with many of the residents’ in the sitting areas of the home and dining rooms. The care of four residents was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and relatives was also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit, the visit on 7th July 2006 and reporting. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
When a prospective resident shows an interest in moving into the home an assessment of their needs is carried out. This is when social services or staff from the home gathers information about the resident to build up a picture of the type of care and support needed by that person. The information is then put onto a special document and this shows if the help that is needed is physical, social or emotional help for example. This means that it is easy to see where the main support is going to be needed, to meet that residents needs. They also continue to be good at involving the relatives of the residents in the home and arrangements continue as they did in January 2006. Special meetings are held on a regular basis, all relatives are invited and dates of these meetings are advertised so everyone is kept informed. Relatives are able to speak to the staff and management at these meetings and pass on their The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 6 views about the home; this can make it better for residents as sometimes things change for the better after the meetings. The way that the home responds to concerns or complaints is also good. One resident said, “ l feel comfortable raising things l am not happy with”. They keep records of any complaint that they receive and write down how they have investigated it and also how they respond to the resident or relative. When they have got some things wrong they have apologised and changed things to try and make sure that this does not happen again. This means that the staff at the home will listen to residents and take action where they can. What has improved since the last inspection? What they could do better:
There are many areas that the home needs to improve in these are some examples. Although the home had made changes in how they monitored the weight and risk for the one resident described in the above section, they need to make sure that they do this for all residents at risk of weight loss. This is very important as some residents living at the home are very dependant on the staff knowing if they are losing weight, and rely on them to provide care to prevent them from falling into ill health as a result of this. One resident had been described in January 2006 as ‘not eating well, soft diet needed has a sore mouth’, this was not reviewed again until 8th July 2006. They also need to improve in the way they manage the medication in the home. Charts used to record when a medication had been given had gaps; also the balances of medication were not correct. Records showed one resident did not have one prescribed medication for 8 days. This is unsafe an immediate requirement had already been made on 7th July 2006 that residents must
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 7 receive prescribed medication. Senior managers at that time took the decision to stop non-nursing staff from giving out medication so trained nurses are now doing this in all parts of the home until a change in system and further training. The management of pressure care also needs to change very quickly, one resident had been assessed by staff as being at high risk of developing pressure sores and staff had described their skin as ‘tissue like’ in November 2005 with instructions to review this at least once a month, this had not been assessed since leaving a gap of over 7 months and put this resident at risk. Staff described the same resident in April 2006 as having a bruised and swollen ankle but did not explain why or how this had happened, again nothing had been written since. There is a special check that should be done before anyone starts working in a Care home; this is through an organisation called the Criminal Records Bureau. This check provides information about a persons’ past to make sure they are suitable to work with vulnerable people. The home had allowed staff to work there without doing this check first and this puts the residents at serious risk, one of the staff as well as not having this check had no references either before being allowed to work at this home. We made what is known as an immediate requirement when we visited earlier in the month, this is something we do when we find something that is a serious concern and to protect the residents the home must change the way they have been doing things straight away. 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.V304975.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 Knolls Care Home DS0000058804.V304975.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The assessment systems in this home are sufficient to ensure the home has adequate information to make an informed decision on whether they are able to meet the needs of the residents. EVIDENCE: Evidence of pre admission/admission assessments was seen within the care records of residents. There were two pro-forma’s in use as the home is planning on changing the format for the way in which they keep records on the care at the home. The amended version makes very clear the needs of the resident showing the physical, social and physiological, which would need to be met by staff. Residents referred through Care Management arrangements also have copies of the health and social services assessment on their individual files. Intermediate care is not offered at the home.
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 10 The Knolls Care Home DS0000058804.V304975.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Care planning and medication systems in this home are insufficient and place residents at risk and harm. EVIDENCE: A requirement was made following the inspection on 7th July 2006 for Care plans to be clear in their content to instruct and guide staff in the care that they must provide to residents and that they must be accurate and up to date. Acknowledgement is given that senior management at the home have been undertaking audits to identify shortfalls, however this previous requirement remains unmet following this inspection therefore an extended timescale for compliance has been given. One resident’s falls, sight, hearing and communication plan had not been reviewed since November 2005 even though their needs in these areas had notably changed. The guidance therefore to staff within the plans were inaccurate and would not meet the needs of this resident. Another residents nutritional plan in January 2006 stated that the resident was not eating well
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 12 and that staff should give a soft diet as the resident had a sore mouth, a 6month period passed before this was assessed again. Other documents showed that the resident was weighed on 29th November 2005 and then not again until 10th July 2006 in this time period they lost weight, this combined failure to monitor and reassess in a timely manor places residents at risk. Another residents care records showed that the resident needed to be weighed monthly; this was last carried out in November 2005. Another residents records showed an entry on 3rd May 2006 that said they had a pressure care ulcer, no reference was made to this again, there was nothing to indicate the care given or if the resident still had this ulcer. Other assessment that should have been carried out monthly relating to pressure care risk had not been undertaken for over 8 months. Therefore a previous requirement to monitor and assess all residents at risk of weight loss in a timely manner including nutritional and pressure care assessment has not been met and an extended timescale for compliance has been given. Medication systems on the ground floor of the home were examined. One resident’s medication administration record had no entries for a 7-day period, no balance of the stock was recorded and the amount of signatures entered onto the record with the amount of tablets counted indicated that at times even though staff had signed to say a medication had been given, it had in fact not. In addition another residents medication record indicated that they had been without their medication for an 8-day period, again the balance of their medication when audited was incorrect. As identified at the inspection on 7th July 2006 one resident had been prescribed a medication relating to their nutritional needs, three weeks had passed and the staff had not obtained this at the time of that visit. Although it is acknowledged that the home then acted following an immediate requirement the systems for the management of medication at the home are insufficient and place the residents at risk. Observation of personal support to residents by staff was seen to be sensitive and respectful. Relatives were seen to visit freely. Staff were observed interacting appropriately with residents, and using their preferred term of address. Through discussion with staff it was confirmed that they had a clear understanding that at all times the privacy and dignity of the residents’ must be maintained when providing personal care. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Support in this home to meet resident’s emotional and cultural needs is inconsistent; this means some residents are at risk of not receiving basic support to maintain a satisfactory level of well-being. EVIDENCE: Information within the care records of residents gave guidance to staff to support residents in maintaining their emotional and cultural needs, this included maintaining acceptable levels of personal presentation as this was essential to their overall feeling of well being. This was noted not to have been carried out examples of this include one male resident was observed to have very long fingernails; he confirmed that this was not through choice and they were full of dirt. This resident when talking made constant attempts to hide his hands. Another resident’s shoes had several stains and a high amount of dirt on them indicating that they had been in this condition for some time, this resident was reliant on staff to carryout support in this area due to reduced physical ability. Information provided by the home showed that the support meetings for relatives continue. This is an opportunity for friends and families to raise any
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 14 ideas or concerns that they have. Residents spoke of visits by their family and substantiated that they had the freedom to see them when they wished and that the home supported them in doing so. Residents confirmed that they were given the opportunity to make choices within their lives. Daily choices included the times that they woke to for some managing their own finances. In addition residents said that they had been able to bring personal possessions with them when they moved into the home. Menus on display in the home showed that a varied and balanced diet was available to residents. A choice is also available so residents are given the opportunity to select their preferred option. Several residents confirmed that they found the food at the home to be sufficient in quality and quantity. A recent change at the home also enables residents to now take their meals within the area that they sit in; this provides for some a more intimate environment. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staff do not have a sufficient level of knowledge and understanding of Adult protection issues for residents to receive the appropriate investigations into concerns raised. EVIDENCE: A recent allegation of possible abuse to a resident at the home was reported by staff as required to Social services. However the home had already instigated an investigation into this matter prior to the arrangement of a strategy meeting as set out in the local Protection of Vulnerable Adults guidance. The decision as to how an allegation should be followed through must be coordinated by Social Services and a joint decision can be taken on how best to protect the resident, if police involvement is needed and which professional body should undertake the investigation. A requirement has been made relating to this following this inspection. The homes complaints procedure has all the required information for example how to complain, whom you can complain too and response times to complainants. This detail is provided to residents in the service user guide and displayed on the public notice boards in the home. Staff were able to give an explanation, which demonstrated their understanding of the homes policy, and what action they would take; additionally residents through discussion said they knew who they would speak to if they were worried or unhappy.
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 16 The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of cleanliness and infection control in this home is good and provides a pleasant environment for the residents. EVIDENCE: Several sitting, dinning areas and residents individual rooms were seen, these were clean and the furnishings and décor within these areas were of a good standard. A requirement was made following the inspection on 7th July 2006 for the carpet to the entrance of the rear garden and corridor area to be replaced due to fading and staining the timescale for compliance has not yet passed. Several residents spoken to said that they found their environment very comfortable and all spoke highly of the standard of the external grounds. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 18 The home is clean and free from offensive odours. Policies are in place regarding infection control and staff were seen to be using protective clothing where needed. The disposal of clinical waste was through a contractual agreement and the inspector saw that this was disposed of correctly. Hand washing facilities were sited in the areas where infected material/clinical waste was being handled. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 19 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, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Systems in place for the recruitment of staff are not sufficient to protect residents and places them at risk. EVIDENCE: At the inspection carried out on 7th July 2006 an immediate requirement was made relating to the recruitment of staff. Two staff had undertaken a 3-day induction programme at the home prior to them receiving a POVA First check or Criminal Records Bureau disclosure and the home had received only one reference for one staff member and for the other staff member no references. No staff has been appointed since that time, therefore no assessment could be made to ascertain if the home had complied with this requirement and this will be carried forward for assessment at the next visit to the home. As reported at the earlier inspection in July 2006 a previous requirement made relating to staff training records and the number and skill mix of staff had not been met so an extended date for compliance was given, this timescale has not yet passed and management advised that the home was working towards this. Staff had undertaken a variety of training courses however training records are unclear as several staff have attended training events but no record has been made in addition the date of attendance and duration needs to be entered.
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 20 Again on this visit as reported earlier in July 2006 staff and residents commented that there were occasions when they felt that there were insufficient staff numbers on duty. This had been subject to a requirement at the inspection in January 2006 and remains unmet. In addition staff reported low morale amongst the team one staff member said “ there are not enough staff, we keep having a change of manager and l can’t remember the last time l had supervision”. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The manager does not have a clear development plan and vision for the home resulting in poor levels of communication with some staff and inconsistency of care for the residents. EVIDENCE: Several staff through discussion felt that the Acting Manager at the home did not make clear the lines of accountability in the home, they were unclear on their roles in the home and what their individual responsibilities were. One member of staff said, “ she never has time, l sometimes need to check something out about a resident because we are not sure what we are supposed to be doing and she doesn’t listen”. The serious concerns identified at the inspection earlier in July 2006 were under the leadership of the present Acting Manager.
The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 22 Information provided by the home shows that they have a system in place that seeks the views of the residents and relatives. An analysis of this information has taken place and the results of this survey are available. Residents confirmed that they are asked their opinion, one resident said, “ Since l have lived here l have been asked on several occasions what l think of the food etc” The home manages a small sum of money on behalf of several residents, as was highlighted at the inspection in January 2006 and earlier in July 2006. Items purchased include hairdressing services and newspapers. The home keeps a record of a running balance, however a previous requirement to maintain a receipt for all expenditure had not been met when assessed on 7th July 2006 and an extended date for compliance was given, the time frame for compliance has not yet passed and will be assessed again at the next visit. The home has a Health and Safety policy. There is evidence within the training records that staff have undertaken fire, manual handling, food hygiene and first aid training, moving and handling training was being carried out at the time of this visit. Risk assessments are also undertaken and were seen. Records are maintained on all safety checks undertaken for example water temperatures. All areas of storage were seen to be locked and could only be accessed by the use of a key. Staff were also observed to undertake safe practice in the areas of food handling and the moving of residents. The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 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 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 X X 3 The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 24 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 12(1)(a), 15(1)(ad) Requirement 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. (Previous requirement timescale of 31/03/06 and 15/07/06 not met) The home must monitor and assess all residents at risk of weight loss in a timely manner including nutritional and pressure care assessment. (Previous requirement timescale of 08/07/06 not met) Information relating to the management of pressure care must be accurate and up to date that makes clear the care that has been given to the resident and all nursing intervention that is required. Accurate records and systems must be in place to ensure all residents receive all prescribed medication and audits can be carried out. Medication administration records must be completed in
DS0000058804.V304975.R01.S.doc Timescale for action 31/08/06 2. OP8 12(1)(a)& (b), 13 & 16 31/08/06 3. OP8 12(1)(a)& (b), 13 & 16 30/09/06 4. OP9 12(1)(a) & 13(2) 31/08/06 5. OP9 12(1)(a) & 13(2) 15/08/06 The Knolls Care Home Version 5.2 Page 25 6. OP12 7. OP18 8. OP19 9. OP27 accordance with national guidance in this area. (Previous requirement timescale not yet passed) 12 & 13 Residents must receive the care and support needed to meet their personal and cultural needs regarding their personal presentation to ensure a satisfactory level of well-being. 12 & 13 The management of all referrals under the Protection of Vulnerable Adults scheme must be in accordance with local guidance. (23)(1)(a) The stained and faded carpet by & the rear entrance to the home (23)(2)(b) must be replaced. (Previous requirement timescale not yet passed) 12(1)(a), The home must undertake a 18(1)(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. (Previous requirement timescale of 30/04/06 not met) 12(1)(a), 19 The home must not commence the employment of staff prior to securing references and the required Criminal Record Bureau checks. (Previous requirement not possible to assess, original timescale remains) Comprehensive staff training records must be maintained to show the date and duration of training undertaken. (Previous requirement timescale of 30/04/06 not met The management of the home must be sufficient to provide effective communication systems
DS0000058804.V304975.R01.S.doc 30/09/06 31/08/06 30/09/06 31/08/06 10. OP29 08/07/06 11. OP30 12(1)(a), 18 31/08/06 12. OP31 9, 10,12 & 13 30/09/06 The Knolls Care Home Version 5.2 Page 26 13. OP35 12(1)(a), 17, 20. and leadership to ensure consistency of care for all residents. Receipts of all expenditure must 31/08/06 be maintained with the resident’s financial records. (Previous requirement timescale of 30/04/06 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. Refer to Standard OP36 Good Practice Recommendations Supervision should be provided at least six times each year. (Previous recommendation not yet met) The Knolls Care Home DS0000058804.V304975.R01.S.doc Version 5.2 Page 27 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
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