Inspection on 27/06/05 for The Knolls Care Home

This inspection was carried out on 27th June 2005.

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 Knolls Care Home 08/05/07

The Knolls Care Home 27/10/06

The Knolls Care Home 18/07/06

The Knolls Care Home 18/01/06

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 Beds LU7 3JE Lead Inspector Leonorah Milton Unannounced 27th June 2005 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 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 I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Knolls Care Home Address Plantation Road Leighton Buzzard Beds LU7 3JE 01525 380600 01525 851847 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Integrated Nursing Homes Ltd Care Home with Nursing 56 Category(ies) of PD(E) Physical Disability over 65 - 10 Both registration, with number OP Old age not falling within any other of places category- 56 Both DE(E) - 10 Both The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home can accommodate a maximum of 56 people. 2 The home can accommodate up to 56 people in the category old age (OP). 3 The home can accommodate up 10 people over 65 years in the category of physical disability PD(E) 4 The home can accommodate up to 10 people over 65 years in the category of dementia DE(E) 5 Service users in the PD(E) category must only be accommodated in the 10 rooms designated and assessed as suited for service users. 6 A suitably qualified registered nurse must, at all times, be in post to support Mrs Bishopp in clinical areas. . Date of last inspection 16/17.11.04 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 had been the registered proprietors for almost the last two years. Mrs D Bisopp had worked at the home for sometime and managed the home for a year and had recently been registered as such. The post of clinical nurse manager was vacant. Support for the nursing team was provided by the Operations Manager. The building consists of a large original period house that had 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 neighboured the local golf club. The town provides a wide range of shops and other amenities but transport is required for service users to get there. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8.40 hours. The methods of inspection included a review of the individual records for the care of four service users, conversations with seven service users, four visitors, five members of staff, the operations manager and the manager. A partial tour of the building was carried out. A director of the company attended in the late afternoon and received feedback about the inspection. This report has taken account of information about the service that was reported subsequent to the inspection. The information was significant and relevant to any report about recent events and standards in the home. What the service does well: What has improved since the last inspection? Environmental standards had improved significantly. Requirements from the previous inspection had been met. A programme of redecoration and refurbishment had progressed. It was explained that bedrooms, which still required refurbishment, were scheduled for work at a rate of one each month. An extension to the building had been completed. The building works and furnishings were of a high standard. An initiative to improve catering arrangements had been implemented by the introduction of a buffet style breakfast so that service users had a choice of a wide range of breakfast dishes served across a large part of the morning. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 6 Record keeping and the overall organisation of the home had improved, Mrs Bishopp having taken on a large task at her appointment to raise the management function and overall performance of the home. The documentation to record service users’ needs and show how this would be met had continued to improve even though there were still some aspects, particularly in relation to those with nursing needs, that required further detail. The appointment of additional permanent staff had meant that the home’s reliance on the use of agency personnel had reduced significantly. Recruitment of additional ancillary personnel meant that the cleaning of the home had also improved. All of the areas of the building seen at this inspection were clean and orderly. Strategies for personnel management had become more established through staff meetings and one to one meetings with a supervisor. The members of staff spoken to at this inspection were supportive of the management team and appreciative of the guidance they had received. One felt that the staffing arrangements were insufficient for the numbers of service users with high dependency needs, as is illustrated in the next section. What they could do better: Some aspects of the care for those with nursing needs were inconsistent. Fluid and turning charts had not been maintained properly in one of the case files seen at this inspection. There was an ongoing investigation into a possible failure to safeguard a service user that had resulted in a serious accident. It was also noted that there had been a delay for a considerable time to ensure that at least one service user had received chiropody care. The management of service users’ nursing needs had fallen to senior personnel from other areas of the organisation after the clinical nurse manager had left. It is a priority that a suitably experienced and qualified person be appointed. There must be continuity of management on site. The conduct of a small percentage of staff continued to be worrying. It was evident that the manager had worked in dealing with members of staff who had disrupted the operation of the home for more than two years. This aspect of the service was greatly improved at the inspection. There was a discernable rise in staff morale that had had in turn lifted the performance of the team. Unfortunately, shortly after the inspection, allegations about serious breaches of professional conduct by a member of the care staff team were reported and are being investigated by the Local Authority. Whilst the investigation is ongoing, it was evident from other allegations made at the same time that there were still rifts between the management of the home and a small element of the staff group that were enough to upset the balance and function of the team. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 7 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 I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 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 standard(s) 1,3,4, Service users or, where appropriate their representatives, had been provided with sufficient information about the service to enable them to make an informed choice about moving into the home. The ability of the home to meet service users’ needs was questionable in some areas because of the influence and impact on the team by a few members of staff who were evidently reluctant to accept decisions made by the management team. EVIDENCE: Information about the operation of the home was available in-house to service users through a detailed statement of purpose, a service user guide and a series of smaller brochures that supplied specific information about the home’s complaints procedures, risk assessment strategies and other aspects of the service. A notice was posted in the foyer of the home that the most recent inspection report by the CSCI was available on request. The manager was advised that the service user guide must contain a summary of the most recent inspection report. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 10 Case files seen at this inspection showed that the home had sought sufficient information about prospective service users’ needs prior to admission to determine that the home had the ability to properly care for service users. As detailed in the summary of this report, there were members of staff who were evidently not focused on the care of service users and had seriously disrupted the harmony of the team. It was reliably reported that some personnel had been very unsettled by recent events and that divisions within the team were emerging again. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10, Arrangements to meet service users’ healthcare needs were insufficient and showed that some needs had not been met. EVIDENCE: Care planning documentation had improved but still required further detail in some areas. The overall presentation of service users’ records was much improved so that it was possible to track progress where it had previously not been possible to do so. The operations manager showed examples of care planning documentation that had been updated so that there was sufficient detail to show how assessed needs would be met. She stated that it was planned that this standard would be applied to all care planning documentation in the near future. The deployment of staff on the ground floor had improved so that a constant staff presence had been maintained in the large lounge/diner to assist as required and prevent accidents, which had occurred previously when the room had been left unsupervised. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 12 One service user who was immobile had sustained a fractured elbow. Investigations were ongoing into the cause. Her care notes indicated that protective bumpers must be in place around her bed. Staff on duty confirmed that bumpers had only been placed on one side of her bed. This must be taken into account in any enquiry. The care plan for this service user had not been updated to take account of a change in need arising from this injury. The same care plan had been updated on 18.07.05 and included foot care. However the service user’s feet were seen and had not received chiropody treatment for sometime. There was no record in place for any preferred arrangements at death as must be assessed with regard to service users’ spiritual and cultural needs. Details should include some information about funeral arrangements. In the bedroom where a frail service user was sitting it was noted that fluids were out of reach, as was the call bell. The service user was sitting in the glare of the sun through the window on this very hot day. The mattress for pressure relief was emitting a loud and persistent bleeping noise that was distracting. A red light on the control panel of the mattress indicated there was something amiss. Although this was reported to the nurse in charge in the morning, nothing was done about the noise or the emergency light until the late afternoon. It was noted however from this service user’s case notes that there had been an improvement in his physical condition since admission to the home from hospital. Medications were divided for administration into two sections. The procedures were assessed for those service users who lived on the upper floor of the home and found to be satisfactory. The doors to a few bathrooms were without privacy locks. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 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 standard(s) 12,13,15 Arrangements to provide service users with a lifestyle that was flexible to suit their needs had improved but there remained a few instances when service users had not been provided with choice or sufficient stimulation. EVIDENCE: The manager reported that an organiser provided activities, which were specifically designed for the diversion of those with dementia. A range of group and one to one activities had been arranged for more able service users who wished to take part. Some had taken weekly trips into town on the local “buzzer bus” service. A poster in the foyer advertised dates for regular in house religious services and also visits by the mobile library. There were few activities for service users seated in the lounge in the nursing unit on the day of the inspection. There was insufficient provision for service users in the nursing unit to make a choice to take their meals seated at a dining table. There was only one dining table in this room with four chairs, which remained unused by all of the service users. Service users in this lounge/diner remained in their armchairs throughout lunch and were served meals on invalid type tables. A meal was placed before a service user but a full five minutes passed before a member of The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 14 staff arrived to feed him. All of the service users in this room were served the same choice of meal. It was also noted that there was insufficient choice given to service users over the lunchtime meal on the ground floor and that a member of staff stood over a service user to feed him, rather than sit alongside as is deemed the best practice. Visitors to the home confirmed that visiting times were unrestricted and they had been informed about their relative’s progress as required. Their comments about their welcome into the home were complimentary. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 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 standard(s) 16,18 There was a possibility that the whistle blowing procedures had been used inappropriately. The effects of investigations into unfounded allegations of abuse had upset the team and ultimately, the care provided to service users. EVIDENCE: Staff had used home’s whistle blowing procedures. Two members of staff had separately reported allegations to the police about serious abuse of service users’ rights to dignity and privacy. The Local Authority in conjunction with the home was investigating these allegations. At the time of writing this report no evidence had been found against the alleged perpetrator of the abuse. There remains however the question of the reports to the police, which were explicit. The absence of the evidence outlined in the allegations suggests that the reports may have had some malicious intent. Whatever the outcomes of the investigation, the whole affair showed that there were members of staff who were not focused on the welfare of service users. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19,20,21,22,23,25, The environment was mostly suitable to meet the assessed needs of service users. EVIDENCE: The building was impressive on arrival in its setting of mature and well-tended grounds. On entering the building, it was evident that care had been taken to preserve the original character of the building that had once been a rather grand private residence. There had been much activity to improve the environment since the previous inspection, so that the overall impression was of a well-adapted and comfortable environment. There were a few omissions to standards, but given the progress to improve the environment within short timescales, it is to be anticipated that the proprietors will ensure that these issues are acted upon promptly. Actions The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 17 must include the provision of privacy locks to all toilet and bathroom facilities and covering for the few remaining exposed radiator surfaces that were noted in bathing facilities. It was also noted that service users could have accessed substances hazardous to health in an unsecured cupboard on the upper floor. The total communal space available to service users was sufficient. However, the organisation for the care of service users into three distinct areas of the building meant that the two units for dementia and nursing care on the upper floor did not provide sufficient space for service users who were able do so, to eat at a dining table. There must be a review of these arrangements to take account of the need to ensure that service users are provided with opportunities also to mobilise as often as possible by transfer to dining tables. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 A small minority of the team were unwilling to accept decisions made by the management team, which threw into question their ability to properly care for service users as directed by their supervisors. EVIDENCE: Previous inspections had identified that the morale of the team had been low following a prolonged series of staff disputes that had been occurring long before the current manager took up her post. At this inspection staff morale had improved significantly. It was evident that the manager and her newly appointed deputy had strived to support individual staff members and to refocus the direction of the team to work as one to achieve the aims of the home. Personnel on duty at this inspection were positive about the direction of the home, their role within the team and the support they had received from supervisors and the manager. However, a series of grievances about the management of the home, reported shortly after this inspection took place, showed that this success had been short lived. This together with the reporting of allegations of serious misconduct against another member of staff showed that there was still an element of discord within this team. There was a report that an aggrieved member of staff had left the building before her shift had ended, which had depleted the team. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 19 The manager did not hold a nursing qualification and it was a condition of registration that a suitably qualified registered nurse is on employed to oversee the provision for service users’ nursing needs. This post had been vacated recently following evidence that the post holder had not fulfilled his role. Clinical advice had been provided by the organisation’s Operations Manager who was visiting at times during the week until the recruitment of a replacement. Evidence elsewhere in this report showed that service users’ healthcare needs had not been fully met and that there was an urgent need for expert direction and supervision of nursing staff on a more regular basis. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,38 The manager had not been fully supported to carry out her role, so that there was a risk that the operation of the home could deteriorate to the detriment of service users’ welfare. EVIDENCE: There was evidence from this and the previous inspection that the manager had run the home through a difficult time. She had overcome challenges from some personnel who had not wished to work to the home’s philosophies of care. She had been mostly successful in this, as was proven by the overall rise in the standard of care, operational procedures and team morale seen at this inspection. The reporting of recent staff grievances against the management of the home was therefore worrying in the light of the previous history of staff dispute. Whilst it is not appropriate to comment on these as yet unresolved issues it is The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 21 nevertheless appropriate to record concerns about the continuity of the management of the home that has been adversely affected by these allegations. The proprietor must investigate these allegations as a matter of urgency so that the manager’s position is clarified. The CSCI must be informed about the detail, investigation and any consequent actions arising in relation to these allegations. To date the CSCI has not been properly informed about these issues as required under the legislation. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 2 2 3 3 3 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 2 x x x 2 x 2 The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(1)(a) (b)(c )(d) Requirement Timescale for action 31.10.05 2. 8 13(1)(b) 3. 8 13(1)(b) 4. 18 13(6),17( 1)(a)(3) (a)(b) The registered provider must draw up care plans for all assessed needs and keep them under review. There must be monthly reviews for all care plans as a minimum. The care plan must be adjusted at any time when there has been a change in the condition of the service user(Previous timescales of 01.08.04 and 31.01.05 had not been met) Arrangements must be made for 31.08.05 service users to receive chiropody treatment that is suitable to their needs on a regular basis. The registered provider must 31.08.053 ensure that all forms for monitoring total care, including fluid intake and turning to relieve pressure, are fully completed. Fluid charts must be totalled regularly to ensure adjustments are made to improve the problem or prompt referral made to health professionals for their opinion. The registered person must 31.08.05 forward to the CSCI a copy of the investigation and its Version 1.30 Page 24 The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc 5. 20 16(2)(c), 23(2)(a) 6. 32 37(g) 7. 33 26(2)(a), (3),(4),5 (a)(b)(c) 13(4)(c ) 8. 38 9. 10. 11. 12. 38 13(4)(c ) conclusions into the alleged abuse of service users privacy and dignity and include any actions taken as a consequence. The registered person must provide a place at a dining table for each service user (Previous timescale of 31.03.05 had not been met) This requirement is adapted at this inspection to read, Each service user who has the ability to dine at table must be provided with the opportunity to do so. The registered provider must provide the CSCI with a copy of his report into the recent allegations about the management of the home and include any arising actions. A copy of the report about the visit to monitor the conduct of the home, made on behalf of the proprietor, must be forwarded to the CSCI every month. The cupboard in the corridor of the unit for the care of those with dementia must be secured to prevent service users from accessing cleaning products. Exposed radiator surfaces and pipework that pose a risk of accidental burn must be covered. 31.10.05 14.08.05. 31.07.05. 31.07.05. 31.10.05 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 11 Good Practice Recommendations Care plans should include service users preferences for I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 25 The Knolls Care Home 2. 3. 4. 5. 36 23 15 22 last rites and similar and indicate whether funeral arrangements are for burial or cremation. Supervision should be provided at least six times each year. The decision by service users to share double bedrooms should be recorded as having been a positive choice Staff should not stand over service users to feed them. The size and layout of bedrooms should be able to accommodate equipment and furniture to meet service users assessed needs. The Knolls Care Home I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 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 I51 S58804 Knolls Care Home V223206 160605 Stage 4.doc Version 1.30 Page 27 - 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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