CARE HOMES FOR OLDER PEOPLE
The Knolls Care Home Plantation Road Leighton Buzzard Bedfordshire LU7 3JE Lead Inspector
Katrina Derbyshire Unannounced Inspection 27th October 2006 10:15 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.V317351.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.V317351.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.V317351.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. 18th 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.V317351.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 27th October 2006. The commercial manager for the company Dawn Bishopp was present throughout the inspection. During the inspection areas of the home were visited and the inspector spent time with many of the residents’ mainly in the ground floor sitting area of the home. The care of four residents’ were examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and their feedback has been used alongside information from the home through written evidence to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. 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:
There are systems in place at this home that make sure areas of health and safety are managed well. Fire equipment is serviced regularly as is other equipment at the home, for example electrical items. Staff are trained in areas such as moving and handling, food hygiene and infection control. This means residents live in a home that has undertaken precautions and measures to make it a safer pace to live and work in. The staff also continue to be good at letting prospective residents know all about the home. When people show 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. The way that the home responds to concerns or complaints also continues to be good. One complaint that the home had received had been looked at in detail by the staff at the home; written information of this is kept. They also offered to meet with the complainant so that they could listen and respond to
The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 6 any concerns that they had. In doing this they show that 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:
At two inspections undertaken in July 2006, we identified concerns about the way the home had monitored residents who were at risk of weight loss. Although the home had made changes in how they monitored the weight and risk for some residents, 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 within their weight chart had instructions to staff for them to be weighed every two weeks. This was not done for a month; the resident in this time had lost a substantial amount of weight. The home should
The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 7 have monitored this as instructed and therefore sought medical support for this resident sooner. Serious concerns regarding the systems and administration of medication were raised at an inspection in July 2006. Senior managers at that time took the decision to stop non-nursing staff from giving out medication so trained nurses now do this in all parts of the home. The recording and administration of most medication is now safe and to a good standard. However the recording and stock of what is known as controlled medication, still requires improvement. One residents stock had four tablets missing from the last fourteen days, another had incorrect balances recorded and another was not signed as being given by two staff as it should be. The home as previously reported, have menus that are on display on both floors of the home. These menus show that a choice is available everyday at mealtimes to the residents. However residents said that they are not given a choice, one resident said “ l don’t see the menus, l can’t see them up there”. The menus showed that several times a week chips or a similar option was on offer, another resident said “ we can’t have chips, the fryer broke months ago so its boiled potatoes now”. The home must not display a menu that it does not and cannot provide. Most residents are not aware of what they are going to have for their dinner and have limited or no choice. There has been a requirement for the home to keep receipts of any expenditure made on behalf of the residents since January 2006. They have just started to keep these. However we looked at a sample of records relating to residents monies. One resident didn’t have a balance sheet, so there was no way of knowing what money had come in or out. This is needed so that there is a clear audit trail to make sure balances can be checked, so residents know how much money they have. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Knolls Care Home DS0000058804.V317351.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.V317351.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment systems in this home continue to be 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: The home has a pre-admission policy and guidance to staff in the area of admissions to the home. It was noted that residents care records contained written evidence that planned admissions had occurred, for one resident a pre admission visit had taken place and the involvement of family and Social Services had been part of their admission. This admission was seen to have followed the homes policy. The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 10 Assessments incorporated the views of residents and their families. Alongside the physical needs of the residents, how they felt about moving into the home had also been included. The Commercial Manager confirmed that all residents are given the opportunity to visit the home prior to any decision being made to move in. Also following admission, a review would take place 6 to 8 weeks following this to ascertain if the resident wished to continue residing at the home. Intermediate care is not offered at the home. The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems for the monitoring of residents weight in this home remains insufficient and leaves them at risk of deterioration in their health. EVIDENCE: Care plans examined showed that all had been rewritten in August 2006. The care plans showed that there was a plan in place for each assessed need of the residents. They were clearly written and the guidance to staff in how to care and support the resident was comprehensive. With the exception of one residents plans all had been reviewed monthly. However staff did not always follow the guidance within these records. One residents weight plan and associated documents, instructed staff to contact a Doctor if their weight loss was more than 3.5kg, this was not done. The
The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 12 resident was weighed on 7th September 2006 and showed a 5.6kg weight loss; the resident was not weighed again until 29th October 2006. Another residents weight plan said for them to be weighed every two weeks, records showed this had not been undertaken due to the scales being broken, this resident when weighed again after 29 days showed a 10kg weight loss. Improvements were noted in the recording of pressure care and action taken. Photos were in place to chart the wound care of a resident. These showed that the dressings and frequency in the nursing intervention resulted in an improvement, and in one instance healing of the residents’ pressure ulcers. Within the records of one resident an entry had been made on 23rd August 2006 to indicate that the resident had climbed over the cot-sides, that were in place on their bed, this had taken place during the night. No follow up had been made to this even though the entry stated ‘cot-sides maybe to dangerous if climbing over them at night’. A requirement is made relating to this issue following this inspection. Medication systems were examined. The storage of medication was seen to be carried out safely; all medication was kept in locked cupboards. The ordering and return of medicines was also seen to follow best practice guidance and clear records of these are kept at the home. Medication administration sheets showed balances recorded and showed the medications residents had been prescribed, these matched the information contained within the care records. However the systems in place for the administration of controlled medication was not sufficient. One residents’ balance showed that four tablets went missing within the previous two week period, staff could offer no explanation as to why or any follow up. Entries within the controlled drugs book showed wrong balances, missing signatures and entries made several times in the wrong section all within the previous two weeks. This must be addressed and a previous requirement concerning the management and systems for medication remains with an extended timescale given for compliance. Residents spoken with said that staff at the home were supportive to them and that they found them very helpful. One resident said ”l find them all very kind”. Staff as part of their induction are trained in how to respect the privacy and dignity of the residents, this was seen within the induction booklet of the home. Observations of the staff showed that they would lower themselves when speaking to residents to ensure they were at the same level. The staff were also seen to knock on doors prior to entering, and seek the consent of the residents before providing assistance. The Knolls Care Home DS0000058804.V317351.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision for the resident’s social, cultural and recreational activities is good. EVIDENCE: This is the fourth visit to the home in 2006 and the information provided by the home showed that the support meeting for relatives continues. This is an opportunity for friends and families to raise any 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. Activities are available to residents each day. These are advertised on a board within the main lounge area of the home, the schedule shows that activities take place in the morning and afternoon. A quiz was taking place during this visit. Residents confirmed that activities were available and that they had a choice in whether they wanted to join in or not. Religious services also take place in the home; these again are advertised on the notice boards in the home, both staff and residents again confirmed that these took place. Within the care records of residents social needs had been assessed, these plans
The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 14 showed residents enjoyed activities such as board games, walks, reading, music and crafts all of which the home provides. The menus that are on display on both floors of the home, show that a choice is available everyday at mealtimes to the residents. However residents said that they are not given a choice, one resident said “ l don’t see the menus, l can’t see them up there”. The menus showed that several times a week chips or a similar option was on offer, another resident said “ we can’t have chips, the fryer broke months ago so its boiled potatoes now”. Catering staff confirmed that there had been no fryer for months and this would not be replaced until the kitchen was refurbished. It was observed on the day of this visit that one resident was given a meal of poached fish, potato and peas with a slice of lemon. The resident stated they didn’t like lemon so staff took the dinner away and gave it to another resident on another table. Residents were not seen to be asked if they wanted what was on their plate. The home must not display a menu that it does not and cannot provide. Most residents are not aware of what they are going to have for their dinner and have limited or no choice. The Knolls Care Home DS0000058804.V317351.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. 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 this service. Staff still 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: Staff and records confirmed that training had taken place in the protection of vulnerable adults. However within the care records of one resident there were several body maps completed, that indicated some unexplained marks and bruising. One entry stated ‘staff noticed two black spots on the resident today ?? how they got them’. Another entry stated ‘large red bruised swollen area on inner thigh, very tender to touch’. None of these unexplained marks or bruises had been referred following the local guidance in the protection of vulnerable adults. Therefore a previous requirement made in this area remains, with an extended timescale given for compliance. The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 16 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. Since the last inspection the home had received a complaint and they had worked with social services in their response to this. Documents were seen that showed the home had looked into all the areas raised by the complainant, and then they had responded. In addition they had offered to meet with the complainant when they remained dissatisfied and were able to offer further explanation at this time. Residents through discussion said they knew who they would speak to if they were worried or unhappy. The Knolls Care Home DS0000058804.V317351.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. 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 this service. The overall quality of the furnishings and fittings is good and provides a spacious and homely environment for the residents to live in. EVIDENCE: Accommodation to residents is across two floors with a passenger lift available to access these. On the ground floor is a large lounge and dining area and an additional sitting area. On the first floor are two smaller sitting rooms, dining space is limited in these areas, and so many residents eat their meals from small tables at their armchairs. Assisted bathing and shower facilities are in place throughout the home. 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 Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 18 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 this was seen to have been done. All residents spoken to say that they found their environment very comfortable and all spoke highly of the standard of the external grounds. The home continues to be 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 is 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.V317351.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place at this home for the recruitment of staff are good, protecting the residents through carrying out all safety checks. EVIDENCE: An immediate requirement was made relating to the recruitment of staff at an inspection in July 2006. Examination of staff records employed since that time show that the home now undertakes all required checks prior to their commencement at the home. Files contained evidence of references, criminal record bureau checks and identification. In addition the home had undertaken an audit of the staff files for those already employed, they had identified any shortfalls in the information and were actively seeking to rectify this. At the time of this visit 60 had been resolved. The commercial manger also advised that an additional member of staff had been allocated to work, on both the ground and first floor of the home. One staff member stated, “ it has helped, we have more time to talk to the residents”. Staffing rotas provided by the home showed that this increase in numbers had taken place. During this visit it was observed that call bells were
The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 20 answered in a timely way, and there was always a staff member available within the communal areas of the home who sat with the residents. Staff confirmed that they had undertaken training since working at the home. Statutory training undertaken included moving and handling and food hygiene. Observations of staff practice in these areas at this inspection showed that they carried out safe practice and followed current national guidance. In addition new staff are now inducted in accordance with the national induction standards, this was inspected. However the full training records of all staff are still to be completed and a previous requirement made relating to this area remains with an extended timescale for compliance given. Key worker and named nurse systems have been re introduced into the home. Staff demonstrated a good understanding of their roles within this system. Alongside their responsibilities outlined within their job descriptions, they have a co-ordinating role in the care of a selection of residents. All residents spoken with, offered praise to the staff at the home. All felt that they were supported by the staff and had been able to build a good relationship with them. The Knolls Care Home DS0000058804.V317351.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place for the day to day management and monitoring of standards at the home are not sufficient at this time to ensure consistency of care for the residents. EVIDENCE: As reported at the inspection in July 2006 information provided by the home still 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, and assistance is offered to complete these surveys if the resident’s wants this.
The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 22 A requirement was made at the inspection in July 2006, as the management at the home was not sufficient to provide effective leadership. Since that time the Acting manager has left and the company placed an area manager at the home, until a new manager could be appointed. However the area manager left a week prior to this inspection. The Commission for Social Care Inspection was not informed of this, in addition only one monthly regulation 26 visit had taken place since the homes last inspection. In view of the concerns raised at that time the monitoring systems in place have not been sufficient. Improvements in some areas have been noted however; further changes still need to be made. 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. A previous requirement to maintain a receipt for all expenditure was noted to now have commenced. However one resident had no balance sheet. There was no way of checking to see if the sum of money being held was correct or to audit any expenditure, a requirement has been made relating to this. Health and safety systems at the home were seen to be carried out in accordance with the guidance within the homes policy. The most recent fire and environmental health inspection reports show that the home had met the standards in these areas. Staff wore protective clothing when serving food at lunchtime. In addition cleaning products were seen to be locked away, risk assessments had been undertaken for areas and activities in the home. Service reports were also examined that showed the equipment in the home was serviced regularly. The Knolls Care Home DS0000058804.V317351.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 1 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 The Knolls Care Home DS0000058804.V317351.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 OP8 Regulation 12(1)(a)& (b), 13 & 16. Requirement 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 and 31/08/06 not met) Follow up must be undertaken when a risk relating to the use of cot-sides has been made, and appropriate action taken. Accurate records and systems must be in place to ensure all residents receive all prescribed medication and audits can be carried out. (Previous requirement timescale of 31/08/06 not met) Medication records must be completed in accordance with national guidance in this area. (Previous requirement timescale of 31/08/06 not met) The management of all referrals under the Protection of Vulnerable Adults scheme must be in accordance with local
DS0000058804.V317351.R01.S.doc Timescale for action 30/11/06 2. OP8 12(1)(a)& (b), &13. 30/11/06 3. OP9 12(1)(a) & 13(2) 30/11/06 4. OP9 12(1)(a) & 13(2) 30/11/06 5. OP18 12 & 13 30/11/06 The Knolls Care Home Version 5.2 Page 25 6. OP30 12(1)(a), 18 guidance. (Previous requirement timescale of 31/08/06 not met) Comprehensive staff training records must be maintained to show the date and duration of training undertaken. (Previous requirement timescale of 30/04/06 and 31/08/06 not met The management systems of the home must be sufficient to provide effective monitoring of standards and to ensure consistency of care for all residents. A balance sheet of monies held on behalf of residents must be maintained to provide a clear audit trail. 31/12/06 7. OP31 9, 10,12 & 13 31/12/06 8. OP35 12(1)(a), 17, 20. 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Knolls Care Home DS0000058804.V317351.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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