Care Home: The Knoll

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What the care home does well People living at The Knoll have varying degrees of communication difficulties. They were therefore unable to contribute fully on the day in terms of expressing their opinions about the service. However all observations and interactions showed that people living there were happy and relaxed in their environment, and that they had very positive relationships with staff and management. Staff know people well and help them to make choices in their daily lives. A relative said "Staff are very, very kind and affectionate and give [relative] the best care. I am still so shocked with the good care they get, and this puts my mind at ease. Overall I am very happy." The home has a friendly and relaxed atmosphere. The team of support staff are established, experienced and have undertaken a good range of training. Staff are aware of people`s needs and behaviours and during the day we were there carried out their duties in a friendly, calm and competent manner. The Knoll provides a clean and well furnished environment for people to live in. People are encouraged to make personal choices about how they wish their personal space to be decorated and arranged. When people are considering moving into The Knoll they will be involved in the process of assessment and deciding if the home is right for them. Good information about the home in formats that they can understand will be available. People will be enabled to have a phased approach to moving in that suits their individual needs. Staff ensure that people living in the home are very well supported in maintaining good healthcare, and accessing other professional services that would benefit their overall care. People are supported to maintain contact with family and friends. What has improved since the last inspection? So that people receive care that is based on their individual needs and well planned, staff have revised care plans since the previous inspection. Care plans now have a more person centred approach and provide staff with good information to guide them in assisting people. Linked to care plans, risk assessments have been developed, so that any risks associated with individual care needs are identified and minimised. Other aspects of documentation that contribute to people`s overall care have been improved or developed, such as nutrition records, and other monitoring tools. Wherever possible information on records is made more accessible to people through the use of pictures or symbols. For people living in the home their lifestyle has been improved through opportunities to undertake different activities, and greater access to the local community. Staff are aware of the need to keep on improving this aspect of care so that people have continuing opportunities for growth and development. A good level of staff training has taken place so that staff have the knowledge and skills to care for people well and safely. Training has included challenging behaviour and medication training that were highlighted as being required at the previous inspection. The Knoll has also done very well in ensuring that all of its support workers have either achieved a National Vocational Qualification in care, or are currently completing this. So that people are cared for safely, and know what to do in an emergency, staff and people living in the home now have regular fire drills CARE HOME ADULTS 18-65 The Knoll 115 Southchurch Boulevard Thorpe Bay Essex SS2 4UR Lead Inspector Ms Vicky Dutton Unannounced Inspection 8th September 2008 08:30 The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Knoll DS0000067787.V371224.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knoll Address 115 Southchurch Boulevard Thorpe Bay Essex SS2 4UR 01702 586684 01702 586684 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) Minster Pathways Limited Vacant Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6), of places Physical disability (6) The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2007 Brief Description of the Service: The Knoll is a large family house situated in a residential area. There are six bedrooms for people within the home, three on the ground floor and three on the first floor. The home has a large lounge overlooking the front garden, a dining area and a quiet room. There is a secluded rear garden. Southend on Sea, Thorpe Bay and Southchurch are close by and are accessible by bus. There is rail access to Southend and London from Southend East railway station. The current scale of charges for people living at The Knoll is between £1,200 and £1,600, dependent on individual needs. A copy of the homes Statement of Purpose and Service Users Guide is readily available. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of seven hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. The home’s Annual Quality Assurance Assessment (AQAA) was sent in to us (CSCI.) The AQAA was received before the due date, was well completed, and outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. Five resident surveys and one relatives survey were returned. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the new manager, the area manager, and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: People living at The Knoll have varying degrees of communication difficulties. They were therefore unable to contribute fully on the day in terms of expressing their opinions about the service. However all observations and interactions showed that people living there were happy and relaxed in their environment, and that they had very positive relationships with staff and management. Staff know people well and help them to make choices in their daily lives. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 6 A relative said “Staff are very, very kind and affectionate and give [relative] the best care. I am still so shocked with the good care they get, and this puts my mind at ease. Overall I am very happy.” The home has a friendly and relaxed atmosphere. The team of support staff are established, experienced and have undertaken a good range of training. Staff are aware of people’s needs and behaviours and during the day we were there carried out their duties in a friendly, calm and competent manner. The Knoll provides a clean and well furnished environment for people to live in. People are encouraged to make personal choices about how they wish their personal space to be decorated and arranged. When people are considering moving into The Knoll they will be involved in the process of assessment and deciding if the home is right for them. Good information about the home in formats that they can understand will be available. People will be enabled to have a phased approach to moving in that suits their individual needs. Staff ensure that people living in the home are very well supported in maintaining good healthcare, and accessing other professional services that would benefit their overall care. People are supported to maintain contact with family and friends. What has improved since the last inspection? So that people receive care that is based on their individual needs and well planned, staff have revised care plans since the previous inspection. Care plans now have a more person centred approach and provide staff with good information to guide them in assisting people. Linked to care plans, risk assessments have been developed, so that any risks associated with individual care needs are identified and minimised. Other aspects of documentation that contribute to people’s overall care have been improved or developed, such as nutrition records, and other monitoring tools. Wherever possible information on records is made more accessible to people through the use of pictures or symbols. For people living in the home their lifestyle has been improved through opportunities to undertake different activities, and greater access to the local community. Staff are aware of the need to keep on improving this aspect of care so that people have continuing opportunities for growth and development. A good level of staff training has taken place so that staff have the knowledge and skills to care for people well and safely. Training has included challenging behaviour and medication training that were highlighted as being required at the previous inspection. The Knoll has also done very well in ensuring that all The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 7 of its support workers have either achieved a National Vocational Qualification in care, or are currently completing this. So that people are cared for safely, and know what to do in an emergency, staff and people living in the home now have regular fire drills What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wanting to move into The Knoll will be involved through assessments and visits in deciding if the home will be suitable for them. EVIDENCE: To provide people with information about the home a Service Users Guide and a Statement of Purpose are available. When viewed, the Service Users Guide was colourful, user friendly and provided good information that would be useful to people considering moving in. The Service Users Guide can be made available in different formats depending people’s individual needs. Five people living at The Knoll returned surveys to us. All said that they had been asked if they wanted to move in, and had received sufficient information about the home. One person had recently moved in. We saw that a thorough pre-admission assessment had been undertaken to ensure that The Knoll could meet their needs. The person had visited to ensure that they liked the home and would get on with the people already living there. The area manager explained that transitional arrangements varied according to individual needs, with some people having many visits and stays building up to moving in, and others less. Visitors to the person who had recently moved in said that they had been very happy with arrangements and that the placement was going very well. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive good and safe care and support through good planning and assessment. EVIDENCE: Everyone, apart from a person who has recently moved into the home, had a comprehensive care file in place. Care plans have been reviewed and replaced since the previous inspection. Those viewed highlighted people’s care needs in relation to all aspects of daily living, including leisure, social, cultural and emotional needs. Clear actions to meet these needs were identified for staff. Care plans reflected individual diverse needs, wishes and preferences. Some aspects of care plans were pictorially represented to aid people’s understanding. No care plan had yet been developed for someone who had been living in the home for two and a half weeks. However good information was available from the pre-admission assessment and the previous placement for staff to be working with. Staff felt that they were still getting to know the person. The The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 11 manager had started to develop a care plan but had been on leave. As far as possible people had been involved in their care planning and had signed their agreement with them. All staff had signed a sheet following each care plan to indicate that they had read and understood them. From observations and interaction during the inspection, people are aware of records kept about them and comfortable with this. One person spent time looking at their care file. Management are planning to improve the care planning system further and encourage ongoing personal development through a short term and long term goal planning approach. Staff do need to ensure that care plans are kept under regular review, and document this process. Many care plans viewed within individual files were overdue for review. A key worker system is operated to provide an individual approach to some aspects of daily living. The new manager is encouraging these staff to take more responsibility for care planning and reviewing information. People are supported to make decisions in their daily lives by staff. This was observed during the inspection when people were offered choices about what they wanted to do, eat and so on. On surveys everyone said that they were free to choose what they did. Where restrictions exist, for example in relation to safely accessing the local community, details are recorded in care planning. Where possible people are supported to manage their own finances. The manager gave examples of this. One person’s records were noted to identify ‘cash point training.’ Since the previous inspection risk assessments have been developed. The Annual Quality Assurance Assessment (AQAA) completed by the manager said, “The home undertakes full commitment to assessing the risks involved in service users daily lives, from the activities and social aspects of their lives to daily living skill tasks and operations. This is done in a way so as to promote their personal development and ability to take risks within their lives which are adequately minimised and with sufficient control measures in place.” We saw that care files had risk assessments in place relevant to people’s individual needs. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy a varied lifestyle that is suited to their individual needs and wishes. EVIDENCE: The AQAA indicated that the development of social opportunities has improved since the previous inspection and is continuing to do so. It said, “The main area of change is that The Knoll is actively involved in developing the social and leisure activities for service users both individually and as a group. The home has further potential to develop the social skills and activities offered to service users both within the home and accessing the community.” Management have struggled to find formal day activity or college courses that are suitable to meet people’s diverse and complex needs. A weekly friendship club is enjoyed by some, and a weekly evening disco and ‘pool nights’ by others. The manager continues to explore local resources to identify courses The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 13 and activities that people say they would like, and works hard to secure them places. In house activities such as arts and crafts, beauty sessions, cookery, knitting and gardening take place. A relative said, “[relative] goes to places that will make [gender] feel better and also does things that that are therapeutic for [gender].” From records viewed people living at The Knoll lead active lives. They access all aspects of community facilities such as the library, local pubs, parks, shopping centres and cinemas. At the inspection people spoke of looking forward to a forthcoming holiday in Blackpool. Where possible the use of public transport is encouraged to develop independence. The manager said that everyone has their own bus pass. The home also has their own minibus to facilitate trips and community access. Visiting at the home is open and friends and family contact encouraged. A member of staff said “Family contact is encouraged with all our service users. I believe all our service users have seen an improvement since moving to The Knoll. Some service users are now having home visits.” During the inspection people spoke about visiting their families. The manager said that staff support to facilitate this was provided when needed. The service users guide gives clear details about expectations related to daily living in the home. Arrangements in relation to smoking and other personal preferences are made clear. Those who are able are encouraged to take part in daily living tasks such as cooking, shopping and laundry. Care plans relating to these tasks were seen in their care files. Care files also included a range of consent forms including one explaining to people that staff may need to be aware of details of their post and assist them in taking appropriate actions. A four weekly rotating menu is used as a basis, but people are free to make individual choices about what they would like to eat. Care plans identify people’s individual likes and dislikes. Staff were heard to offer people choices. At lunch on the day of inspection individual choices were made and respected. There are dining tables in the three living areas of the home so that people’s behavioural needs, or individual preferences about who to eat with can be managed. Records seen showed that people living at The Knoll enjoy a balanced diet. People’s individual dietary needs and understood and managed. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive good personal and health care support. EVIDENCE: During the day people were offered good support by experienced staff. Most people living at The Knoll have some level of communication difficulty, so were unable to say how they felt about the care offered at the home. However all were observed to have a happy and relaxed relationship with staff. The AQAA said, “Personal care is provided in a flexible, sensitive manner in line with care plan guidelines and promoting their dignity and independence.” Care plans viewed detailed preferred routines and the assistance needed. A relative said that, “[Relatives] privacy and dignity is respected by all the staff.” Each person has a comprehensive health care file in place. These detailed all aspects of people’s healthcare needs, and showed that relevant professionals are involved with each individuals care. Files viewed showed that detailed records are kept of visits to doctors or other professionals. Regular health checks were identified as having been undertaken. These were tracked by the use of ‘yearly planners’ for all aspects of health care. During the inspection one The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 15 person was supported to attend a doctors appointment and a hospital appointment. Staff were patient in explaining several times what would happen, and who would be there to support them. A member of staff said, “Families are made fully aware of any issues affecting service users and any illnesses or hospital visits. I believe all our families are more than happy in this department. I believe a considerable improvement in two of our service users health has occurred since arriving at The Knoll.” A relative said, “If at all [relative] is not feeling well staff would have [gender] checked out as soon as possible by the doctor or other professional that is appropriate.” Medication practice at The Knoll is generally very well managed to ensure people’s safety. No one currently living at The Knoll is able to manage their own medication. Consent for staff to assist them with this aspect of care was recorded. People’s health files contained comprehensive details of individual medicines used, their purpose, potential side effects and so on. Two members of staff are involved in each medication round to ensure accuracy. When we viewed the system we saw that storage was suitable, and records viewed were well maintained. Advice was given in relation to best practice issues such as ensuring handwritten entries on medication administration record (MAR) sheets are double signed to confirm the all details were correct, and dating boxed/bottled medication on commencement. Protocols for medicine that are prescribed to be taken ‘as and when required’ (PRN) should be developed. Staff that administer medication have undertaken a basic course offered by the supplying pharmacist. Two staff had, prior to undertaking this course, completed an in house medication administration assessment. It was advised that all staff should have their competence periodically assessed to ensure ongoing good practice. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected by a clear complaints process, and procedures within the home. EVIDENCE: No complaints about the service have been made to staff or received by us, (CSCI) since the previous inspection. It was seen that systems are in place to record any concerns raised. Each person has a copy of the complaints procedure given to them. This is available in their care file. The complaints procedure is available in a pictorial and symbol (widget) format to meet individual needs. On surveys people said that they knew who to speak to if they were not happy and knew how to make a complaint. Staff training records showed that they had attended training in safeguarding adults. The manager said that further training is planned for October. One member of staff said, “I have read and understood the whistle blowing policy. I know the procedure to follow. Lots of training is provided by the employers about vulnerable adults.” It was reported that no one currently living at The Knoll has major behavioural difficulties that would require the use of restraint techniques. Care files viewed showed that people’s behaviour is understood by staff with appropriate risk assessments and care plans being in place. Training records confirmed that staff have received training in managing challenging behaviour. The area manager confirmed that all staff complete an initial three day course, which is adapted to meet the individual behavioural needs of people living in the home. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 17 Then regular two day updates take place. The next update training is planned for October. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable and well maintained home. EVIDENCE: The AQAA said, “Environmentally the home has made continual developments since it opened and remains a warm, clean, pleasant and welcoming environment for service users, staff and visitors. All necessary adaptions and modifications are made for each individual service user to meet their assessed needs before and during their transition to the home. Within the last year a new maintenance department has been set up for the homes in Southend and The Knoll has benefited from having access when needed to the qualified maintenance support to deal with environmental issues that occur during the course of each week.” The home provides people with spacious communal and private accommodation. Bedrooms viewed with people’s permission were personalised, and it was clear that this is encouraged. On the day of inspection one person had just had new furnishings of their own choice The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 19 delivered. A person who had recently moved in was being encouraged to choose what colour they wanted their room decorated in. Although some communal areas of the home would benefit from some redecoration, generally the standard of decoration, furnishings and fittings is very high. On surveys everyone said that the home was ‘always’ fresh and clean. On the day of inspection the home was clean in all areas viewed. There was a good size laundry area that can meet the needs of people living in the home. Staff training records showed that they had received training in infection control so that they work safely. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are cared for by an established staff team that are experienced and well trained. EVIDENCE: One relative was effusive in their praise of the home and it’s staff. They said, “I believe that [Names of senior staff] and all of the other staff have the right skills and experience to support individuals needs in an excellent manner.” They also said that staff were very caring and supportive. On surveys people said that staff ‘always’ treated them well. Of the ten support staff working in the home, eight have achieved a National Vocational Qualification (NVQ) in care. The remaining two staff are currently completing this qualification. The home have exceeded the expectation of 50 of staff being trained to NVQ level two or above. Training records showed a good level of core training. From the AQAA and discussion on the day, management hope to build on this and ensure that all staff have opportunities for training in areas such as autism and total communication, which some staff have already done. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 21 To ensure that knowledge and understanding has been gained, when staff attend training they also complete an in house form to test their knowledge of the subject trained in. Examples of this were seen in relation to Safeguarding training. The AQAA said that plans for the next twelve months were, “Further development of staff training and supervision is a key aim of the service.” On the day of inspection five people were being accommodated. To provide for their needs rotas viewed showed that three or four staff are provided during the day. At night there is one asleep and one awake member of staff on duty. Agency staff are not used at The Knoll so consistency is always provided for people. As at the previous inspection it was noted that staff work many straight through shifts from 07.30 to 22.00. On one weeks rota viewed some staff had worked from 58 to 80 hours in one week. This is not good practice as staff may become tired. It was said that the particular week viewed had been exceptional due to leave, and indeed other weeks viewed did provide a better picture. However this practice does need to be monitored. A strength of The Knoll is that, apart from the manager role, it has a very stable staff group. Staff said, “Our support team has been consistent for over a year now with a very low staff turnover. I feel this is very important for staff training and service user confidence. In my 18 months here plenty of training has been offered and I have recently completed an NVQ,” and, “I believe standards are high regarding the care of our service users. This has come from a stable consistent staff team and high standards demanded by inspectors.” It was stated that no staff have been recruited since the previous inspection. At the previous inspection a requirement was made in relation to recruitment, as processes then in place were not seen to be robust enough to fully protect people. The requirement will be carried forward to the next inspection in order that good practice can be verified. The recruitment and interview process was discussed and the manager said that people living in the home are involved in the process. The AQAA said, “Service users have been involved with the recruiting and hiring of staff for their home because they had identified this as something they wished to be more involved in.” Evidence was seen in existing staff files that an induction process takes place. Staff complete a basic home’s induction and then go on to undertake a Skills for Care training programme. Although it was possible to evidence a good deal of staff training, individual staff training and development assessments and profiles were not in place. Anecdotal evidence was given that staff had opportunities to undertake training relevant to specific individual needs, such as language skills, but this process was not formalised. As identified in the AQAA regular staff supervision is another area that needs to be developed. Some supervision has taken place this year. The area manager thought that everyone had received at least one supervision, but due to the departure of the previous manager records could not be located. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe home where day to day management is good. EVIDENCE: Since The Knoll was registered in 2006, there have been four managers in post who have then left. The most recent manager left a few weeks prior to this inspection. In spite of this the home has steadily developed and improved. The rest of the staff group have remained stable to provide ongoing consistency for people living in the home. On the day of inspection the deputy manager, who has worked at the home since it opened, agreed to take on the manager’s role and intends to apply for registration. They hold NVQ at level three in care and are enrolled to commence level four. They are also intending to undertake the Registered Managers Award. The manager is experienced and from records viewed has undertaken much relevant training. From discussions throughout the day, the manager demonstrated a clear The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 23 understanding of the key principles of the service, and was a strong advocate for people’s rights to access good services. People have the opportunity to express their views about the service. Monthly meetings are held for people living in the home. Minutes are kept of these meetings and showed that things such as food and activities are discussed. People’s files showed that ‘Service user Satisfaction Questionnaires’ were completed in August this year. The survey was well presented in a user friendly format with pictorial elements to help people’s understanding. The area manager said that a quality assurance exercise is also completed from the organisations head office. This audits all services and produces charts and action plans. As required by regulation, regular monthly visits to the home are undertaken by the area manager. These visits include talking to staff and people living in the home. The AQAA completed by the (then) deputy manager was well completed, and provided good information about The Knoll. The AQQA showed a recognition of what further improvements need to be made. No health and safety issues were noted during the inspection. The previous inspection raised that staff had not received fire training and that regular drills were not held. Fire training for staff has still not taken place but it was seen that this is now planned for early October. Regular tests and drills are now being undertaken. Records of these were seen and showed that staff and people living in the home are involved to ensure that everyone understands what to do in an emergency. A current fire risk assessment was in place. The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 2 X 3 X X X 3 The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 25 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 YA34 Regulation 19 Requirement Robust recruitment procedures must be adopted to ensure people are safeguarded from abuse. This requirement with a compliance date of 31/10/07 has been carried forward as the outcome could not be fully assessed at this inspection. Timescale for action 30/09/08 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 YA6 Good Practice Recommendations Care plans should continue to be developed to reflect people’s aspirations and Goals. They should also be kept under regular review to reflect any changes. The best practice issues identified in the report in relation to medication management should be actioned. These are: DS0000067787.V371224.R01.S.doc Version 5.2 Page 26 2. YA20 The Knoll The development of protocols for medicines prescribed ‘as and when required’ (PRN) The checking and countersigning of handwritten entries on the MAR sheet to show that the correct details and amounts have been recorded. Dating boxed/bottled medication when commencing. The periodic monitoring of staff competences in relation to medication administration. 3. YA33 The amount of ‘double shifts’ and hours worked by staff should be monitored to ensure their own and residents safety. To ensure that people are cared for by staff that have the correct skills to meet the needs of people training and development profiles should be developed for the home and individual staff. So that staff receive good ongoing support they should receive formal supervision at least six times a year. 4. YA35 5. YA36 The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Knoll DS0000067787.V371224.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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