Care Home: The Knoll Care Home

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What has improved since the last inspection? The home has improved the standard of nursing care provided at the home. The number and frequency of pressure ulcers (also known as bed sores) has decreased. The number of people experiencing weight loss has also decreased. Where there are issues with failing health staff are now more proactive in recognising this and seeking the help and support of other professionals. Relationships which were once strained between the home and other health professionals are now on much improved. This is due to increased communication from all parties and the sharing of information. Feedback from the local social workers confirmed that they are now happy to place people looking for residential care. Social workers and care managers stated that they had seen improvements in the care and support afforded to people living at the home and placed people with confidence.The Knoll Nursing HomeDS0000066156.V375991.R01.S.doc Version 5.2 Page 7Care planning has improved although some areas need continued improvements. On the whole however they now provide clear guidance to staff on the care needs of the individuals living at the home. The environment has improved with new lounge furniture. The furniture in the lounge is now positioned to create more of a homely feel and the reduction in previously institutional feel of the home. The development of a dedicated dining space has improved the dining experience for people living at the home. Since the last inspection the number of adjustable beds has increased. All people with nursing needs now have access to this equipment. Some additional developments within the current home are planned once the building works have been completed. The storage, documentation and administration of medication has improved and now complies with good practise guidelines. A staff recruitment procedure has improved with all checks on new employees now being completed prior to the individual commencing work at the home. Staff training including induction is now more robust and staff appear to have completed all mandatory training. What the care home could do better: Although the care planning process has improved overall not all the care plans had been completed to the same standard. The management need to ensure that all the care plans contain up to date information and provide clear guidance to the staff on the care needs of all the individuals living at the home. The care plans need to also consider the recent guidance on Mental Capacity and deprivation of liberties. Charts had been introduced for some people living at the home. These charts are used to document such things as a change of position and diet and fluids taken. Some of the charts had not been completed. It is therefore difficult to assess how these influence the care and support that is being provided by staff. The home now provides a range of training to staff at the home. The completion of the planned training matrix will ensure that future training can be planned and provide an easy reference to the training staff have undertaken. Although the outcomes for people living at the home are positive the home has currently to implement a formal quality assurance system. The implementation of such a system will ensure that the quality of the care provided remains goodThe Knoll Nursing HomeDS0000066156.V375991.R01.S.doc Version 5.2 Page 8and that people living at the home, relatives and staff have the opportunity to have input into the continued development of the service. Key inspection report CARE HOMES FOR OLDER PEOPLE The Knoll Nursing Home 33 Preston Road Yeovil Somerset BA21 3AE Lead Inspector Justine Button Unannounced Inspection 15th June 2009 09:00 DS0000066156.V375991.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knoll Nursing Home Address 33 Preston Road Yeovil Somerset BA21 3AE 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) 01935 421822 The Knoll Nursing Home Limited Mrs Tricia Susan Oliver Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 25. 21st May 2008 Date of last inspection Brief Description of the Service: The home is a converted house with a purpose built extension, situated a few minutes walk from the centre of Yeovil. Accommodation is on two floors. All the bedrooms are single occupancy. There are an adequate number of adapted bathrooms. There is a large reception area that provides seating fir guests and visitors to the home. This area also provides a quiet area for those people living at the home who do not want to watch TV. There is a large lounge area on the ground floor. A dining area has now been developed. There are well-maintained gardens and patio area, which can be seen from the two main sitting areas. The home provides general nursing care for older people and can offer personal care for three people. The manager lives on the property and the proprietor has day-to-day contact with the people living at the home. The service is currently undergoing some building work which will increase the number of bedrooms by seven and increase the communal space available. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Key unannounced inspection was carried out over one days by one inspector. The Manager was available on the day of the inspection. The inspector would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CQC Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Information is requested from each home by us on an annual basis. Information from the homes Annual Quality Assurance Assessment (AQAA) was been used throughout the inspection process. Information held in the AQAA was confirmed during the inspection visit. Records examined during the inspection were individuals care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, quality assurance processes and staff supervision records. We also conducted a tour of the premises. Current fee levels at the home range from £550 to 750 per week dependent on need and the room occupied. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. The quality rating for this care home is: two star good service What the service does well: Since being employed at the home the current manager and owner have made significant changes to the running of the services. This has had a positive impact on the care and support afforded to people living at the home. People’s The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 6 rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home, on the whole, was clean, tidy and free from unpleasant odours. People are able to bring in furniture and personal belongings to personalise their private room. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as very good, very kind. People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. What has improved since the last inspection? The home has improved the standard of nursing care provided at the home. The number and frequency of pressure ulcers (also known as bed sores) has decreased. The number of people experiencing weight loss has also decreased. Where there are issues with failing health staff are now more proactive in recognising this and seeking the help and support of other professionals. Relationships which were once strained between the home and other health professionals are now on much improved. This is due to increased communication from all parties and the sharing of information. Feedback from the local social workers confirmed that they are now happy to place people looking for residential care. Social workers and care managers stated that they had seen improvements in the care and support afforded to people living at the home and placed people with confidence. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 7 Care planning has improved although some areas need continued improvements. On the whole however they now provide clear guidance to staff on the care needs of the individuals living at the home. The environment has improved with new lounge furniture. The furniture in the lounge is now positioned to create more of a homely feel and the reduction in previously institutional feel of the home. The development of a dedicated dining space has improved the dining experience for people living at the home. Since the last inspection the number of adjustable beds has increased. All people with nursing needs now have access to this equipment. Some additional developments within the current home are planned once the building works have been completed. The storage, documentation and administration of medication has improved and now complies with good practise guidelines. A staff recruitment procedure has improved with all checks on new employees now being completed prior to the individual commencing work at the home. Staff training including induction is now more robust and staff appear to have completed all mandatory training. What they could do better: Although the care planning process has improved overall not all the care plans had been completed to the same standard. The management need to ensure that all the care plans contain up to date information and provide clear guidance to the staff on the care needs of all the individuals living at the home. The care plans need to also consider the recent guidance on Mental Capacity and deprivation of liberties. Charts had been introduced for some people living at the home. These charts are used to document such things as a change of position and diet and fluids taken. Some of the charts had not been completed. It is therefore difficult to assess how these influence the care and support that is being provided by staff. The home now provides a range of training to staff at the home. The completion of the planned training matrix will ensure that future training can be planned and provide an easy reference to the training staff have undertaken. Although the outcomes for people living at the home are positive the home has currently to implement a formal quality assurance system. The implementation of such a system will ensure that the quality of the care provided remains good The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 8 and that people living at the home, relatives and staff have the opportunity to have input into the continued development of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 9 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 Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Standard 6 is not applicable People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. The home ensures that people are appropriately assessed before a placement is offered. EVIDENCE: Care homes are required to have information available to individuals with regard to the care and services that are provided at the home. This information The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 11 is called the statement of purpose and service user guide. Since the last inspection the Statement of purpose and service user guide have been up dated. Relevant information is now available both to people thinking of moving to the home and to those already living at The Knoll. The terms and conditions of stay for the home have been updated and a copy of these was seen. These have been given to all people living at the home and will be used for all future admissions. Extra charges are met by individuals for newspapers, hairdressing, trips, outings, personal toiletries items and special requirements. Pre-admission assessments completed for people moving into the home by the home manager. We were able to see evidence that prospective service users were fully assessed prior to being offered a placement at the home. Completed pre-admission assessments were seen to be in place in service user care plans examined. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process at the home has improved although additional developments are required. The health care needs of people living at the home are met for most of the people living at the home. The storage and documentation of medication has improved in line with manufactures and good practice guidelines EVIDENCE: The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 13 At the last inspection it was reported that the care planning process was inadequate as the plans did not give clear guidance to staff on the needs of the individuals living at the home. Since the last inspection the staff have worked at reviewing and developing the care planning process. This has also been confirmed by other professionals who have been visiting the home to review the care of individuals as part of the recent concerns. Some of the plans viewed however require ongoing and additional development. It was confirmed by viewing the records for one individual that they had lost some weight. It was apparent that small amount of weight was being lost every month resulting in a net weight loss over a period of three months. Weight loss in older people can be significant and can be used to signify that the individual is becoming frailer and can also impact on the increase the risk of sustaining such things as pressure ulcers (also known as bed sores). It could not be confirmed if staff had recognised this weight loss. A care plan had not been developed to address these care needs and it could not be confirmed therefore if staff were taking appropriate action to stem the weight loss. Information in the plans and assessments needs to be consistent to ensure that staff deliver the care and support to the individual in a consistent way and to ensure that care needs are met appropriately. The care plans for the individual were not always specific and were ambiguous in places. For example the individual was immobile and required staff support to move or change position. The assessments and associated care plans for this area did not tell staff the equipment to be used nor the frequency that a positional change would be required. Again the plans need to give clear guidance to staff to ensure that care and support is delivered appropriately. This individual had some tissue damage. A care plan was in place for this aspect of the individuals needs. It became apparent that this tissue damage had healed however this was not reflected in the care plan seen. This was raised with the nurse in charge who rectified this issue during the inspection. The bedroom for this individual was viewed during the inspection. This showed that appropriate pressure reliving equipment was in place. The equipment in use was in line with the care plan. During the course of this inspection this individual was supported to change position on a regular basis in line with the care plan. A change of position is required to help in the prevention and the healing of any pressure damage. The staff had commenced charts to record the frequency of positional change and the amount of fluids taken however these had not been completed consistently by staff. Charts such as these are used to assess if the care and support provided by staff is effective and adequate. The information used in the charts should influence the care and support provided. If the charts are not completed consistently therefore their use is questionable. It is advised that if charts are assessed as being required that these are then completed fully by staff in order that care can be monitored and altered if required. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 14 The care plans for another three individuals were viewed. These contained a range of assessments and associated care plans. These contained more information and reflected the care needs of the individual in more detail than the documentation for the other individual. The Mental Capacity Act Deprivation of Liberty safeguards (formerly known as the Bournewood safeguards) were introduced through the Mental Health Act 2007 (which received Royal Assent in July 2007). The safeguards are designed to protect the interests of an extremely vulnerable group of service users and to: - ensure people can be given the care they need in the least restrictive regimes - prevent arbitrary decisions that deprive vulnerable people of their liberty - provide safeguards for vulnerable people - provide them with rights of challenge against unlawful detention - avoid unnecessary bureaucracy It is expected that staff in care homes consider this act when providing care and support to people. There is documentation in the care plans seen to address the guidance in the act however this has yet to be completed. In addition staff training in this area is planned by the home. The care plans seen confirmed that people living at the home have access to a range of health care professionals. This included input from district nurses, GPs, Social workers & palliative care specialists. At the last key inspection concerns were noted with regard to the storage and recording of medication. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored on this visit. Creams and lotions stored in peoples bedrooms related to the individual to whom they are prescribed and have a date of opening. This is required to ensure that creams and lotions are not used after the expiry date or shelf life. The storage of insulin for people with diabetes was found to be adequate. This will ensure that the effectiveness of the insulin is not compromised. Medication requiring refrigeration is stored at the correct temperature. At least one person at the home requires the use of oxygen. The management need to ensure that there is adequate signage on doors leading to areas where oxygen is in use. This will ensure that health and safety is not compromised. People who were able to express a view and relatives were very positive about the care they received. This was confirmed both during the inspection. Staff interactions with individuals were noted to be very warm, professional and respectful. Interventions were observed to be unhurried. Feedback from people included I am very happy here, The care is excellent, Staff are lovely. Staff were heard explaining interventions to individuals before carrying out. People who appeared relaxed and comfortable throughout the day. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 15 The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a range of activities at the home. This is an improvement on previous inspections carried out at the home. Visitors were seen to be visiting the home on the day of the inspection. All stated that they are made welcome at any time. Choices are available to people living at the home. Meals and mealtimes are a pleasant experience with some dining space now available. EVIDENCE: The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 17 On the day of the inspection a number of people who live at the home were in the garden with the activities coordinator playing games. Although the main area of the garden is being used by the builders there remains a secluded and shady area of garden to the rear of the home. In addition there is a enclosed courtyard which has a range of table and chairs for people to use. The home has acquired a number of chickens which are kept in a run at the rear of the home. Everyone enjoyed talking about the chickens. The home has two puppies who currently live with the manager in the flat above the home. The puppies visit the home on a regular basis and it is intended that they will spend increasing amount of time within the home as they become older. In addition to the activities organised and planned by the activities coordinator it is now evident that the care staff have adopted a culture of a more person centred approach and that the care staff do not now seen activities and communication as solely the remit of the activities r. Staff were observed sitting and talking to people during the quieter periods of the day. Everyone we spoke with said the food was very good or excellent. One person said there is always a choice and if you dont like that they will do you something else One relative stated that she felt the standard of food was good and that there was always a range of fresh vegetables available. The food served on the day of the inspection looked and smelt appealing with a range of vegetable available. A choice of meal was evident. A four week rolling menu has been developed including a hot option in the evening. The home had now developed a dining area which has immensely improved the feel of all meal times. The homes AQAA stated that the home would like to continue the development and opportunity for al people to sit at a table at mealtimes. A number of people required staff support at meal times. Staff were observed to sit down when they supported people to eat. This allows staff to ensure that they have the time to spend with people during meals and ensures that meal times are a pleasant experience for all. This time also allows staff to monitor dietary intake effectively which will promote the general health of people living at the home. A number of people living at the home have difficulty in swallowing or require specialist diets, for example if they have skin damage or have experienced weight loss. On the day of the inspection a range of specialist diets and supplements were available throughout the day according to the individuals assessed needs and in line with care plans. It was however noted that on the afternoon drinks trolley biscuits only were available. Biscuits may not be appropriate for all people living at the home and consideration should be given to increasing the range of snacks available at these times. Although a choice of meals is available at all times and a written menu is on display it could not be confirmed how all people living at the home make choices in this area. Some people living at the home cannot verbally express their choices. Staff could develop a system were they plate up the choices and show these to people who can then make a choice. Alternatively staff could The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 18 develop pictures and photographs of the food again enabling people to have a greater understanding on what is being offered. Visitors were seen visiting family and friends throughout the day of the inspection. People living at the home stated that visitors were made to feel welcome. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure in place. The home has systems in place to reduce the risk of harm or abuse to the people living there. EVIDENCE: The home had a complaints procedure, which was available to people living at the home, staff, and visitors. It forms part of the Service User Guide and is detailed in the Statement of Purpose. The home has developed a new comments, complaints and compliments from that people may use to record their feelings about the care and support given at the home. People who were able and staff spoken with informed us that they would not hesitate in raising concerns if they had any. Feedback forms received also confirmed that people would not hesitate to raise concerns and were clear who The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 20 they would speak to do this. A number of staff spoken during both visit stated that they felt that the standard of care and support was good. Three staff were spoken to during the visits and asked what they would do if they suspected abuse was occurring at the home or if they saw another staff member acting inappropriately. All of the staff gave clear answers whilst the remaining staff member was unsure what she would do. Staff training in this area has been given Since the last key inspection staff recruitment procedures have been reviewed and are now robust. This protects the People living at the home. The home is currently undergoing an extension and as such workmen from outside contractors are undertaking this work. The workmen did not have access to the home. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the building are looking tired and worn but it is understood that this will be rectified once the new building has been completed. There has been an increase in the number of adjustable beds all people with nursing needs have this equipment. People are able to individualise their private rooms. People are able to have access to a garden although this is currently restricted due to construction of a new building. The cleanliness of the home was good. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 22 EVIDENCE: A new building is in the process of being developed at the site of the home. This will increase the number of bedrooms by seven. Additional communal space will also be provided A tour of the building was conducted during the inspection. There are a range of communal areas including a lounge and a dining room. This space complies with the requirements of 4.1sq m per service users. The furnishings and decoration are all homely and varied although tired looking in parts. Although some of the areas in the home have been redecorated and modernised the owner of the home stated additional refurbishment will occur once the dirty work form the new building is completed. There is a range of specialist equipment including air mattresses and cushions used to help in the prevention of pressure sores. People who are frail and nursed in bed for long periods should be provided with an adjustable bed to reduce the risk of back injury to staff. The number available has increased since the last inspection. We were informed during the inspection that these will be upgraded as part of the ongoing refurbishment at the home. The home does provide access to outdoor space in the form of a garden and patio area. The access to this space is currently limited due to the building works that are being completed. Parking is also restricted at this time. The home was clean and tidy on the day of the inspection. The AQAA sent to us confirms that all necessary maintenance is completed. Since the last inspection the home has employed a maintenance person which has helped to ensure that the building is maintained to a satisfactory level and that all health and safety checks are completed on regular basis. On the day of the inspection oxygen was in use at the home. The management need to ensure that appropriate signage is in place where oxygen is in use. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers at the home appeared to be adequate to meet the needs of the people living at the home. An up to date training matrix was not available however staff stated that they received sufficient training to fulfil their job role. Staff told us that they felt well supported by the management team. Staff recruitment procedures have improved and all satisfactory checks are now completed. New staff receive an improve induction programme. EVIDENCE: The standards of care and support afforded to people living at the home were observed to be good. Feedback obtained during the inspection told us that staffing levels were adequate. This was confirmed on reviewing the duty rota’s. The home currently employs one registered nurse and two care staff on night The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 24 duty. One registered Nurses and four care staff in the morning. One Registered Nurse and four care staff in the evening. The home is run over two floors.. A range of ancillary staff including cooks, kitchen assistant’s administration staff and cleaners are also employed. Two staff recruitment files were viewed. These demonstrated that all necessary checks were completed prior to the individuals commencing employment at the home. This is a significant improvement on the findings of previous inspections. The home has reviewed the staff induction process and this now meets good practise guidance. Staff spoken during the inspection who were newly employed confirmed that they had undertaken an induction programme and that this had been beneficial. Staff training was viewed. The home does not currently have a training matrix although one is being developed. A training matrix allows you to view the training completed and any training due easily. The manager provided us with a blank copy which she hopes to have completed over the next few months. Staff training certificates are currently held in the individual employee’s personal file. Due to the lack of training matrix as sample of these were viewed. These demonstrated that staff had undertaken all necessary training. Information was also obtained from the AQAA, sent to us prior to the inspection. This document also confirm that all staff have undertaken all necessary mandatory training. Staff spoken to during the inspection stated that they felt that had received sufficient training in order for them to complete their job role. In addition outcomes for people living at the home are positive. The AQAA stated that the Registered Nurses have undertaken training in record keeping. A number of staff at the home are undertaking or have completed an NVQ. Staff spoken to during the inspection stated that they felt supported by the management team at the home and that they received regular supervision and appraisals. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is opportunity for people to feedback on the day-to-day running of the home and on what it offers people living here. The home needs to develop a more formal quality assurance system. People living at the home are protected by robust policies and procedures at the home. The home is well and safely maintained. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager is Mrs Oliver. Mrs Oliver is a registered Nurse and has numerous years experience in the health care field and of running care homes. Since taking up the position of registered manager at the home Mrs Oliver has been instrumental in improving the standard to care and support afforded to people living at the home. This was confirmed by the feedback from people living at the home, staff, relatives and professionals that visit the home. The manager was on duty and was helpful in assisting with the inspection process. Staff and people at the home had a good rapport with the manager. The manager demonstrated that she is knowledgeable about care and has a good understanding of the people living at the home. The AQAA indicated that the manager has regular meetings to update all departments. Meetings are held for the people in residence at intervals. This was confirmed by asking the people who are living at the home. Both the home manager and the owner have regular day to day contact with all people living at the home, relatives and staff. However the manager confirmed that she is yet to develop a formal quality assurance system. This is recommended to ensure that the standards within the home are maintained. In addition this will ensure that all parties have the opportunity to influence the care that is provided at the home. The AQAA indicated that maintenance of equipment had been addressed in 2008 and was up to date. This included the servicing of the passenger lift, people hoists, fire safety equipment, gas appliances and the heating system. The home regularly informs us of any incidents as required under Regulation 37. The manager regularly completes audits of the home to ensure that the standard of care and service provided remains good. This includes audits of such things as accidents and incidents. The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 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 3 3 2 3 3 3 3 3 The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP33 OP30 OP8 OP7 OP7 OP8 Good Practice Recommendations The management should consider the development of a formal quality assurance system. Consideration should be given to the completion of the training matrix to ensure that future training needs can be easily seen and planned. Documentation such as fluid, diet and turn charts should be completed fully in order that they can influence the care and support that is provided. The care plans need to consider the Mental Capacity Act and the deprivation of Liberties guidance. All the care plans need to be developed to ensure that they give clear guidance to staff on the care needs of the individual. Signage must be provided in all arrears where oxygen is in use. DS0000066156.V375991.R01.S.doc Version 5.2 Page 29 The Knoll Nursing Home The Knoll Nursing Home DS0000066156.V375991.R01.S.doc Version 5.2 Page 30 Care Quality Commission North South West Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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