Care Home: The Knoll Nursing Home

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What the care home does well See summary. What has improved since the last inspection? See summary. What the care home could do better: See summary. Key inspection report Care homes for older people Name: Address: The Knoll Nursing Home 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Bentley     Date: 0 5 0 1 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 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. 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 Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: The Knoll Nursing Home 30 Leeds Road Greengates Bradford West Yorkshire BD10 9SX 01274619207 01274620194 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Knoll Nursing Home Ltd c/o ADL plc care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home The Knoll is a detached, converted Victorian property. It is located in a residential area close to local amenities and on public transport routes. A long driveway leads to the home and there are parking areas to the front of the property. There are gardens surrounding the home. The accommodation is over four floors. A passenger lift goes to all floors. There are thirty-nine bedrooms in total; thirty-six single and three shared rooms. Eleven of the bedrooms have en-suite facilities. There are four communal bathrooms, three showers and ten communal toilets. There are three lounges on the ground floor. One has a conservatory area and two of the lounges are also used for dining. The home has been vacant since July 2008. Care Homes for Older People Page 4 of 24 Over 65 42 0 0 3 0 4 0 2 2 0 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: At the last key inspection on 8 August 2007 the quality rating for this service was 1 star, adequate. No site visit has taken place at this inspection as there is no one living in the home and it has been vacant since July 2008. On 4 July 2008 a random inspection was carried out as information had been received that people living in the home were at risk due to a number of issues. We found that people were not receiving the proper care to meet their personal and health care needs, peoples nutritional needs were not being met, people were not receiving the care they needed to prevent and treat pressure sores and there were not enough staff to meet peoples needs or keep them safe. Concerns had also been raised with Bradford Adult Protection Unit. As a result, an emergency adult protection meeting was convened which included Bradford Metropolitan District Council, the Primary Care Trust Care Homes for Older People Page 5 of 24 and the Commission. The meeting decided that the only course of action to ensure the safety of people living at the home was to move them immediately to other care settings. Had this action not been taken we would have considered making an application for an urgent cancellation of registration. Following the meeting Bradford Council and the PCT went into the home and reassessed all 28 people living at The Knoll and in consultation with relatives moved everyone to other care settings. Following this action the provider decided to close the home and there have been no further people accommodated, although the service is still currently registered with us. On 22 December 2008 a Notice of Proposal to cancel the registration was served on the provider. The legal process gives the provider the opportunity to make representations and therefore the quality rating for this service remains adequate until the legal processes have concluded. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 9 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 10 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 11 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 12 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 13 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 14 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Dormant service, see summary. Evidence: Dormant service, see summary. Care Homes for Older People Page 15 of 24 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 In order to make sure that 19/08/2008 people?s personal, social and healthcare needs are identified and met the care plans must be more detailed and informative. They must provide staff with clear guidance about how to meet individuals? needs. The provider must make sure that all staff are aware of and follow the guidance in these plans. Timescales of 01/02/06, 04/12/06 and 31/08/07. Compliance with this requirement has not been assessed. 2 8 12, 13 In order to make sure that 19/08/2008 peoples health care needs are met, steps must be taken to make sure that appropriate professional advice and support is requested. For example, the falls prevention team for people at risk of falling and the GP and dietician for people at risk of losing weight. Timescale of 19/01/08 not met. Steps must be taken to make Care Homes for Older People Page 16 of 24 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action sure that, if urine and blood samples are requested by healthcare professionals, they are obtained and sent to the appropriate surgery/hospital. In order to evidence that this is being done, records must be kept. This requirement was not looked as part of this visit. Records monitoring care provided such as changes of position, food and fluid intake must be kept up to date to show how the risks are being managed. This will help to identify when further input from other health care professionals may be needed. Timescale of 19/01/08 not met. Written agreements and consents must be in place when forms of restraint, such as the use of Kirton chairs are used. A thorough risk assessment must be carried out before considering their use. Timescales of 06/11/06 and 30/06/07 have previously not been met. Compliance with this requirement has not been assessed. 3 9 13(2) Handwritten entries on the Medication Administration Record must contain all essential information, be 19/08/2008 Care Homes for Older People Page 17 of 24 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action signed & dated by the author, and then checked & countersigned by a witness to reduce the risk of mistakes when copying information from another source. This requirement was not looked as part of this visit. 4 9 13 In order to protect people 21/08/2008 and make sure they are given medication as prescribed by their doctors the provider must take immediate action to make sure that safe systems are in place for the ordering, receiving, storing and administration of medications. The policies and procedures must be in line with the Royal Pharmaceutical Guidelines and reflect current good practice and legislatory requirements. Staff dealing with medication must receive appropriate training. Timescales of 01/09/06, 30/06/07 and 30/12/07 have not been met. Compliance with this requirement has not been assessed. Registered nurses must be aware of their personal and professional responsibility and accountability and abide by the professional codes of conduct issued by the Care Homes for Older People Page 18 of 24 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action nursing and Midwifery Council. Compliance with this requirement has not been assessed. 5 9 13(2) The registered person must 19/08/2008 ensure that all medicines are stored securely at the temperature recommended by the manufacturer so that they are safe to use. This requirement was not looked as part of this visit. Compliance with this requirement has not been assessed. The registered provider must 19/08/2008 make sure that residents are consulted about their social interests and a suitable programme of activities arranged for them. The needs and abilities of residents must be taken into account. Compliance with this requirement has not been assessed. The registered person must 19/08/2008 make sure that after the meeting and visit with the fire safety officer happen any works recommended after are carried out within the timescales agreed with the fire safety officer. Compliance with this requirement has not been 6 12 16 7 19 23 Care Homes for Older People Page 19 of 24 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action assessed. 8 26 13 In order to prevent the risk 19/08/2008 of cross infection, steps must be taken to review the ways laundry is dealt with before it is bagged and sent out to the commercial laundry. Compliance with this requirement has not been assessed. 9 27 18 In order to protect people 19/08/2008 and make sure that their health, safety and well-being are maintained and their needs are met. The provider must make sure that there are enough staff on duty at all times. Peoples needs and dependency levels must be taken into account. Steps must be taken to make sure that care staff are not taken away from their caring roles to carry out domestic duties. An Immediate Requirement was made for 08/08/07. A timescale of 31/08/07 to meet the requirement was given in the inspection report for August 2007. The timescales of 30/12/07 and 31/01/08 were not met. These timescales have not been met. Compliance with this requirement has not been assessed. Care Homes for Older People Page 20 of 24 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 10 30 18 In order to make sure that 19/08/2008 staff are trained and competent to meet the needs of people living in the home, the provider must make sure that the training programme is updated and developed. It must make sure that all staff, including qualified nurses, have the knowledge and skills to maintain the health, safety and wellbeing of residents and themselves as well as training around specialist healthcare needs of residents such as dementia, stroke etc. The provider must make sure that the qualified nurses receive training appropriate to their roles and that they are aware at all times of their personal and professional responsibility and accountability as set out in the Codes of Practice issued by the Nursing and Midwifery Council. Compliance with this requirement has not been assessed. 11 38 13 and 17 In order to make sure that equipment in the home is being properly maintained the provider must inform CSCI of the dates when maintenance and safety checks were carried out. 19/08/2008 Care Homes for Older People Page 21 of 24 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action In order to maintain the health and safety of people who have been identified as needing bed rails, the provider must make sure that full and detailed risk assessments of why they are being used are carried out. The assessments must include what type is being used, how they are fitted, how often they are to be checked and who by. Records must be kept. Compliance with this requirement has not been assessed. Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: 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). 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. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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