Care Home: The Knoll Nursing Home

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What the care home does well People considering moving into The Knoll are given an information pack that tells them everything they need to know about the home. Residents receive good quality nursing care and they are treated with dignity and respect. Residents like living in the home, staff like working in the home and relatives feel that The Knoll is a good home. Here are some of the residents and relatives comments, "The Knoll is a bright airy home with pleasant and helpful staff." "Looks after us well. The staff are always cheerful." "All the staff at The Knoll Nursing Home are always very kind and helpful. I would recommend anyone who is looking for care for a member of their family to The Knoll." "The home always makes visitors welcome at any time and always offer refreshments." "Always the person in charge is available to talk to if needed or arrangements are made." "The care of residents is to a high standard, the staff are friendly and polite." Here is a health professional`s comment, "There is an excellent level of service provision individually tailored to clients` needs and abilities. This is an exemplary home." Here are a couple of staff members` comments, "We always take resident choices into consideration." "Most of the staff have been at The Knoll for years. The turnover of staff is low." The home is kept clean and hygienic. There are excellent procedures in place to prevent the spread of infection within the home. Staff are well trained and the staff training programme makes sure that staff are able to maintain and develop their skills. This means that they know how to care for residents properly and keep them safe. The home is well managed and promotes residents` best interests. The manager has put excellent audit systems in place for all aspects of the running of the home. This makes sure that any changes needed are promptly made, so that the high standards the home sets itself are being maintained and developed. What has improved since the last inspection? They have acted upon the things raised as a result of our random inspection and made further changes as a result of their own quality monitoring assessment of how they are doing. They have strengthened the way they carry out their pre admission assessments. This now includes making sure that when residents who have been admitted to hospital return to The Knoll, they have a full assessment by the home to make sure that the home can continue to meet their needs. They have revised and updated the contract and terms and conditions of residency offered to residents upon admission, to make sure it covers everything that is needed. Staff have updated their training on the protection of vulnerable adults, so that they know what to do if they suspect something might be wrong. They have also continued to offer staff a wide variety of training to help develop their knowledge. Residents can therefore be confident that they will be cared for by well trained, skilled and competent staff. They have made lots more building changes and continued with the refurbishment and redecoration of the home to keep it homely for people to live in. Here are some of the things they have done, They have extended the lounge and created a new balcony on the first floor, which residents have been enjoying making use of during the summer months. They have created a new shower room, which residents thoroughly enjoy. They have provided seven new profiling beds, which gives more comfort and safety for residents and staff. They have enlarged the clinical room, provided a new sluice machine and a new dishwasher. They have created a new office that is in heart of the building. This has been designed in such a way so that the nurses can discreetly monitor the safety of the residents who are in the lounges while they are writing their notes. A new purpose built residential home has been built next door, which is now complete and it is hoped to open it in the coming months. Residents, relatives and staff have been kept fully informed regarding the progress and their views taken into account. What the care home could do better: They have a development plan for the home, which is based upon people`s views. As they have identified things that could be done better they have made changes and they have plans in place to continue with the building improvements in the forthcoming year. This will include upgrading the lift to a much bigger size. They have excellent management practices in place and we are confident that they will continue with the ongoing development of the home. We have not made any requirements or recommendations in this report. Key inspection report Care homes for older people Name: Address: The Knoll Nursing Home 196 Dover Road Walmer Deal Kent CT14 7NB     The quality rating for this care home is:   three star excellent 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: Christine Grafton     Date: 1 9 1 0 2 0 0 9 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 29 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 29 Information about the care home Name of care home: Address: The Knoll Nursing Home 196 Dover Road Walmer Deal Kent CT14 7NB 01304374679 F/P01304374679 rajandknoll@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Raj & Knoll Ltd care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the folloiwng categories: Old age, not falling within any other category - (OP). Date of last inspection Brief description of the care home The Knoll Nursing Home is a large detached building, situated in a residential area of Walmer. It is near to local shops and amenities, Walmer Castle, and the sea, and is within easy reach of the town of Deal. The home is owned by Raj and Knoll Limited, and managed by Mrs. A. Patel, one of the providers. Accommodation is mostly provided in ground and first floor bedrooms, although there is also a shared room on the second floor. There are fifteen single bedrooms and seven doubles. Eight bedrooms have en-suite facilities. All floors can be Care Homes for Older People Page 4 of 29 Over 65 29 0 2 8 1 0 2 0 0 8 Brief description of the care home reached via a small passenger lift. Outdoor space is currently limited to a small patio area which is accessible for service users to sit out in good weather. However, there is a large public park almost opposite The Knoll which is often used to take Service Users out for walks. The providers have purchased the adjoining premises, demolished the building, and a new separate residential home has been built next door. The manager plans to run the two homes with a shared staff group. Some structural alterations and refurbishment of the existing building will also take place. At the time of this inspection, the fees range from £595.00 to £725.00 per week for nursing care and £495.00 to 525.00 per wek for residential care. There is also a contract price of around £420.00 per week agreed with the local authority and the manager says they do not ask for a top up fee in such cases. Details about the homes services and copies of our last inspection report are available in the service users guide which is given to all residents on admission and other people on request. Care Homes for Older People Page 5 of 29 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: three star excellent 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: This report takes account of information received since the last key inspection of 14th November 2006. Since that time we have carried out an annual service review on 5th May 2008, which does not involve a visit to the home and an unannounced random inspection visit on 28th October 2008. This was made as a result of information received that was investigated by social services under their safeguarding vulnerable adults procedures. This was satisfactorily concluded and some recommendations were made that the manager promptly responded to. For this key inspection, we visited the home on 19th October 2009 without telling anyone we were coming so that we could see what it is like for people living there on a usual day. We arrived at 10:00 hours and stayed until 16:10 hours. During our visit, we spoke to Amita Patel, the registered manager, staff and residents. The manager showed us around the communal areas of the home and we saw a sample of bedrooms. We observed what was going on, the home routines, staff practices, and Care Homes for Older People Page 6 of 29 what activities were taking place. We spoke to some of the people living in the home. People who live in care homes are sometimes referred to as service users or alternatively as residents. We have used the term residents to describe them throughout this report. We spent time in the two lounges, which gave us the opportunity to observe the interactions between staff and residents. We spoke to four staff members, including one nurse, two members of the care staff and the cook. We also spoke to two visiting relatives and two visiting health care professionals, whose feedback about the home has been incorporated into this report. We looked at some of the homes records. These included things like the residents individual written plans of care, medication records, the staff rota, a sample of the staff records and training records, plus a sample of the management records, including staff and resident meeting minutes. We also used the homes annual quality assurance assessment known as an AQAA for short. This is a document that all homes have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets us know when they have completed important environmental safety checks. Information from the last inspection is also referred to. We sent some surveys out to a sample of residents, health care professionals and staff prior to our visit. At the time of writing this report, eleven residents, seven staff and seven health care professionals have returned their surveys. Their responses have all been very positive; they are referred to in the report and have been used to inform our judgements. At the time of our visit there were 29 residents living at the home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? They have acted upon the things raised as a result of our random inspection and made Care Homes for Older People Page 8 of 29 further changes as a result of their own quality monitoring assessment of how they are doing. They have strengthened the way they carry out their pre admission assessments. This now includes making sure that when residents who have been admitted to hospital return to The Knoll, they have a full assessment by the home to make sure that the home can continue to meet their needs. They have revised and updated the contract and terms and conditions of residency offered to residents upon admission, to make sure it covers everything that is needed. Staff have updated their training on the protection of vulnerable adults, so that they know what to do if they suspect something might be wrong. They have also continued to offer staff a wide variety of training to help develop their knowledge. Residents can therefore be confident that they will be cared for by well trained, skilled and competent staff. They have made lots more building changes and continued with the refurbishment and redecoration of the home to keep it homely for people to live in. Here are some of the things they have done, They have extended the lounge and created a new balcony on the first floor, which residents have been enjoying making use of during the summer months. They have created a new shower room, which residents thoroughly enjoy. They have provided seven new profiling beds, which gives more comfort and safety for residents and staff. They have enlarged the clinical room, provided a new sluice machine and a new dishwasher. They have created a new office that is in heart of the building. This has been designed in such a way so that the nurses can discreetly monitor the safety of the residents who are in the lounges while they are writing their notes. A new purpose built residential home has been built next door, which is now complete and it is hoped to open it in the coming months. Residents, relatives and staff have been kept fully informed regarding the progress and their views taken into account. What they could do better: They have a development plan for the home, which is based upon peoples views. As they have identified things that could be done better they have made changes and they have plans in place to continue with the building improvements in the forthcoming year. This will include upgrading the lift to a much bigger size. They have excellent management practices in place and we are confident that they will continue with the ongoing development of the home. We have not made any requirements or recommendations in this report. Care Homes for Older People Page 9 of 29 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 10 of 29 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 11 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home are given all the information they need to decide if it is right for them. They benefit from having an assessment that tells staff about them and the support they need. Changes have been made to improve the homes practice in this respect so that people are only admitted if the home is sure that their needs can be met. Evidence: Prospective residents are given an information pack that contains a welcome letter, the homes statement of purpose, service users guide and a copy of the last inspection report. The document is well produced in an easy to read format and contains all the information that people need to make a decision about moving in. It is written in a way that makes it interesting and meaningful. People are invited to visit the home before making the final decision about moving in. Responses in all eleven surveys returned from people who live in the home indicated Care Homes for Older People Page 12 of 29 Evidence: Yes that they received enough information to help decide if this home was the right place for them. Before a person moves into the home, the manager (or deputy) goes out and does an assessment to see if the home can meet their needs. A copy of the joint hospital and social services assessment is also obtained. We saw assessments completed for two residents. These contained lots of details about the persons individual needs and showed that all the activities of daily living had been covered, such as, mobility, nutritional needs, personal care, continence care, nursing details, including pain assessment, dependency assessments and social care. A detailed care plan is then drawn up following admission. The manager says she makes sure that the home will be able to meet the persons needs before confirming the placement and any specialist equipment needed is put in place prior to admission. Then a trial period of four weeks is offered, at the end of which a review is held to check to see if the placement is suitable from both perspectives. The manager confirmed that the recommendation to revise the contract and terms and conditions of residency, made as a result of our random inspection of 28th October 2008, has been addressed. They have also tightened their pre admission procedures to make sure they can meet the persons needs before offering a placement and acted upon recommendations made following a visit from the local authoritys contracts officers. Care Homes for Older People Page 13 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their health needs will be met. They can be assured that they will receive sensitive and efficient care, knowing that their individual needs will be met in a manner that shows the utmost respect for their dignity. They are protected by the homes policies and procedures for dealing with medicines. Evidence: Each resident has a plan of care that is drawn up on admission and continually reviewed and updated as their needs change. At the last inspection, the care plans were judged as good. We looked at two care plans to see if this was still the case and found that it is. We found that care plans contain a wide range of information covering everything that staff need to know in order to provide the right care for individuals. For each need assessed, there is a detailed plan of care specifying what needs to be done to meet the persons needs. The records we saw contained lots of information covering a diverse range of needs. These include things such as, skin integrity and the risk of pressure sore development, as well as any pressure relieving equipment being Care Homes for Older People Page 14 of 29 Evidence: used. We saw the records for a resident that needs wound care. These include a specific wound care plan with body map and a separate report completed by the nurse each time the dressings have been changed. This shows the healing progress of the wound, and the type of dressings used. Photographs of the wounds healing process have been taken and consent obtained. These show a gradual improvement with the wound becoming smaller. Residents health is closely monitored and other health care professionals are fully involved. We saw records of visits by general practitioners (GPs), dietician, speech and language specialist and chiropodist. The nurse on duty writes a daily report for each resident. These provide a clear picture of daily health progress or deterioration, and any changes in mental state. Care staff complete fluid balance records and turn charts for residents who are really unwell. Care staff are given directions for residents personal care during the shift handovers and they carry their own notebooks to record any changes. These are then passed to the nurse to write into the care plan. The deputy manager is responsible for the overseeing of the medications. Since the last inspection, the clinical room has been enlarged, and the room is well set out with good medication storage. Our last report showed that medication, including controlled drugs, and creams and lotions, was being stored appropriately, with good records maintained for receipt and disposal of medication. Policies and procedures were in place that were easy to follow and medication administration records (MAR sheets) were all well completed. The manager stated that the same procedures were being maintained. The manager has an audit system in place for checking all aspects of medication storage and administration. This audit is carried out twice yearly. Hazard warning signs were seen where oxygen is stored or in use. We looked at a sample of controlled drugs records and saw that these had been double signed and the numbers of drugs left matched the records. Residents were well groomed and residents and relatives spoken to said they are treated with respect. Attention to detail was apparent, for example in relation to their clothing, hair styling, shaving and teeth cleaning. Staff were seen to interact well with residents, and to speak to them respectfully and with kindness. This was confirmed in all the surveys we received from residents, relatives, health care professionals and staff, which were all positive. Care Homes for Older People Page 15 of 29 Evidence: A relative summed this up by saying, My mother has certainly improved since leaving hospital to enter the home. In appearance and ability to communicate. We are extremely happy with the care she receives. The last report indicated that the home provides excellent palliative care for residents who have a terminal illness. The manager confirmed that this has continued. The manager, the deputy manager and one of the nurses have completed palliative care training at a nearby hospice, which has been passed down to other staff. The home has signed up to two special arrangements enabling continuity of care for residents at this difficult time. These are known as the Liverpool Care Pathway and the Gold Standards Framework. Local GP surgeries are happy to link in with this, and when residents are entered on the register, additional services can be accessed more quickly. The home works closely with the hospice and a liaison nurse visits to give advice. A GP commented, There is an excellent level of service provision individually tailored to clients needs and abilities. This is an exemplary home. During our visit we also spoke with a visiting Quality Assurance Nurse Advisor from the NHS Community Services. She told us that she has been visiting this home eight years and that the service provided to residents is good. She summarised this by saying, Everyone here is very calm. Staff give eye contact, acknowledge you, smile. They have a good support system from GP practices. It is so open here, they have nothing to hide. They allow me to happily wonder around. All of this confirms that the excellent standard of health and personal care provision seen at our last inspection has been maintained. Care Homes for Older People Page 16 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having opportunities to take part in activities that suit their needs and from being able to keep in contact with families and friends. They also benefit from being offered a varied menu and having relaxed mealtimes. Food is well prepared and there is a good daily choice to provide a nutritious diet. Evidence: Informative life histories are included in each residents care plan so that staff know about their backgrounds and past interests. A relative spoke about how this information had been used in a positive way so that their relative (the resident) was less anxious and much calmer, due to the way that staff talk to and respond to them. This had been brought about by staff knowing more about them. The home has an activities programme that includes a range of different daily activities, such as twice weekly exercise sessions covering armchair and leg exercises and ball games to promote coordination. One of these activities was taking place during our visit and we saw that residents were actively involved and several commented on how much they enjoy and look forward to these sessions. Other activities include bingo, quizzes, reminiscence, sing alongs, weekly hairdresser and Care Homes for Older People Page 17 of 29 Evidence: aromatherapist visits and regular visits from outside entertainers. A record is kept of each individual residents daily activities, this may just be reading with them, giving them a manicure, or helping them to join in with organised activities. Staff spoke about doing arm massages with residents and said how beneficial this is for the residents. They also commented on how much they enjoy doing this activity with the residents, as it gives them the opportunity to sit with them individually and they notice the calming effect it has on them. Visitors said that they are warmly welcomed into the home. There are regular communion and church services held in the home and visits from different ministers (Church of England and Roman Catholic) are arranged as appropriate. We observed the lunchtime meal being served to residents. Meals are taken in the lounges, which the manager stated was the residents choice. They can also have their meals in their own rooms if they wish. We saw residents being served their meals in a calm unhurried way. Where residents needed help with eating, staff were seen sitting with them and calmly assisting them, engaging in conversation about the meal and offering encouragement where necessary. Staff were also seen encouraging residents to feed themselves wherever possible. Liquidised or pureed meals are attractively served with portions of meat, vegetable and potatoes served separately on the plate. We talked to the cook who said that choice is offered at every mealtime. She goes round the day before to ask what the residents would like. They can also change their mind on the day and their choice will be accommodated. All meals are prepared by cooks. Care staff prepare drinks mid morning and mid afternoon, as they know what residents will like, and they then feed drinks to those who need assistance. Staff who prepare food and drinks have completed basic food hygiene training. Feedback from residents in their surveys indicates their views that the food is good. Of the eleven service user surveys returned, five indicated that they always like the food and four indicated that they usually do, with the other two leaving this question blank. A relative commented that they have visited a number of times at mealtimes and that the food is always nicely served and said how well staff assist with feeding people. The staff training matrix indicates that eight staff have had training on malnutrition. Care Homes for Older People Page 18 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that any complaints will be listened to and acted upon. They can be assured that they will be protected by the homes procedures and practices to safeguard them from abuse. Evidence: The home has a well written complaints procedure which is prominently displayed in the entrance hall and is included in the service users guide. Every resident is given a copy of this either before, or when, they are admitted to the home. The procedure includes information about Social Services, the Care Quality Commission, Patient Advisory Liaison Service and the Ombudsman, so that residents and relatives have a choice of where to go for help. A hard backed book is kept by the visitors book for people to write in any concerns, comments or suggestions. Any serious complaints are recorded on a separate complaints form, and are followed up by the manager. The manager said that any complaints are thoroughly investigated, with the outcome forwarded to the complainant within 28 days, or usually much sooner. In their AQAA they say that by adopting the notion, a complaint or concern expressed by one resident would help them improve the quality of life for all other residents, they have not made the same mistake twice. Since our last inspection there has been one complaint that was investigated by social services under their safeguarding vulnerable adults procedures. We also carried out an Care Homes for Older People Page 19 of 29 Evidence: unannounced random inspection as a result of this. The home fully cooperated in the investigation and has acted upon the recommendations made. Staff receive training on how to protect people and keep them safe. We talked to three staff members who all confirmed they had received recent update training on the protection of vulnerable adults and indicated that they know what to do if they suspected that something might not be right. They commented that if anything is wrong, the manager encourages them to say and always looks into any issues immediately and sorts things out. One commented, We treat residents as we would want to be treated ourselves. Care Homes for Older People Page 20 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a clean, comfortable, homely environment that suits their individual and collective needs. They also benefit from the good practices in place to maintain hygiene and prevent the spread of infection within the home, protecting them from risk of harm. Evidence: In their AQAA they say, The environment is an important and vital part of care and that they have made ongoing reinvestment into the facilities of the home. We saw that what they say is correct. They say that the home is always friendly, clean and welcoming and this was confirmed in what we saw and by the comments received in surveys returned by residents, relatives, health care professionals and staff. We looked at the communal areas of the home and a sample of bedrooms. All areas seen were very clean and fresh smelling. They have continued with their ongoing refurbishment and decoration programme. Within the past twelve months they have provided seven new profiling beds, created a new shower room, which residents thoroughly enjoy, they have enlarged the clinical room and created a new balcony on the first floor, which residents have been enjoying making use of during the summer months. Care Homes for Older People Page 21 of 29 Evidence: They also have a new sluice machine, a new dishwasher, they have extended the lounge and they have created a new office. This has been designed with double full length glass doors at the entrance, which overlook the front lounge and a window that overlooks the back lounge. This means that the nurses can discreetly monitor the safety of the residents who are in the lounges on more of an ongoing basis. A new purpose built residential home has been built next door, which had just been completed and, at the time of our visit, was due to be handed over by the builders the following week. They have been working closely with residents, their relatives and care managers during the construction of the new home. The manager stated that when this is ready for people to move in, the residents of The Knoll will be given the opportunity to move to the new home, or to stay in the existing older building. Once the new home is up and running, they plan to continue with the refurbishment in this building and have plans for a new much larger lift to be installed. This will be done as a two stage process to reduce disturbance to residents. Bedrooms seen have been personalised, suitably furnished and well equipped. Toilets are fitted with raised seats, toilet surrounds, and grab rails as appropriate. Shared bedrooms have suitable screening for privacy. The home has assisted baths, including a Parker bath. There is a good variety of hoists for different room areas and to suit residents different needs. They also have a hoist that has an extra high weight bearing facility for any heavier people. There are two cleaners employed who cover every day and keep the home clean. They also do the laundry. The laundry is suitably equipped, including washing machines with a sluice facility. A red alginate bag system is used for soiled items. There are two separate sluices, one of which has been fitted with a new sluice disinfector. In their AQAA they state, We are one of the very few homes in the area that is part of a government led Foundation Programme in Infection Control of Health Care Facility. We discussed this with the manager, who said that this has been brought about to tackle healthcare associated infections outside of hospital. An outside agency assesses the home and carries out regular audits. The home has been rated very high. As well as this, the manager carries out her own infection control audits as part of her quality assurance monitoring. Care Homes for Older People Page 22 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they will be supported by competent and qualified staff, knowing there will be enough staff on duty at all times to meet their needs. They can be assured that the homes recruitment procedures and practices will protect them. Evidence: We looked at the staff rota and discussed staffing levels with the manager. The home has one registered nurse plus five carers on duty in the mornings, and one nurse plus three carers in the afternoons. The manager is a registered nurse and works Monday to Friday from 08.00 to 18.00 hours. She is supernumerary on most shifts, but actively takes part in the nursing duties of the home, as well as management. She covers some nursing shifts as the allocated nurse, in order to retain her nursing skills. Also we saw that on some shifts there are three nurses in the building, as the manager, deputy manager and another nurse may all be on duty, for example, when in house training or staff supervision is taking place. Since the last inspection, they have introduced a new shift pattern, whereby the afternoon staff come on duty at 12.00 and as the morning staff go off duty at 14.00 hours, this means that there are significantly more staff on duty to cover the peak time when lunch is served, to help those people who need assistance with feeding. There are two staff on duty at night, one nurse and one carer, but another three or Care Homes for Older People Page 23 of 29 Evidence: four care staff start work at 07.00, so all busy peak times are well covered. In addition to the care staff, there is a cook on duty each day and there are two cleaners employed who cover the whole week. The rota shows that on three days a week there are two cleaners on duty together. We spoke to three staff members and asked them whether in their views they usually have enough staff on duty. They all agreed that the new arrangement is working well and that generally they have sufficient time to meet residents needs. They were quick to point out that if they have a busy shift, the manager listens to them and makes adjustments to the rota as necessary, or works on shift to help out herself. The AQAA states that they have good staff retention. This was confirmed in discussion with three staff during our visit and in a staff survey comment, Most of the staff have been at The Knoll for years. The turnover of staff is low. Staff commented on the good training provided. This includes a thorough induction programme. Following this, care staff are encouraged and supported to achieve their National Vocational Qualification (NVQ) in care level 2 or above. Information in the AQAA indicates that they have continued to exceed the fifty percent target of care staff trained to NVQ level 2 and nine out of sixteen care staff have their NVQ level 2 or above. Staff have also attended a wide variety of courses, including, catheter care training, hand and arm massage training, nutrition in older adults, malnutrition, communication and dementia care training. The qualified nurses have attended courses appropriate to their nursing practice such as, wound care management, tissue viability, malnutrition MUST tool, infection control and healthcare associated infection. A number of security checks are carried out on new staff before they start work at the home. We looked at two staff files and saw that the checks specified in the National Minimum Standards and legislation had been done, including past employment checks, two written references and police checks. This helps to make sure that staff are trustworthy and safe to be around the residents living in the home. Care Homes for Older People Page 24 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be well managed in a way that safeguards residents best interests, promoting and protecting their health, safety and welfare. There is an atmosphere of openness and respect where residents, relatives and staff opinions really matter. Residents benefit from the excellent quality monitoring processes that have been developed. These ensure that changes are made by management where necessary, as things are identified, or as a result of listening to people. This means that the high standards the home sets itself are being maintained and developed. Evidence: The manager is a registered nurse who has a Diploma in Care Home Practice, a BSc honours in Rehabilitation Nursing and over twenty years experience in running the home. She keeps her own nurse practice up to date by attending other relevant courses and study. She provides good leadership and has a strong presence in the home, being readily available for staff, residents and relatives as needed. She carries Care Homes for Older People Page 25 of 29 Evidence: out nursing duties as well as management and leads the staff team in furthering their understanding, knowledge and skills. Staff say that the manager is very supportive and always ready to listen to them to discuss and sort out any issues promptly. Information is passed on between staff during the daily handovers and regular staff meetings are held. The minutes of a meeting held following a complaint made showed that the outcome had been discussed, and indicated that a lesson had been learnt regarding the admission process, which we have seen has been improved as a result. The meeting also covered practice issues such as weight loss and malnutrition in care homes. Staff were given the opportunity to raise any more points. Recent residents meeting minutes showed that there was discussion about the new home being built next door and suggestions for activities and entertainment choices. The manager also carries out quality assurance surveys in the home and audits the results. These are excellently arranged and include a PIE chart to show the results. The home does not manage residents finances. Residents have a lockable facility for anything they wish to look after themselves, otherwise they appoint a representative. Extra payments, such as hairdressing and chiropody, are paid for by the home and then the relatives, or representatives, are billed for the extras. Staff supervision sessions are delegated between nurses, and are carried out five times per year, with a sixth meeting as a yearly appraisal. Nurses have practical clinical supervision sessions as well. The manager ensures safe working practices by keeping staff mandatory training up to date. She has introduced a wide range of risk assessments and is proactive in carrying out audits for different areas. This includes accident and incident records, which are audited monthly, showing any patterns or risks, which can be diminished by a change of protocol. The AQAA indicates that the homes equipment is regularly serviced and no safety hazards were observed by us during our visit. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 27 of 29 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 28 of 29 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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