Care Home: The Knoll Private Residential Care Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well The appearance of the home provides a clean, pleasant and comfortable environment for people to live in. Service users spoke favorably about the environment in which they lived and those service users who could express a view, liked their bedrooms and felt the standard of cleanliness in the home was always very good.The atmosphere in the home during the visit was relaxed, friendly and welcoming. The home carries out assessments of each prospective service user before they come to live at The Knoll and this information was used to develop the care plans.This ensures that the home has the necessary skills and experience to care and support people who go to live there. Service users were registered with a General Practitioner (GP) and were supported to receive support from other health professionals as needed. Staff showed their skills in communicating with service users. The relationships between the staff and service users were friendly and it was evident they knew them well. From our observations during the visit it was evident the service users were treated with respect and dignity and their right to privacy was promoted. Staff were seen speaking quietly to service users and providing personal care and support in private without bringing attention to the individual. Service users spoken to, said they could have visitors at any time, went out when they wanted and were supported to do what they could for themselves. Service users said during the visit that they were more than satisfied with the way staff looked after them. They said they felt involved in their care and were kept informed of how their care or support could be provided. The manager encourages and supports staff to undertake training courses according to their needs. The staff are professional in their approach and are committed and enthusiastic. Over 75% of care staff at The Knoll have successfully completed NVQ training at level 2, two senior staff have obtained NVQ 4 qualifications. This enables them to do there job well and care and support service users as they should. What has improved since the last inspection? The manager has reviewed and researched activities which service users would like to take part in and have increased the activity and stimulation provided. A lot of time has been taken by the manager and staff to provide a range of activities.Continual reviews of ideas are taking place to further consider how the service users social care needs can be further developed and improved upon on a one to one basis or in smaller groups. Service user meetings have been introduced which allow group discussions and encourages all who want to discuss the home and any developments. Menus have been updated to reflect the suggestions service users have made. Service users were complimentary about the quality and quantity of food served to them.A number of bedrooms have been redecorated and new furniture has been purchased for others. In the lounge five new lounge chairs have been purchased to ensure service users comfort. New curtains and blinds have been purchased for different rooms in the house. The home has a rolling programme of redecoration and refurbishment to keep the home looking clean and comfortable for people living there. The manager believes this enhances the lives of those living at The Knoll. A more thorough induction training programme has been introduced by the manager for new staff to take part in. The manager looks at staff as individuals and their past work and life experience to ensure that the right level of training is provided and is evidenced by the written work new staff need to research. The manager said this was working well. What the care home could do better: When a service user is prescribed controlled drugs best practice is to ensure that one staff signs the medication records and a second staff member also signs as witness in the medication administration records. The manager needs to ensure that when a service user is prescribed a variable dose of medication the actual number administered is always recorded so there is an accurate record of medication given. The manager needs to make sure that when the doctor changes the regularity of a prescribed medication that this is printed on the medication records to confirm that service users are given their medication as it was prescribed. To safeguard service users and staff the manager needs to ensure that when controlled drugs are no longer used that the detail of what has happened to them for example, they are returned to the pharmacist.That this detail is written in the controlled drugs book. Staff need to be reminded of their responsibilities when identifying an omission of recording in the controlled drugs register and ensure that an accurate record of administration is recorded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Knoll Private Residential Care Home 109 Church Road Urmston Manchester M41 9FJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: The Knoll Private Residential Care Home 109 Church Road Urmston Manchester M41 9FJ 01617553818 01617472513 office@callaghansons.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Knoll Care Partnership Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 10 dementia old age, not falling within any other category Additional conditions: 10 0 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 10 Date of last inspection Brief description of the care home The Knoll is a residential care home that is registered to provide care for up to 10 residents whose primary care needs are due their old age, including residents who may have a diagnosis of dementia. The Knoll is one of two care homes owned by the Knoll Care Partnership Limited, the other being The Fairways. Mrs Claire Gardom is the registered manager at the home. The home is situated in the Urmston area of Manchester and is within easy reach of local shops, public transport and the motorway network. Care Homes for Older People Page 4 of 28 Brief description of the care home Accommodation comprises of eight single occupancy bedrooms and one shared bedroom. None of the bedrooms have en suite facilities, however all bedrooms have a wash hand basin. Three bedrooms are situated on the ground floor and all others are on the first floor. There is an assisted bathroom on the first floor and a separate toilet and accessible shower on the ground floor. There is a large dining room at the front of the house, which also has a couple of lounge chairs in for people living at the home to use. This is situated on the ground floor. A large lounge and new sun room is at the back of the house which leads on to a new terrace area. A stair lift is available to assist people living at the home to their bedrooms on the first floor. There are gardens and car parking to the front and rear of the home. The home operates a no-smoking policy. The home has a statement of purpose and service user guide, which were reported to be given to people living at the home or their families. The fees for staying at the home were reported to be between 360 and 398.60 pounds per week. Care Homes for Older People Page 5 of 28 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 visit was unannounced, which means that the manager, staff and service users were not told that we would be visiting, and took place on 5th May 2009 commencing at 9:45am. The manager was available on the visit. The manager provided us with a lot of detail, information and support during the visit in addition to the support from staff and service users. The manager has a wealth of knowledge about service users and their needs and support. The inspection of The Knoll included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection. Care Homes for Older People Page 6 of 28 We looked at the Annual Service Review (ASR) that was carried out on 29th April 2008. This is a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. At that time we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. We also sent The Knoll a form before this visit for them to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information the manager of The Knoll provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). The Knoll was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at The Knoll, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at The Knoll talking with the manager and staff. A tour of The Knoll was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how The Knoll was meeting the needs of service users and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of service users. The care service provided to two service users was looked at in detail to help form an opinion of the quality of the care provided. The term preferred by people consulted during the visit was service users. This term is, therefore, used throughout the report when referring to people living at The Knoll. A brief explanation of the inspection process was provided to the manager at the beginning of the visit and time was spent at the end of the visit again with the manager to provide verbal feedback. We have received no complaints about this service or had any safeguarding referrals. What the care home does well: What has improved since the last inspection? The manager has reviewed and researched activities which service users would like to take part in and have increased the activity and stimulation provided. A lot of time has been taken by the manager and staff to provide a range of activities.Continual reviews of ideas are taking place to further consider how the service users social care needs can be further developed and improved upon on a one to one basis or in smaller groups. Service user meetings have been introduced which allow group discussions and encourages all who want to discuss the home and any developments. Menus have been updated to reflect the suggestions service users have made. Service users were complimentary about the quality and quantity of food served to them. Care Homes for Older People Page 8 of 28 A number of bedrooms have been redecorated and new furniture has been purchased for others. In the lounge five new lounge chairs have been purchased to ensure service users comfort. New curtains and blinds have been purchased for different rooms in the house. The home has a rolling programme of redecoration and refurbishment to keep the home looking clean and comfortable for people living there. The manager believes this enhances the lives of those living at The Knoll. A more thorough induction training programme has been introduced by the manager for new staff to take part in. The manager looks at staff as individuals and their past work and life experience to ensure that the right level of training is provided and is evidenced by the written work new staff need to research. The manager said this was working well. 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 set out 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 9 of 28 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 10 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home received sufficient information to help them make a decision and staff received enough information to understand the persons needs. Evidence: The AQAA completed by the manager before the visit told us that, All the relevant information is given to all prospective service users or their families in an easy to follow format and all prospective service users and their families are encouraged to visit the home as many times as they like prior to admission. Upon admission of a new service user, all staff are made aware of that individuals conditions, medical background and needs based on a thorough assessment carried out by the manager prior to admission. We spoke to people living at The Knoll about their recent experience of coming to stay Care Homes for Older People Page 11 of 28 Evidence: at the home. One person told us that their family had heard about the home and its good reputation and decided from that that they would like to try the home. They said the manager came out to see them and she brought some paperwork with her which they were able to read. They said they liked the personality of the manager and the way she was with them and felt confident enough to give the home a try. The person said they were at the home for a trial period and were happy with the care and support they received, they liked the food and the staff were kind and helpful. One person said the manager and staff were supportive to them in the early days when they were feeling out of sorts having given up so much. Another person said their relative also chose the home for them and looked round to check it out before they came to visit when they spent a couple of hours at the home talking to people who live there having a good look round and chatting to staff, before they made their decision to have a trial stay. Both people were clear that they were having a trial to make sure that the home is what they wanted and that the home could look after them properly. The manager told us that she undertakes an assessment of all prospective service users needs to check that the staff have the skills, knowledge, training and expertise to look after service users well. The manager also said that they look at the needs of the current service user group to check if the person would fit into the home and the ways of the home. We looked at two service users care files. In these files, there was an assessment by the manager looking at the specifics of their care and how they would like their care to be provided. When we last visited the Knoll we made a recommendation to increase the size of the typing in the statement of purpose and service user guide to make it easier to read. These are documents that service users are given with all the information they need to know about the home.This has been done to make sure that the people reading this information can do so quite easily. The AQAA indicated that in the last twelve months the manager has reviewed and amended the statement of purpose making it more legible and more thorough Care Homes for Older People Page 12 of 28 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. People who live at The Knoll are involved with the development of their individual care plans so they receive the care and support they need in the way they prefer. Evidence: The manager told us that the home has, thorough and well developed care plans which all staff read regularly. And that all staff are, knowledgeable about the service users in their care and keep themselves well informed of any changes. People living at The Knoll told us that they were involved in putting together their care plan. They said they had been asked what support they need and were provided with the care and support that they require. One person said that their relative was also involved in discussions to check out certain things and asked to clarify different points. One service user told us that they had been asked about their likes and dislikes with regard to meals and told us that they can have their breakfast in their bedroom if they prefer or come downstairs to eat in the dining room. One service user said they were Care Homes for Older People Page 13 of 28 Evidence: getting used to the ways things worked and said they just wanted to fit in which they feel so far they have done quite well. Service users told us the manager and staff asked them lots of questions at the beginning, and, as time goes by and they write these things down in the care plan to help them to support them in a way that they want. A service user said they had been asked when they used to have a bath at home and staff try their best to make sure this routine is the same as it was before they came to live at The Knoll. Service users did say that staff were kind, helpful and listen to them and advise and support them to settle in and, be comfortable. The care plans we looked at were different and individualised to the person. The care plans are reviewed monthly or we were told they would be reviewed more regularly if the service users needs change. One member of staff said that when a service user first comes into the Knoll they are constantly updating the care plan with additional detail as they get to know the person better. The care plans we looked at also had risk assessments in place. This promotes the service user to carry out daily living tasks and identified what needs to be in place to minimize any risk to them. One service user said they need to walk with their frame and staff remind and encourage them to do this as they could fall if they tried to walk without it. They told us that this is written down in their paperwork. One service user is able to administer their own medication and takes responsibility for this. We were told that there was a risk assessment in place which enabled them to carry on doing this for as long as they were able and that this risk assessment is periodically reviewed to make sure the service user is safe. There are routines in the home but these are flexible depending on the people living there as opposed to being task led. Service users spoken to felt that their views and opinions counted for something and staff make changes on receiving comments from them. One service user commented that the bread and butter pudding served at lunch was beautiful but would have been more enjoyable if it had been served with custard as opposed to ice cream. Staff said they would make custard next time. The conversations gave the impression that service users were part of the home and had equal opportunities to make comment and change things. We looked at the reports staff complete to detail the support and care service users receive. The detail within the care files demonstrated that service users had access to support from health care professionals on a regular basis. This included health care checks, appointments with the optician, dentist, chiropodist and hearing tests when Care Homes for Older People Page 14 of 28 Evidence: needed. We spoke to a health care professional during our visit who said that staff responded well to support from health care professionals and contacted them periodically for support or to request advice. District nurses currently visit specific service users twice a week and said that at other times they do not need to visit when service users health care needs are fine. We asked service users what they thought the home did well. One service user responded, Look after people.Another service user said, The carers at The Knoll treat us as individuals and with respect. They laugh and joke with us. Always have time for each of us and take time to find out about us. Staff said they were, always given up to date information about the needs of people they support or care for. One staff added, Myself doesnt do care plans but to keep myself up to date I have read through them. Another member of staff said they are always given up to date info about the needs of the people they support or care for and added, our care plans are always up to date. The manager told us that when service users come to stay at the home they are asked if they would like to look after their own medication. If this is what they want to do they are given the support to do this. This includes a locked cupboard for their medication, risk assessments completed and reviewed regularly and assistance and advice given as needed. The manager said they have stringent policies and training schedules for all staff administering medication and have reviewed and invigorated our policies to include an annual medication review. Ten members of staff are attending a medication training course in the weeks after this visit. This course is open to all staff and some have been specifically chosen as the manager believes further training is required by them. We looked at the medication administration records. These are records that are printed by the pharmacist and detail the prescribed medication and the dosage and time service users should should have their medication. There were no omissions in the recording of medication administration which means that service users received their medication when they should do to keep them well. We made a recommendation on our last visit that any handwritten medication details on the medication administration records should be signed and dated and an additional member of staff should sign to validate the details. This is an additional safeguard to make sure no mistakes or made when copying out the prescription and ensure service users get the medication that they are prescribed by their doctor. The manager told us Care Homes for Older People Page 15 of 28 Evidence: that this practice has always been in place and our observations on the last visit was an oversight. There were no handwritten medication on the records we looked at on the visit,the manager did say they would be double signed and verified. One of the records indicated that the service user should have a particular type of medication twice a day. The detail recorded indicated that they were having their medication less frequently. We were told that this medication was now prescribed when the service user needed it. This was not written on the records as it should be. The manager needs to get in touch with the service users doctor to ask that this change is made. For another service user the doctor has prescribed one or two tablets, four times a day. The actual number given was not included on the record for this service user. So that the records are accurate, the actual number does need to be included. For other service users who are prescribed a variation, such as this, the medication administration records did detail how many tablets they had been given. One service user was prescribed controlled drugs. Best practice is when this type of medication is administered that two staff sign the medication records. This would be an additional safeguard and needs to be arranged. We looked at the controlled drugs record book. This is a special register for recording this type of medication. The entries we checked were usually witnessed, accurate and complete. Witnessed records and secure storage of controlled drugs help prevent mishandling and misuse. There was one day when a service users controlled drugs medication was not signed as taken from stock within this register. The staff on the following day should have identified this shortfall and brought this to the managers attention, so that this could be remedied. Medication should only be signed for as administered at the time it was given and not after the event. An explanation should be indicated, if on the medication records, by denoting a symbol and explaining on the reverse of the record what happened or by way of explanation when this happens when giving out controlled drugs. The manager said that based on the feedback they have received, both formally and informally they are positive that all service users feel very well cared for and that they are treated with respect. Care Homes for Older People Page 16 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide variation and interest for people living at The Knoll. Evidence: We made a recommendation on our last visit that there should be some discussions with people living at The Knoll about activities they would like to take part in and these should be provided where possible. The AQAA completed by the manager told us that they had, in the last twelve months developed the activities provided to service users. She told us, An activities schedule is updated each month and posted on the dining room door where service users and families can see what will be happening during the coming month. The activities programme has been extended to include theatre trips twice a year, cinema trips, monthly crafting sessions. The musical therapy sessions and sing a longs that were held exclusively at out sister home, now alternate monthly between the two homes enabling those who choose not to go out to still enjoy the entertainment. New shows have been put on with a professional touring company. More games have been bought for example, indoor carpet bowls, bean bag throwing game and lots of crafting Care Homes for Older People Page 17 of 28 Evidence: equipment. When we spoke with service users they told us that they had been potting up plants and making pictures and have in the past made calenders and other art work. One service user said they liked the exercise class. One service user did say that they were used to keeping busy when they were at home and realise that they have little to do in the home in relation to jobs but that it was hard when they were used to keeping busy. Service users were seen to go out during our visit and some had planned to go to the cinema but decided against this due to the rain, and the fact they have to walk a way from the car when they get to the cinema. Staff were seen filing and shaping some service users nails and applying nail varnish to those that wanted this. We asked service users what could the home do better. One service user responded, Something more to do that is foolproof and everybody can do. We were told that service users had been on trips to the national war museum and are booked to visit a country park in June 2009 and have a garden party with entertainments booked for July 2009. The manager is looking into getting the mobile library to stop close to the home so that service users can loan and choose books for themselves. There is a three week menu. The menus do not detail a choice to the meals served. Service users were seen to be having the same meal as one another. One service user said the staff know what we all like and give us what we like. The lunch shared with service users was gammon ham, mash potatoes, cauliflower, broccoli and carrots served with an onion sauce. The main meal was followed by bread and butter pudding with ice cream. The menus are reviewed and updated on a quarterly basis in consultation with service users. We were told after having some feedback from service users, sweet and sour chicken was added to the menu for three service users, Cornish pasties have been reintroduced and more pasta is offered. Fresh produce is always used and all meals are home made. When we asked staff what the service does well, one member of staff said, I like the way food is prepared. Food is always eaten hot. A record is kept of the meals served and indicates which service users had the meal and others which had something else. Care Homes for Older People Page 18 of 28 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. Complaints are handled well and taken seriously ensuring people feel listened to.Service users and relatives were able to express their views and make a complaint should they wish to. Evidence: The Commission had received no complaints and there had been no safeguarding adult referrals. The comment cards and the service users who were spoken with said, should they have any complaints they knew who to approach, however no one had any issues of concern. The manager had received training in safeguarding adults and all staff had attended the local authoritys training on the protection of vulnerable adults or had received in house training in this. All staff told us that they knew what to do if a service user or their relative or representative or friend has concerns about the home. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Knoll provides a safe and comfortable home that is well maintained and decorated and furnished to a good standard. Evidence: We had a look around the inside of the building and we found the home to be presented as being well maintained and decorated. The home was clean and tidy with no unpleasant odours in any part of the house we looked at. This was reported by service users and visitors to be usual. One service user said the house was clean and tidy and modern but was also lived in and not uncomfortable. We went to look inside some of the service users bedrooms. The bedrooms we saw were personalised with ornaments and furnishings. The manager said that all service users are offered a key to their bedroom but all at the moment have not taken this up and are happy that their bedroom doors are unlocked. The Knoll had adequate bathing and toilet facilities including some support aids for service users with restricted mobility. This enables service users to retain some independence. Care Homes for Older People Page 20 of 28 Evidence: There was an area at the back of the building which is used by service users to sit outside in the warmer weather, which is private from the main road. This enables service users to have access to fresh air and they can go out independently down the ramped area. A wheelchair lift is also available outside of the house so this ensures that any service users who go outside in a wheelchair can continue to do so. All service users who were asked, said they liked their room. One service user said the home is spotless,could not fault it. Fabulous rooms, they are always cleaning. One person said, the best thing about the home is its homely feel and added, The Knoll is clean and friendly not the workhouse. There was evidence of an ongoing programme of decoration and refurbishment, which included the purchase of some new lounge chairs and the refurbishment of two bedrooms including re decoration and new bedroom furniture. Routine maintenance work was carried out efficiently and a record of this was available. This ensures that equipment is working safely and properly. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at The Knoll are supported by well trained, effective staff who have gone through a thorough recruitment process so peoples needs are met and they are safe from possible harm or poor practice. Evidence: There were sufficient staff employed to ensure service users health and personal care needs were met in a clean and comfortable home. Staff responded yes to the question are there enough staff to meet the individual needs of all the people who use the service.Service users said there seemed to be enough staff to look after them well and be there when they need them. The staff had received training in core skills such as adult protection, medication administration, moving and handling and health and safety. Over 75 of the staff team had completed a National Vocational Qualification (NVQ) Level 2 and or Level 3 with two staff having obtained their NVQ level 4. This exceeds the standards which asks for fifty percent of staff to have NVQ training. The manager told us that management fully appreciate that we are only as good as the people we employ, so we work hard to recruit staff of the highest calibre. All potential employees are vigorously interviewed and vetted before any appointment is Care Homes for Older People Page 22 of 28 Evidence: made. If people do not complete their training or work to our standards during their probationary period, no permanent contract will be offered. The staff files of the last three members of staff to be employed were looked at. They contained all the documents and references as required by the regulations before staff start work. The majority of the staff team have worked at The Knoll for a number of years and know each other well, are aware of the procedures and practices at the home and enjoy what they do. One member of staff told us, my references were checked before I started. Then shortly when I started I was there only a week or so then the CRB (criminal record disclosure) check was done. The manager explained to us the detail of the induction training staff receive, and we were able to observe the first session of the training and the work required from staff as part of their induction into care at The Knoll. One staff said the induction covered everything they needed to know about the job before they started and that the had been given training which is relevant to their role, helps them understand and meet the individual needs of service users. And added, training and courses are offered to all staff all the time which is very good to me as member of staff. In response to the question what does the service do well one staff said, They keep us up to date. Training is up to date and regular and the management is approachable and listen. Staff said their manager regularly meets with them to give support and discuss how they are working. One staff said, We meet when we have one to ones and appraisals.A member of staff said they had worked at The Knoll for a number of years and the managers are very nice and the staff work well as a team. Another staff member said,we can go to our management at any time to discuss any issues we have. In response to the question what does the service do well one staff said, They keep us up to date. Training is up to date and regular and the management is approachable and listen. Care Homes for Older People Page 23 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Knoll is managed with systems, policies and procedures in place to ensure the health and safety of staff and people living there are promoted and protected. The manager is appropriately experienced and qualified to run a care home for the benefit of service users.Quality Audit processes provide a framework to further improve services for the service users. Evidence: The manager is experienced and is fully aware of her responsibilities. The manager clearly demonstrated her knowledge and understanding of the service users well and her effectiveness at managing this care home. Staff said the manager was approachable and fair. We asked staff if there was anything that they would like to tell us. One staff responded, Yes it is about the manager. She is very good and listens when you ask something. She is never cross, always smiling and she is very supportive. Care Homes for Older People Page 24 of 28 Evidence: A system was in place for all the policies and procedures to be reviewed and updated. The home was maintaining a fire maintenance record with the required checks and fire drills carried out. A fire risk assessment was available and staff had been trained in fire safety. Maintenance contracts were in place to regularly monitor the health and safety aspects of the home. The manager was not responsible for any of the service users finances. We were told that service users, their family or friends or appointed persons were responsible for this. Staff have an opportunity to meet with their manager regularly and these meetings are used to discuss staff practice, the philosophy of the home and plan any training needs.Formal staff supervision and annual appraisal was recorded in individual staff files. Accident reports are completed for accidents, incidents and occurrences, which are maintained on service users individual files. An analysis of these events is undertaken in an attempt to safeguard service users and mimimise risk of them hurting themselves. Quality assurance surveys are routinely sent out to service users, their relatives, staff and visiting health care professionals to obtain their views and opinions about the service provided at The Knoll. An analysis is done of the comments which is either dealt with individually if the response is about an improvement for an individual or collectively if the comments are general. This helps the management of the home to evaluate what people think about what they do and support them to develop the service provided to service users. Care Homes for Older People Page 25 of 28 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 26 of 28 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 1 9 When a service user is prescribed controlled drugs best practice is to ensure that one staff signs the medication records and a second staff member also signs as witness in the medication administration records. The manager needs to ensure that when a service user is prescribed a variable dose of medication the actual number administered is always recorded so there is an accurate record of medication given. Make sure that when the doctor changes the regularity of a prescribed medication that this is printed on the medication records to confirm that service users are given their medication as it was prescribed. Ensure that when controlled drugs are no longer used that the detail of what has happened to them for example they are returned to the pharmacist that this detail is written in the controlled drugs book. Staff need to be reminded of their responsibilities when identifying an omission of recording in the controlled drugs register and ensure that an accurate record of administration is recorded. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!