Archived: Knoll House Care Home

Updated 3 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 01 October 2014 and was unannounced.

The inspection was undertaken by two inspectors who were supported by a specialist advisor. The specialist advisor had knowledge about health and safety and infection control. Before the inspection we sent the provider a document to complete telling us about their service. We refer to this as a Provider Information Return (PIR). The registered provider failed to complete and return this. The law requires providers to notify us about certain events that take place in the home (Notifications). We had not received any recent notifications from the provider. Before the inspection we spoke to the staff who work at Wolverhampton Council with responsibility for placing people at Knoll House (Commissioner’s). We reviewed information we had recently received from West Midlands Fire Service and from a nurse who was a specialist in infection prevention who worked for the local hospital. The information we received raised concerns about the safety and suitability of the service.

One day prior to our inspection staff working at Wolverhampton Council took the decision to stop paying for people to live at Knoll House and to find people an alternative home. People and their relatives had been informed of this decision shortly before our inspection started. The concerns identified during this inspection alongside concerns raised by other agencies resulted in everyone being offered alternative accommodation very quickly and the home closed on 03 October 2014.

During our inspection we met all of the 16 people living at the home, we spoke with four friends and relatives, and one health professional. People living at Knoll House, their relatives and staff had been informed on the day prior to our inspection that the home would be closing and people would be moving to other local care homes. This had been distressing news for people and the conversations we had concentrated on this rather than people’s current experience of Knoll House.

During the inspection we spent time in the communal areas of the home, talking with people and watching the way staff supported people. With consent we undertook a full tour of the premises including people’s bedrooms and the garden. We spoke with all the staff on duty and at length with the senior carer. We supported our observations with written records. We looked at eight records about care, nine medicine administration charts, seven staff files and a selection of records about health and safety.

Updated 3 March 2015

This inspection took place on 01 October 2014, and was unannounced. This meant the provider had no notice that we would be inspecting the home.

Knoll House was last inspected in February 2014 when we followed up on concerns about the condition of the building that we had first reported on in March 2013. In February 2014 we found that the provider had failed to meet the compliance action we issued to improve the safety and suitability of the building. During this inspection in October 2014 we found that the work to maintain and improve the premises that we said needed to be undertaken had still not been completed. Our inspection findings alongside information we had received from West Midlands Fire Service and a specialist Infection Prevention Nurse showed that there was a breach in the legal requirements that providers must meet.

Knoll House is registered to provide care and accommodation for up to 32 older people. At the time of our visit 16 people were resident at the home and two people were being treated in hospital. People all had their own bedrooms, some rooms had an ensuite bathroom, and there were shared toilets, bathrooms, dining rooms and lounges. The home should have a registered manager but this position had been vacant for over six months. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There was no one in overall charge of the home.

We did not find that people using the service were safe. The registered provider had failed to keep the premises well maintained and clean. This placed people at risk of infection and people were not fully protected in the event of a fire breaking out in the building. The provider had failed to ensure that adequate numbers of staff were on duty. This meant staff were not always getting adequate rests between their shifts and that people were not always able to have their medicines at the correct time.

People were not benefitting from a service that was helping them live in the way they had chosen, or which would ensure they maintained good health. Talking to staff and looking at staff training records confirmed that staff had not been provided with the training they needed to update and develop their skills. At the time of our inspection the provider had failed to provide funds to purchase food. Stocks were running low with no finance available in the home to purchase more. We found evidence that staff had purchased items from their own money to ensure people always had adequate food and drinks and some staff had paid for snacks that people particularly enjoyed. People living in the home told us they were aware food stocks had sometimes run low and on occasions they had run out of basics such as tea to drink. People had been supported to see the doctor, dentist and optician. People with specialist health needs had been supported to attend clinics and appointments at the local hospital. We were particularly concerned for the safety and welfare of people with complex needs. We made the local authority aware of these concerns to ensure people were urgently reviewed and got the support they required.

The staff team ensured people were well cared for to the best of their ability with the resources they had available. The registered provider had not operated the service in a way that would ensure good care could be given. During our inspection we observed and listened to staff supporting people. We heard kind and friendly interactions and often staff and people living at the home enjoyed a laugh together. People we met had been supported to wash and dress in a style that suited their taste, gender and preferences. Staff we spoke with informed us they had not been paid their salaries for two months. Despite this they had continued to work at the home and provide care. Staff told us they had done this because of the relationships they had built up with people over time. People received care in the way that they needed and preferred.

Written records we saw contained information about people’s life story and people important to them. This helped staff get to know people. Staff we spoke with were aware of people’s specific needs and preferences and were able to tell us how they included this in their care.

People did not benefit from a well led service. The home had been without a registered manager for over six months. The registered provider had failed to make suitable arrangements for the day to day management of the home and we found that senior care staff were doing their best to lead the home on a shift to shift basis.

You can see what action we told the provider to take at the back of the full version of the report.