The Knowle Care Home

Updated 9 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was completed by1 inspector.

Service and service type

The Knowle is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Knowle is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post, however, there was a manager in place who had applied to be registered.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people living in the home and the relatives of 4 people on the telephone. We spoke with 8 staff, including the registered manager, senior staff, care staff, kitchen and domestic staff. We also spoke with visiting area managers. We reviewed the care records of 4 people, the medicine records for 10 people. We looked at a range of records including those related to the safety of the premises and equipment and the manager's oversight and governance. We looked at the staff areas, people's communal facilities and visited 12 bedrooms.

Updated 9 March 2024

About the service

The Knowle Care Home provides personal care and accommodation, for up to 32 people, some of whom are living with dementia. At the time of inspection there were 28 people living in the home. Accommodation is provided in single rooms over two floors. There is a lift for access. There are a variety of communal areas and an enclosed courtyard and gardens outside.

People’s experience of using this service and what we found

People did not always receive person centred care which achieved good outcomes. The culture in the home needed to improve to ensure people felt their preferences were respected. We have identified a breach of regulations in relation to good governance. Comments from people living in the home included; "Some staff are very caring but some can be horrible to me." Another person said; "I have been here a year and I have never had hot water." We have identified a breach in relation to leadership.

People's medicine records did not include the time of administration for medicines that needed to be spaced evenly or before or after food. Not all staff had up to date medicines training or competency assessments in place. We have identified a breach of regulation in relation to safe care and treatment.

Opportunities to learn from incidents by following the providers procedures to analyse and understand lessons learned had been missed. We have made a recommendation about this in the safe domain.

People were supported by enough staff, based on the providers' assessment of people's needs. Relatives told us; "There seem to be more staff recently." People living in the home told us; "When I press my buzzer the staff come quickly." However, another person said; "When I ring my buzzer I have to wait a long time." People were supported by staff who had been recruited properly with all necessary checks completed before they started work.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection and update

The last rating for this service was requires improvement. (published 21 June 2022). We found breaches of regulation in relation to safe care and treatment and leadership. The provider completed an action plan after the last inspection to show what they would do, and by when to improve. At this inspection we found some improvement had been made but the provider remained in breach of regulations.

At our last inspection we recommended the provider follow good practice guidance in relation to contemporaneous record keeping. At this inspection we found more improvement could be made.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels. A decision was made to inspect and look at those risks.

Enforcement and recommendations

We have identified breaches in relation to; safe care and treatment and good governance. We have made a recommendation in relation to understanding lessons learned. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.