The Knowle Care Home

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.

People's experience of using the service and what we found

Risk management needed to improve in relation to; falls monitoring, record keeping and the cleanliness of some staff areas. We have identified a breach of the regulations in relation to mitigating the risks of falls. We have made recommendations about record keeping and cleanliness of some staff areas in the report.

People were supported by trained staff who were caring and compassionate. Enough staff were in place to maintain people's safety, the manager had already identified this could be improved by introducing an additional shift over teatime and the early evening.

People received their medicines from trained staff who had their competencies checked by management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The manager, who had only been in post for a short time, had begun to embed improvements to care quality and record keeping. The manager and staff helped ensure people were involved and their voices heard. People had found some reorganisation of communal areas had added value to their home and created more space and social opportunities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at the last inspection

The last rating for this service was good, published (8 December 2020). At this inspection the overall rating has deteriorated to requires improvement.

Why we inspected

We received concerns in relation to the management of medicines, moving and handling, nutritional needs and maintaining people's dignity. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Knowle Care Home is a care home providing personal care to 24 older people at the time of our inspection. The service can support up to 32 people in single bedrooms. Accommodation is provided over two floors accessible by a passenger lift, with various communal spaces for people’s comfort. The Knowle Care Home will be referred to as The Knowle within this report.

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

The management team had effective procedures to assess, monitor and maintain a safe environment. People said they felt safe and comfortable. One person stated, “I’m safe and happy. I feel alive here.” The registered manager maintained good standards in the safe management of people’s medicines. There were good stocks of Personal Protective Equipment (PPE), which staff used correctly. People said staffing levels were sufficient to meet their needs.

People and relatives told us they felt staff were keen to optimise their wellbeing during the pandemic and that their voice mattered. People, staff and relatives were very complementary about the registered manager. One person said, “She’s always a good, kind manager, she never changes.”

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

Rating at last inspection and update

The last rating for this service was good (published 12 February 2019).

Why we inspected

We received concerns in relation to medication administration, care planning, falls management and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Knowle Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 26 July 2017, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection visit, people and their relatives told us they felt The Knowle was a safe home to live in and visit. One person said, “My [relative] doesn’t have to worry about me when I am here. The staff are very friendly and take good care of me.” The registered manager had robust systems to maintain a safe environment and reduce the risk of accidents and incidents. We saw evidence staff had relevant training and were knowledgeable about who to report safeguarding concerns to.

We discussed the management of medicines with people, who said this was safely administered at The Knowle. An excellent electronic medication recording system was used whereby information was accurately documented and failsafe processes prevented the risk of errors.

The provider followed the same safe recruitment procedures we found during our last inspection. We saw this contributed to good staffing levels and skill mixes at The Knowle and we observed a patient, unhurried workforce. A person who lived at the home stated, “I need help sometimes and the girls are always around to help.” A range of courses and regular supervision helped staff to strengthen their skills. A staff member told us, “There’s plenty of training available.”

Those who lived at The Knowle and their relatives consistently spoke about good nutritional support and meal options. A relative told us, “The food [my relative] is given is good and there is plenty of choice.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Care records included written consent to care.

We observed interactions between staff and people who lived at The Knowle showed trust and empathy. The registered manager assessed and promoted people’s diverse needs to maintain their human rights. This included the right to be involved in decision-making and care planning. One person said, “I am cared for very well. My personal needs are met.”

The focus of support provision centred on people’s individualised needs and actions to help them retain their independence. Information found in care records included details to guide staff to understand the person and their preferences.

People, staff and relatives said the management team was supportive, approachable and led the home well. One staff member told us, “[The registered manager’s] approachable and gets everything we need to do our jobs.” The management team completed a variety of systems to check quality assurance and people’s experiences of living at The Knowle.

Further information is in the detailed findings below.

The Knowle is registered to provide personal care for up to 32 older people. The home offers short and long term care. Accommodation is provided on the ground and first floor, which is accessed by a passenger lift. There are fifteen single and four double bedrooms, five of which have en-suite facilities. There are two communal lounges, a dining room and a conservatory on the ground floor and ramped access to the garden.

People who lived at The Knowle Care Home told us they felt safe and supported by staff and the management team. Assessments took place to ensure people’s needs could be met by the service. Care records included detailed risk assessments, which provided staff with guidance on how risks to people were minimised.

Systems were in place to reduce people being at risk of harm and potential abuse. Staff had received up-to-date safeguarding training and understood the provider's safeguarding adult’s procedures. People told us there were enough staff on duty and the staff came quickly to any requests for support.

People were protected by suitable procedures for the recruitment of staff. We saw records which showed the provider had undertaken checks. These checks ensured staff had the required knowledge and skills, and were of good character before they were employed at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received care which was relevant to their needs and effective because they were supported by an established staff team. They had received appropriate training such as moving and handling and had a good understanding of people’s needs.

We found the service was pro-active in supporting people to have sufficient nutrition and hydration. Peoples comments about the quality of food varied. One person said, “The food is good, sometimes the vegetables are watery.” We raised this with the registered manager who agreed to address this and speak to people about the quality of the food to ensure consistency.

Care plans showed where appropriate staff had made referrals to health care professionals such as the community nursing team and doctors.

We received consistent positive feedback about the care provided at The Knowle Care Home from people who lived at the home and their relatives. We saw, from care records, staff had discussed people's preferences for end of life care. We found assessments were undertaken by the registered manager and staff prior to any person being accepted into the home.

The registered manager and staff told us they fully involved people and their families in their care planning. People we saw were well presented and staff sought to maintain people's dignity throughout the day.

People were encouraged to raise any concerns or complaints. The service had a complaints procedure. People we spoke with said they felt comfortable raising concerns if they were unhappy about any aspect of their care.

The Knowle Care Home had procedures to monitor the quality of the service provided. Regular audits had been completed. These checks helped to drive up improvements in the service. This helped to ensure people were living in a safe environment.

The registered manager kept up to date with current good practice guidelines. We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

People told us that they were able to determine their care and support and we observed that care and support was offered to people when staff anticipated they needed it, or when it was requested.

People told us that there care was met with the support from staff. We saw one person continually approached staff asking them to see a district nurse. Staff were patient to explain they would do this and arranged for the district nurse to visit.

Staff were recruited appropriately and supported to develop their knowledge and skills.

The safety systems and equipment in the home was regularly maintained and serviced as part of the quality and safety monitoring systems in place.