Archived: Knowles Court Care Home

We found the following examples of good practice.

The service was clean and well ventilated in line with best practice guidance.

Infection prevention and control audits were carried out regularly and were effective in identifying areas for improvement.

The service was closed to non essential visitors. People were supported to keep in touch with family and friends by way of telephone and video calls.

Compassionate visits for people receiving end of life care were arranged safely.

Further information is in the detailed findings below.

Knowles Court is a residential care home with nursing providing personal and nursing care and when operating at full capacity can accommodate 145 people. The service consists of five separate single storey buildings, at the time of our inspection only three houses were in use. There were 60 people using the service, the majority of whom were older people. Headley House provides personal care and support to people living with dementia. Fairfax House provides personal care and support and Ryecroft House provides nursing care and support.

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

People looked well cared for and comfortable.

People were supported to take part in a variety of in-house activities.

Relatives told us they were happy with the care and support provided. They told us they were supported to keep in touch with their relatives.

Staff told us they would have no hesitation in recommending the home to family and/or friends.

The premises were well maintained.

We were assured the provider had appropriate infection prevention and control infection procedures in place.

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 June 2019) and there two breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the requirement notices we previously served in relation to Regulations 15 (Premises and equipment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Knowles Court 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.

Knowles Court Care Home has five individual single storey houses. At the time of the inspection only four of the five houses were occupied, and 68 people were using the service. Headley House provides care and support to people living with dementia. Ryecroft House provides nursing care for older people, Fairfax House provides care and support to older people and Rosewood House provides support to people with learning disabilities.

The care service at Rosewood House has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service was not always delivered in line with these values, because people living at Rosewood House did not have an equally suitable environment to other citizens who used the service.

People’s experience of using this service:

In three houses we found the accommodation at Knowles Court provided people with a pleasant and comfortable environment. On Rosewood House the environment was not appropriately maintained and decorated to an acceptable standard to support people to live in a dignified way. We discussed this with provider and they told us they would make immediate improvements to the environment. Improvements had begun to be implemented by the second day of our inspection.

People told us they felt safe at Knowles Court Care Home. Staff had a good understanding of how to safeguard adults from abuse.

Staff were aware of their responsibilities if they were concerned a person was at risk of harm. Care files contained detailed individual risk assessments to reduce risks to people’s safety and welfare.

Feedback from people and staff about sufficient staff being on duty was mixed. Adequate staff were deployed to meet people’s needs, however more staff on duty would enable people to lead more fulfilling lives.

We made a recommendation about this staffing.

Staff recruitment was safe. Staff had undertaken training relevant to their roles and there were clear lines of communication and accountability within the home.

A system was in place to ensure medicines were managed in a safe way. Staff were trained and supported to ensure they were competent to administer medicines.

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. Mental capacity assessments and best interest decisions were usually completed when decisions needed to be made.

Most people told us they enjoyed their meals and we saw people received support with meals and drinks when required. Staff knew how to access relevant healthcare professionals if their input was required.

People and their relatives told us staff were caring and supported them in a way that considered their dignity, privacy and diverse needs.

Most people and their relatives told us they were in receipt of care that was responsive to their needs and preferences. Some people on Rosewood House were not always supported to lead fulfilling lives.

We made a recommendation about this.

People told us they knew what to do if they had any concerns or complaints about the service and the management team were accessible. Complaints had been acted on when they arose.

We saw detailed information documented about people’s end of life care and advanced care plans were in place if people wanted to record their future wishes.

Most people told us they thought the service was well led. Since our last inspection Improvements had been made, however, some areas of governance still needed to improve. The registered provider had failed to improve the quality and safety of the environment of Rosewood House. Feedback about lack of opportunities for community involvement and outings on Rosewood House had not been acted on and up to date activity records were not always kept.

People who used the service, staff and relatives were asked for their views about the service and these were usually acted on.

Rating at last inspection: Requires improvement (Report published 02 February 2018).

Why we inspected: This was a planned inspection based on the last ratings inspection.

Improvement action we have told the provider to take: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We have told the registered provider to send us an action plan. We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

Knowles Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Knowles Court Care Home has five individual single storey houses and is situated in Holmewood, a residential area on the outskirts of Bradford. At the time of the inspection only four of the five houses were occupied. Headley House provides care and support to people living with dementia. Ryecroft House provides nursing care for older people, Fairfax House provides care and support to older people and Rosewood House provides support to people with learning disabilities.

Overall we found the accommodation at Knowles Court provided people with a pleasant and comfortable environment. However, we found attention was needed to the décor and furnishings on Rosewood House especially in the communal areas. We have therefore asked the registered manager to discuss the plans for Rosewood House with the new registered providers and provide us with a written response.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected.

Overall we found there were sufficient staff on duty to meet people’s needs. However, we recommended that the registered manager kept staffing levels under review.

Staff had undertaken training relevant to their roles and there were clear lines of communication and accountability within the home.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

The relatives we spoke with told us they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.

People told us they enjoyed the food and we saw a wide range of food and drinks were available and people’s weight was monitored to ensure they had sufficient to eat and drink.

There was a range of activities for people to participate in, including activities and events in the home and in the local community. However, we concluded that more could be done to provide people with a stimulating environment on both the dementia care and learning disability units.

We saw the complaints policy had been available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

The care plans in place were person centred and contained individual risk assessments which identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity. However, we found some care plans had not been updated following significant changes in people’s needs.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists.

We found medication policies and procedures were in place and staff responsible for administering medicines received appropriate training. Overall we found people received their prescribed medicines and medicines were managed properly and safely. However, staff needed to be more vigilant when completing topical medication records and stock control records for PRN ‘As and when required’ medicines.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required. However, we found some concerns highlighted in the body of this report had been identified through the quality assurance monitoring system.

We found one breach of regulations in relation to Good governance. You can see what action we told the provider to take at the back of the full version of the report.