The Care Quality Commission
  • Care Home
  • Care home

Archived: Knights Court Nursing Home

Overall: Good read more about inspection ratings

105-109 High Street, Edgware, Middlesex, HA8 7DB

Provided and run by:
Life Style Care (2011) plc

Important: The provider of this service changed. See new profile
Important: The provider of this service changed. See old profile

All Inspections

14 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We inspected Knights Court Nursing Home on 14 July 2014. This was an unannounced inspection.

We carried out two inspections during 2013 when we found concerns that required actions. The service met the regulations we inspected against at their last inspection on 2 January 2014.

Knights Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom may also have dementia. There were 52 people living at the home when we visited. The reason for the low number of people using the service was that the local authority placed an embargo on admissions between April and October 2013 following several serious concerns. The registered manager was appointed in July 2013 and registered in March 2014. She ensured that new admissions since October 2013 had been actioned slowly so that there was no risk of further concerns. 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Further concerns about staffing issues were raised anonymously in June 2014. We checked on the issues during this inspection and did not find any evidence to corroborate these concerns.

Staff we spoke with during our visit told us that there had been “great improvements” since the registered manager was appointed. One staff member said, “She is a superb manager, very supportive.” A relative said, “Things have really improved over the last three to four months. The staff have got to know [my relative’s] ways much better and they are now able to communicate with them.” The registered manager made changes in the management structure and responsibilities, and appointed new staff and nurses so that there was an improved level of staffing on all units. The registered manager was aware that there were still challenges to address in order for the service to be able to provide a consistently good level of care. They ensured a gradual increase in new admissions to ensure that staff were able to meet all their needs. The provision of responsive dementia care was not consistent throughout the home, and the provider was making some changes to the environment to address this.

People told us that there were always staff available to help them when needed. Relatives of people who used the service told us that they visited the home at different times and on different days, and the staff always made them feel welcome. They said that staff were caring and treated people with respect, and that their relative was always comfortable and looked well cared for. One relative said, “I would recommend this home.” Another relative said “I wish I could move [another relative] into this home; I would be very happy if [this relative] was here.”

The service was meeting the requirements of the Deprivation of Liberty safeguards (DOLS). The registered manager and staff understood when an application for a DoLS authorisation should be made and how to submit one. The registered manager was aware of the 2014 High Court judgements which widened the scope of the legislation.

Staff told us that they had regular training that provided them with the skills to understand and meet the needs of people who used the service. A new member of staff said they had been given training as part of the induction so that they were able to respond to people’s care needs.

Staff were aware of people’s rights to be involved in decisions and to make choices about their care and treatment. Care plans showed these preferences. People who used the service and their relatives told us that they had agreed their care plans and they were able to make their views known.

Staff treated people with dignity and respect and supported them in a caring way. Three members of staff were ‘Dignity Champions ‘with additional training and responsibility for encouraging other staff to respect people’s dignity.

Care plans for people with dementia provided information on how each person communicated and the best way for staff to support them with their specific needs. All staff completed training in understanding dementia. Our observations in the dementia units showed that people were mostly alert and interested in their surroundings. Staff engaged people in conversation and talked with them while assisting them. However provision of dementia care was not consistent in the two units, due to differences in the environment. In one unit the lounge was divided and chairs arranged in small social groups to encourage socialising and conversation. In the other unit chairs were arranged around the outside of the lounge and people only engaged in conversation when staff spoke to them.

2 January 2014

During an inspection looking at part of the service

We carried out this inspection to check if the provider had complied with three compliance actions from a previous inspection of the service. We spoke with five people who used the service and four relatives. We examined records and also spoke with staff on duty to make a judgement as to whether the provider was meeting Outcome 4 : Care and welfare of people who use services and was compliant with Regulation 9, Outcome 7 : Safeguarding vulnerable people who use services and was compliant with Regulation 11 and Outcome 14 Supporting workers and was compliant with Regulation 23 (Health and Social Care Act 2008 Regulated Activities) Regulations 2010.

At this inspection we were satisfied that people who used the service were treated with respect and well cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. There were suitable arrangements for safeguarding people and for ensuring that their rights were protected. We observed that staff were attentive and responsive towards people.

People who used the service and their relatives informed us that they were satisfied with the care provided. Staff had been provided with appropriate support and training and this was evidenced in records examined.

30 July 2013

During an inspection looking at part of the service

Our inspection of 8, 9 and 10 April 2013 found concerns with all the essential standards that we inspected. The provider wrote to us with action plans to address all of the concerns.

On this occasion we found improvements in the areas of consent, nutrition, medication and record keeping. However there were further concerns with safeguarding people in the home, care and welfare and training for staff.

People we spoke with told us that they were satisfied with the care they received. One person said, 'The staff are wonderful,' and another told us, 'I don't mind it here.' A visiting relative told us, 'Staff are very kind and helpful.'

One person said that there was some entertainment provided, but another told us, 'There is not enough to do.'

We spent some time observing care to help us understand the experience of people who could not talk with us. During our observations staff showed limited understanding of the needs of people with dementia. There were no activities for people who were less able to communicate to take part in.

The care plans for people with dementia did not provide information on each person's specific needs and their methods of communication.

We observed an incident of restraint that was not recognised and reported as a safeguarding concern.

Training records did not provide evidence that all essential training was up to date.

8, 9, 10 April 2013

During a routine inspection

Most of the people we spoke said that there were fewer activities in the home because the activities co-ordinator had left the home.

Two visiting relatives did not wish to speak with us, and one told us that they 'did not have anything nice to say about the home'. One visiting relative told us that they were generally satisfied with the care their relative received. They said that the staff looked after their relative well, but they 'could smile more often'. Another person, whose relative had Alzheimer's disease, said that the staff did not understand their relative's needs.

People with dementia did not experience care, treatment and support that met their needs and protected their rights. Nursing and care staff did not have sufficient skills and training in dementia care to ensure that they could understand and meet the needs of people with dementia.

People were not supported to be able to eat and drink sufficient amounts to meet their needs. We saw evidence that the risks of malnutrition were not monitored and recorded affectively.

The provider had not dealt with instances of possible abuse appropriately, to protect and safeguard people in the home.

Medicines were not administered safely. Arrangements for the recording of medicine did not ensure that prescribed medicines were given to people appropriately.

31 August 2012

During an inspection looking at part of the service

We spoke with six people who use the service who told us they were happy living at the home and thought they were well cared for. One person told us "they are very good here, and do their best to help you".

We found since our last inspection on the 29 June and 3 July 2012 the service had improved. We found the provider was now completing relevant care assessments in line with legal requirements where people were thought unable to make decisions for themselves.

We also found that staff were completing care tasks in line with people's care plans, for example, staff were more aware of people who were at risk of choking. Staff were also more aware of people's moving and handling needs and were carrying out care tasks in line with people's care plans.

29 June 2012

During a routine inspection

People using the service told us that they enjoyed living at the home and staff were kind and caring.

Relatives of people using the service told us they are frequently involved in the planning of care and are invited to meetings in the home on a regular basis.

10 February 2012

During an inspection in response to concerns

Most relatives said staff involved them in making decisions about the care of people and in drawing up and reviewing care plans and risk assessments. One out of the five relatives we spoke with, said they had not been involved in the review of the care of the person they visited, for more than six months.

Relatives said staff informed them when people's needs changed. They reported that staff called them when people sustained accidents or incidents to keep them up to date with people's wellbeing. One relative said 'They [staff] will ring if there is a problem'.

The majority of relatives said people received a good standard of care and staff monitored people's conditions and took prompt action when people were not well. We however noted that people on one unit did not always receive baths/showers according to their care plans and were not always moved and transferred safely and appropriately.

Relatives said the home was clean, but we observed that the en-suites to people's bedrooms were not so clean and we saw splashes and stains on some doors to the en-suites. Relatives told us that the condition of some items of furniture was not so good and needed to be replaced. Our observations confirmed this.