Knightwell House

Knightwell House is a residential care home providing personal care to 10 older people at the time of the inspection. The service can support up to 13 people with learning disabilities and autism.

The home is set out over 3 floors with communal spaces for people to use.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People had not always had all of the risks associated with their care assessed or mitigated. Care plans needed further information about how to reduce risks in people’s care. Whilst systems in place supported people to receive their medicines safely, medicine competency checks for staff had not been recorded.

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.

Staff supported people to access health and social care support and people had their individual dietary needs met.

Right Care:

Improvements were needed in maintaining oversight of refresher training for staff to ensure they had current knowledge of the topic area.

The service had enough staff to meet people’s needs and staff understood how to protect people from poor care and abuse. Staff received training on how to recognise and report abuse and they knew how to apply it.

People could communicate with staff and understand information given to them because they were supported by a consistent staff team who understood their needs.

Right Culture:

Systems to oversee the quality of the service were not always effective. We identified care records were not always up to date, oversight of when training needed to be completed was not in place and on-going checks on the suitability of staff needed to improve.

The service enabled people to feedback their views about the care they received and acted on this feedback.

Staff placed people’s wishes, needs, and rights at the heart of everything they did.

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

Rating at last inspection

We carried out a targeted infection control inspection which did not rate the service (published 09 April 2021). The last rating for this service was good (published 17 January 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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 inspection reports and timeline’ link for Knightwell House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to how the provider monitors the quality of the service. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation around how the service is assessed and monitored for the risk of a closed culture.

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.

¿ On their arrival at the home, visitors were screened for symptoms of Covid-19 and where required, would complete a lateral flow test to ensure their visit could take place safely in line with current guidance.

¿ Testing of staff and people for COVID-19 was happening and staff were undertaking further infection control and prevention training.

¿ Cleaning schedules and cleaning of touch points had been increased to help lower the risk of infection.

¿ People were supported to maintain contact with their friends and relatives.

¿ Social activities had been adapted to keep people active during the pandemic. Staff ensured people sanitised their hands prior to and after taking part in group activities.

• People were kept safe and secure from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider. People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

• Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs.

• Staff sought people’s consent before providing care and support. 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.

• People were treated with kindness and compassion. People’s rights to privacy were respected by the staff that supported them and their dignity was maintained. People were supported to express their views and be actively involved in making decisions about their care and support needs.

• People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well.

• People using the service, their relatives and staff were confident about approaching the registered manager if they needed to. The provider had effective auditing systems in place to monitor the effectiveness and quality of service provision. The views of people and their relatives on the quality of the service, were gathered and used to support service development.

Rating at last inspection: Good. The last report for Knightwell House was published on 5 July 2016.

About the service: Knightwell House is registered to provide care for 13 people. The service cares for people with learning disabilities and at the time of our visit they were providing care and support for 11 people.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated as Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Knightwell House is a registered care home providing accommodation and personal care for up to 13 people with learning disabilities. At the time of our inspection there were 12 people living at the home.

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.

People were safe and secure. Relatives believed their family members were kept safe. Risks to people had been assessed and managed appropriately.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual needs.

People safely received their medicines as prescribed to them.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat and meal times were flexible to meet people’s needs.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there was positive communication and interaction between staff and the people living at the location. Staff were aware of the signs that would indicate a person was unhappy and knew what action to take to support people effectively.

People’s right to privacy were upheld by staff that treated them with dignity and respect. People’s choices and independence was respected and promoted and staff responded appropriately to people’s support needs.

People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

The provider had management systems in place to audit, assess and monitor the quality of the service provided, to ensure that people were benefitting from a service that was continually developing.

We saw that people's needs had been assessed and planned for. All the people we spoke with told us they were happy living at the home. One person told us, "We can have a bit of fun with the staff." Another person told us, "They (staff) look after me well. Help me out with activities." Staff were knowledgeable about people's needs and the support they needed.

People's nutritional needs had been assessed and planned for. People confirmed that they had a choice at meal times and were involved in choosing meals. This showed that people's nutritional needs were met.

The environment met people's needs. All the people spoken with told us they were happy with their bedrooms. One person confirmed they had been asked if they wanted a lock on their bedroom door and spent time in the garden. This meant people were happy with their environment.

All the people spoken with told us there were sufficient staff to meet their needs and staff confirmed this.

We saw that there was a complaints procedure in place. One person told us, "I would tell Brian if I was not happy." All the people spoken with told us they felt safe in the home.

We saw that people were treated with respect and dignity and were at ease with the staff.

People told us they could choose how they spent their time, what they ate and drank and what to wear. One person told us, "We can choose what we do. I go out on the bus on my own, visit my family and choose which centres I go to."

People were dressed in individual styles. Attention had been given to their personal care so that their self esteem was promoted.

People told us the staff had helped them to become more independent. One person told us, 'I have learned how to make a drink and how to keep my room clean.'

We saw that people had personalised care plans so that staff knew about the things that were important to them. Staff referred people to other professionals and followed their advice to ensure that people's health needs were met.

Systems were in place to ensure that people were safeguarded from harm.

Staff were trained so that they had the skills and knowledge to meet peoples needs and ensure their wellbeing.

People living there and their relatives were asked for their views about the home so that the quality of the service improved.