• Care Home
  • Care home

Archived: Knowle House Nursing Home

Overall: Good read more about inspection ratings

Lingfield Road, East Grinstead, West Sussex, RH19 2EJ (01342) 317740

Provided and run by:
Yourcare Limited

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

All Inspections

3 October 2017

During a routine inspection

The inspection took place on the 3 October 2017 and was unannounced.

Knowle House Nursing Home provides personal care, accommodation and nursing care for up to 35 people. On the day of our inspection there were 22 older people at the service, some of whom were living with dementia and chronic health conditions. The service is spread over three floors with a passenger lift, communal lounge and dining room and a garden.

At the last inspection on 8 September 2015, the service was rated Good. At this inspection we found the service remained Good.

People and relatives told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People and relatives also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team which we observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People, staff and relatives found the management team approachable and professional.

Further information is in the detailed findings below:

8 September 2015

During a routine inspection

Knowle House Nursing Home is registered to accommodate up to 33 people who require support with personal and nursing care. It specialises in providing support to older people. At the time of our visit there were 23 people living at the service. The service had 19 single rooms and eight shared rooms. Only one of the shared rooms was occupied by two people who had lived at the service for a number of years. Accommodation is provided across three floors with the first and second floors accessed via a shaft lift. There is level access throughout the building and grounds.

The service had a registered manager. 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. In this service the registered manager is also the registered person.

We carried out an unannounced comprehensive inspection of Knowle House Nursing Home on the 8 September 2015. As part of this inspection we checked what action had been taken to address the breaches of legal requirements we had identified at our last inspection on 19 November 2014. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection we found improvements had been made and sustained and all the breaches previously identified had been addressed.

Without exception the feedback about the management of the service and the improvements made was positive. The provider had employed a new registered manager who started work at the service at the beginning of January 2015 who had overseen the implementation of the provider’s action plan and taken steps to ensure the improvements were embedded into everyday practice. One relative said, “There were huge problems in the past with the management continually changing. Now they’ve got a permanent manager who is brilliant and a deputy, which they needed, it’s great. The manager has made a huge difference”. Another relative said, “There have been big improvements in the management. I’m very impressed with the place and the care and attention given. Other people seem happy and contented too”. A staff member said, “I think the manager is really good. They’re so easy to talk to and will always listen”. Another staff member told us, “The manager is really friendly but at the same time, really clear that the residents come first. You know where you stand”. Staff felt management were supportive. They told us there was a positive and open culture and enjoyed coming to work.

Improvements had been made in relation to the arrangements in place for people to give their views on the service. People and their relatives were able to contribute to meetings and make suggestions concerning their welfare and future service provision. One person told us, “We have club meetings about what we’ve done, do we want to improve it and make it better or do we want to scrap it all together. The secretary takes the minutes and gives us a leaflet about it for us to think about.” A relative told following our last inspection the provider had called a residents and relatives meeting at which the provider, “Invited questions about the inspection and asked for suggestions from people about improvements they could make which they took on board.”

Action had been taken to improve the safe management of people’s medicines. The arrangements in place for the ordering, storage and administration of people’s medicines were safe and people received their medicines when they needed them. A visitor told us their relative had their medicines on time and said, “I visit regularly and know the tablets are always given on time. The patches are given right down to the minute.”

Improvements had been made in relation to the protecting people against the risk of abuse. People and their visitors told us they felt safe and raised no concerns about their safety. Staff were aware of what constitutes abuse and had completed relevant training. The registered manager and staff had a good understanding of the protocols for making a safeguarding referral. Incidents that affected people's safety had been recorded and investigated. A relative told us, “I’ve never heard or seen anything going on that I needed to say anything about and I would have no reservations in doing so.” A staff member said, “If someone was handling someone roughly, then I would go straight to the manager or to Social Services if I had to”.

Improvements had been made to the safety and delivery of care people received. Risks had been appropriately identified and robustly addressed in relation to people’s specific needs. For example assessments of people’s risk of falls and developing pressure areas had taken place and strategies were in place to reduce these risk. There was constant monitoring and reassessment of risks which ensured that staff took actions to protect people for example we saw staff reminding people who needed to use walking frames to use them.

Improvement had been made in relation to planning people’s care. People and their representatives had been involved in the development of care plans which were centred on the person and detailed their likes and dislikes and where known, their personal histories. People’s needs and preferences were detailed such as whether they needed assistance to brush their hair and whether they liked to wear makeup and jewellery. A visitor told us they and their relative had been fully involved in compiling the care plan they said, “The care plan has been signed, sealed and delivered. That was one of the problems there had been, care plans were out of date. That is one of the things (registered managers name) did; make sure they were all redone and brought up to date.”

Improvements had been made in relation to making sure lawful consent had been gained from people for their care and treatment. Mental capacity assessments had been completed in line with legal requirements. Where people lacked the mental capacity to make decisions the management and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and how to submit one. Deprivations of Liberty Safeguards (DoLS) authorisations were in place and care plans clearly identified if someone was subject to a DoLS.

Staffing levels had improved and were based on the individual needs of people. Staff were seen spending individual time with people and responding to call bells and requests for assistance quickly. A relative told us, “Whenever I visit, there are plenty of people around and they seem to have to time to talk to people”. One staff member told us, “We’re lucky I suppose. We have enough staff to cope and to spend time with the residents”. Staff recruitment ensured staff were suitable to work at the service. Relevant identity and security checks had been completed before staff were deployed to work.

Staff training and support had improved. Staff had completed training that was relevant to their roles and which provided them with the skills they needed to meet people’s needs. For example staff had completed training in the administration of medicines and supporting people living with dementia. One staff member told us, “I’d never done this type of work before so I did a lot of shadowing. I thought the induction was really good”. Another staff member said, “I learned a lot from the induction. I felt quite confident afterwards”. Staff received regular supervision where they could speak in confidence with their line manager about any concerns they may have and discuss their personal and professional development.

Improvements had been made to the quality assurance systems in place and internal audits the results of which were used to help drive improvements in the service. Accidents and incidents were recorded and the results analysed to identify and emerging themes and patterns, and action had been taken to reduce the risk of re-occurrence.

People’s dignity and privacy was protected. For example we saw staff knocked on people’s doors and waiting for a response before entering their rooms. Doors were shut when staff supported people with personal care and ‘Do not disturb signs were hung on the door’. People were seen to be appropriately covered throughout hoisting procedures, and were referred to by their preferred term of address.

Staff knew people well and had formed strong bonds with them. One person said, “We get on well; I have a laugh with the girls.” Another person said, “They are very lovely the girls so pleasant. They guide you and help you. A very happy bunch. Anyone can come in and have lunch with us if you want.” A visitor told us, “I come in at all times of day and days of the week. They would never know when I might call in but many times when I’ve turned up there has been a carer holding mums hand or talking to her”. They also said “They really did help me and mum to settle in. They built up her confidence bit by bit and eventually she started to come down (to the communal area) and now she’s really settled here”.

People were supported to make their own decisions and remain independent. One person told us, “I do things on my own and at my own speed, sometimes they chivvy me along but they don’t interfere.” A staff member told us, “I like to get people to make their own decisions if they can. For example, if someone doesn’t want to do something, then it’s up to them”. Another staff member told us, “We have to remember it’s their home. We won’t go wrong if we remember that”.

Visitors were welcomed and visiting times were not restricted. One visitor told us, “I really like the homeliness. They always ask me if I want a cup of tea or coffee. They keep me up to date when I visit or they ring me if anything has happened, they discuss everything with me. These girls are really caring”.

Staff were kind and respectful when interacting with people giving them time and space to respond to questions, and were patient when people wanted to speak and struggled to say what they needed. People looked comfortable and they were supported to maintain their personal and physical appearance. For example, people were well dressed and groomed. People could bring their own furniture and personal belongings to help them feel at home. Thought had been given to the decoration of people’s rooms and communal areas which had been decorated with wall paper which gave the rooms a domestic feel.

People enjoyed the meaningful activities provided. They liked the social aspect of activities and in particular when they took place in conservatory. One person told us, “The music’s good, we sing together, I like that. The activities that (activity organisers name) does are really good. We can make suggestions and decide together what we want to do.” A book of interest to the individual with a book mark stating, ‘Please read this to (person’s name) at every opportunity’ had been placed in the room of each person who spent a lot of time in their room. There were raised beds in the garden to enable people who liked gardening to use and a vegetable plot where seedlings people had grown had been planted.

People had a choice of food at meal times and specialist diets were catered for. People who needed help to eat and drink were supported appropriately. People’s weight was monitored and referrals were made for specialist health care support as needed. For example for Speech and Language Therapy and input from GP’s.

People had been provided with a guide to the service and were aware of how to raise concerns and complaints and felt able to do so. Complaints received had been recorded and responded to appropriately in line with the provider’s policy.

19 November 2014

During a routine inspection

This unannounced inspection took place on 19 November 2014.

Knowle House Nursing Home provides accommodation and nursing care for up to 35 older people who have nursing needs. The home supported people who were living with the early stages of dementia. The home has 27 bedrooms with seven of these being shared rooms. There were 26 people living at the home.

The home had not had a registered manager since September 2012. The provider told us they were in the process of recruiting for this position and as an interim measure they had an acting manager to oversee the home. 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 and their relatives spoke highly of the staff and the home. They told us staff were kind and respectful and supported them to make day to day choices. People were not provided with opportunities to be actively involved in decisions about their care and the home. We have made a recommendation about involving people in decisions about their care and the home.

There were policies and procedures regarding the safeguarding of adults at risk, however some staff lacked knowledge and understanding of what safeguarding meant for people. Where safeguarding incidents had occurred the home had not used these as an opportunity to learn and inform future practice.

Medicines were not always given as prescribed because the home had run out of stock and had not obtained prescribed medicines for people. There was a lack of recording of medicine errors and the acting manager did not always recognise these. There was no evidence that any planning or action had been taken to prevent reoccurrence of medicines errors. The provider was unable to demonstrate that staff were appropriately trained and competent in medicines management. There was a lack of guidance for people who were prescribed ‘as required’ medicines which are taken on an occasional basis.

Some risk assessments for people lacked detail or were incomplete. Whilst some care plans provided detailed information to guide staff about the support a person needed, others were not always personalised and did not provide sufficient guidance.

Staff lacked an understanding of the Mental Capacity Act 2005 and as such the principles of this had not been applied in full. Where people were deemed to lack capacity this was not based on their ability to make specific decisions and implied they could not make any decisions for themselves. There was no evidence of ‘best interests’ decision making processes being followed. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Three applications for DoLS had been made. The provider was aware of when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

The home did not effectively review information gathered from investigations and quality audits. Staff were not consistently provided with opportunities to discuss issues of concern, look at practice and discuss improvements.

There were enough staff on duty to meet people’s needs. Appropriate checks had been undertaken, however, where the Disclosure and Barring Service (DBS) checks identified concerns, no further action to explore these to ensure there were no risks for people living at the home had been taken. The provider was unaware of the concerns raised within the checks.

People had no concerns or complaints about the home and would speak to the manager or a relative if they did. When complaints had been received these had been dealt with appropriately and action had been taken. However, the provider had not identified a pattern and could not demonstrate learning. We have made a recommendation about the learning from complaints.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

23 October 2013

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

On the day of our inspection there were 28 people living at the home.

We spoke with five people, four of whom were able to communicate their experiences of using this service. We also spoke with three relatives and four members of staff.

We found that people living at this home were well cared for and felt safe. We saw that people were treated as individuals and had enough information to make decisions about their care and treatment. Staff told us they felt well supported to deliver high quality care. One person told us they "couldn't wish for anyone better".

Two relatives told us they were very happy with the care their mother received and one said the "staff were always welcoming".

People had access to a range of activities but were given the choice as to which ones they wanted to take part in. People we spoke to said the food was very good and their individual preferences were always taken into account. Another person told us they were "very happy here".

13 February 2013

During a routine inspection

We spoke with people and their relatives who told us that they were treated as individuals and that they were given information and choices in relation to their care. People told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations. On relative said to us ''I feel happier about going on holiday knowing that she is being cared for''.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so. We saw that care activities were altered to suit individual needs.

We were shown examples of care records which were organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.

20 March 2012

During a routine inspection

People said they liked living at Knowle House Nursing Home. They said they had visited the home before admission and been involved in discussions about the help they needed and their preferred day to day routines. People said there were different activities to do and that they could join in with activities if they wanted to. They said they were happy with the support they received and the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. People said they knew who to speak to should they have any concerns, but said they had no complaints. People commented 'No complaints about the home it's marvellous' and 'Staff are wonderful they are all angels'.