Knellwood

During this inspection, we checked whether the provider had maintained the improvements they had made. We found the provider had made and sustained the required improvements and there was no longer a breach of Regulations.

Knellwood is a care home for up to 52 people who require nursing and personal care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 48 people living at the home.

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. The registered manager was not available for us to speak with on the day of inspection.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally. The provider was in the process of trialling the deployment of extra staff at busy times to see if that further improved the quality of care.

The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting. Risks to people were assessed and action was taken to minimise any avoidable harm to people.

There were systems and processes in place to ensure medicines were managed safely in accordance with current guidance and regulations. Staff were sufficiently trained and regularly assessed for their competency of administering medication.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally where this was required. The management team analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet individual's’ needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

The management team and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The management team had created an inclusive and open culture at the home. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them.

People's’ independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.

Practical arrangements including staff rotas were organised so that staff had time to listen to people, build relationships and trust, answer their questions, provide information, and involve people in decisions.

The service was responsive and involved people in developing their support plans where possible which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The service was well managed and well-led by the management team who provided clear and direct leadership, which inspired staff to provide good quality care. The safety and quality of the support people received was effectively monitored and any identified shortfalls were acted upon to drive continuous improvement of the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. The provider wrote to us on 23 May 2017 to inform us they had completed all the improvements listed on their action plan.

We carried out a focused inspection on the 08 July 2017 to check whether that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Knellwood’ on our website at www.cqc.org.uk.'

Knellwood is a care home with nursing providing a service for up to 52 older people, some of whom may be living with dementia. There were 44 people living at the service when we carried out the inspection.

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.

At our focused inspection on 8 July, we found that some staff still had not received all the training required by legislation and recommended as best practice by the Department of Health and Skills for Care (SfC), for staff working care homes with nursing. Some staff had not received training in first aid, infection control and equality and diversity. Other staff required training updates in first aid to help ensure their skills and knowledge were current. This meant that people were potentially put at risk as staff had not received suitable training to deliver basic life support in an emergency situation or work effectively to reduce the risk of spreading infections.

The provider had made improvements to ensure that the content of their mandatory training for staff was in line with legalisation and best practice. The provider was due to introduce a new reoccurring programme of refresher training which would give staff access to regular training updates for subjects covered in their training induction. The course had yet to be implemented and therefore we could not comment on its effectiveness during this inspection, but we will look at this during our next comprehensive inspection.

Staff had received improved access to training in, safeguarding, The Mental Capacity Act 2005, food hygiene, moving and handling and control of substances hazardous to health.

Training was classroom based and the registered manger believed in the benefits of providing real life experiences during training to promote empathic care in staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Knellwood is a care home with nursing providing a service for up to 52 older people, some of whom may be living with dementia. At the time of our inspection there were 49 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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. The registered manager was present and assisted us during this inspection.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk.

People were protected from environmental risks to their safety. Premises risk assessments and health and safety audits were carried out regularly and any issues identified were dealt with quickly. Furniture and fixtures were of good quality and well maintained.

People received care and support from staff who knew them well. They received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans were reviewed monthly or as changes occurred.

People received effective health care and support. They saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure those rights were promoted.

Meals were nutritious and varied. People told us they enjoyed the meals at the service and confirmed they were given choices.

People were treated with care and kindness. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity and always asked their consent before providing care.

People were aware of how to make a complaint and told us they would speak to the registered manager or one of the staff. They told us they could approach management and staff with any concerns and felt they would listen and take action. People benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work.

People living at the service felt there was a good atmosphere and thought they were provided with a comfortable and homely environment to live in. People living at the service, relatives, staff and health professionals felt the service was well-managed. Staff told us the management were open with them and communicated what was happening at the service and with the people living there.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff had not always received appropriate training and training updates that were necessary to enable them to carry out the duties they were employed to perform. You can see what action we told the provider to take at the back of the full version of this report..

During our visit we reviewed care plans and associated records. All of the care plans contained up to date information about the care and support people required. However some of the information was unclear. For example when a person was considered at risk of pressure ulcer development a standard assessment form was used but this information this did not always transfer to a care plan. This may have meant staff did not receive clear information about the care and support they should provide.

The provider kept a record of accidents to people but did not monitor these for trends in terms of location or time of day. For example, falls to people were a common accident to affect people. From the information recorded it would have been possible to monitor these for frequency and severity in terms of time of day and location. This meant it was not possible to identify risks to of falls occurring at key periods and therefore to implement risk reduction programmes.

We found that people's views and their preferences had been sought by the staff on a daily basis and had been recorded within their care plans. We found that detailed risk assessments had been completed for each person and these had been regularly reviewed and updated.

The safeguarding policy was up to date and staff had been trained in safeguarding procedures.

The service's medicines policy was being followed and medicines records had been accurate.

The service had been following their recruitment policy and all required documentation had been obtained from people prior to their employment.

The service had procedures in place to obtain feedback from people who used the home, their relatives and staff members and the service had notified the Care Quality Commission (CQC) where this had been required.