20 March 2017
During a routine inspection
Knights Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom may also have dementia. There were 62 people living at the home when we visited.
At our last inspection on 27 and 28 July and 1 August 2016 we rated the service as "Requires Improvement". We found breaches of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to documentation and audits. We also made a recommendation in respect of activities available in the home.
There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.
People and their relatives informed us that they were satisfied with the care and services provided in the home. People told us they felt safe in the home and around staff. Relatives of people who used the service told us they were confident that people were safe in the home and raised no concerns in respect of this.
Our previous inspection found that a number of people had acquired pressure sores that were rated as grade three or four, which meant they were at high risk of developing life-threatening infections. During this inspection on 20 March 2017 we found that the number of people with pressure sores in the home had reduced significantly.
During our visit, we reviewed people’s care and support records looking at how pressure area risks were identified and managed for people. Our last visit found that there was a lack of consistent documentation in respect of turning and repositioning of people. During this inspection on 20 March 2017, we found that the home had taken necessary action in respect of this and made significant improvements to the way in which they recorded turning and repositioning of people.
Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm. People's care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that that people received safe and appropriate care. People had access to healthcare professionals.
There were systems and processes in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.
On the day of the inspection, we observed that there were sufficient numbers of staff to meet people's individual care needs. Staff did not appear to be rushed. However, people who used the service and relatives we spoke with told us that staffing levels were inadequate. The majority of staff we spoke with told us that generally there were sufficient numbers of staff. We discussed this with the registered manager and she provided us with the staff dependency tool they used in order to decide the appropriate level of staffing required. The registered manager also explained that since the last inspection, they had an extra member of care staff on duty during the day on one unit.
Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. Some people were prescribed medicines to be taken “when required”. However, the protocols were not always up to date. We saw that the clinical lead had identified this as part of the medicines monthly audit and had already started to update people’s care plans and “medicines when required” protocols.
Staff employed by the home underwent a robust procedure to check they were appropriate to work with people. Staff were provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from management.
People's health and social care needs had been appropriately assessed. Care plans were person-centred and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people's needs changed.
Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.
The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The home had made necessary applications for DoLS and we saw evidence that authorisations had been granted and some were awaiting approval.
There were suitable arrangements for the provision of food to ensure that people's dietary needs were met. There were mixed reviews about the food provided. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented.
On the day of the inspection, we observed some positive interaction between staff and people who used the service. The overall atmosphere in the home was calm and we saw people were treated with respect and dignity. However, during lunch we observed that there was a lack of interaction from staff. Staff were task focused and failed to sit and interact with people to ensure lunchtime was an enjoyable and sociable experience. We observed staff talking with one another rather than with people. We have made a recommendation in respect of this.
People and relatives spoke positively about the atmosphere in the home. Bedrooms had been personalised with people's belongings to assist people to feel at home.
During the previous inspection, we found that there was a lack of activities available for people to participate in at the home and made a recommendation in respect of this. During this inspection on 20 March 2017, we found the home had taken action and made significant improvements in respect of this. Since the last inspection, they had employed two activities coordinators and implemented a monthly activities timetable. A variety of activities were available which included coffee mornings, arts and craft, armchair netball, film matinee and bingo.
Staff were informed of changes occurring within the home through handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.
The home had carried out a satisfaction survey in April 2016 and the registered manager confirmed the next survey was due to take place in April 2017. People and relatives spoke positively about the registered manager. They said that the registered manager was approachable and willing to listen. Complaints had been appropriately responded to in accordance with the home’s policy.
There was a management structure in place with a team of nurses, care workers, kitchen and domestic staff, clinical lead, deputy manager and the registered manager. Since the previous inspection, the home had appointed a new deputy manager and clinical lead. The deputy manager had been in post for approximately six weeks and the clinical manager in post for approximately three months at the time of the inspection.
Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about the registered manager and the support received from her. They said that they did not hesitate about bringing any concerns to management.
During the previous inspection, we found there were some areas of care where the quality of the service people received was not effectively checked and the home failed to identify failings. We found a breach of regulation in respect of this. During the inspection on 20 March 2017, we observed that the home had made significant improvements in respect of this. We found deficiencies in respect of medicines and interaction between care staff and people and found that the home had already identified these areas for improvement through their own internal audits and were in the process of addressing these issues. It was therefore evident that the home had an effective system in place for assessing, monitoring and improving the quality of the care they provide.
The home undertook checks and audits of the quality of the service in order to improve the service as a result. We saw evidence that regular audits and checks had been carried out at regular intervals in areas such as health and safety, equipment, cleanliness of the home, medicines and staff training.