Knowle Court

Knowle Court is a residential care home providing personal care to up to 22 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 22 people using the service.

People’s experience of the service and what we found:

People were safe because systems were in place to make sure risks to people were assessed and actions taken to mitigate the risk. Medicines were managed safely.

There were enough staff to keep people safe. Staff received good support from the management team and followed a training programme that supported them in carrying out their roles.

People were protected from the spread of infection because good systems and processes were in place. People lived in a pleasant environment. They enjoyed the food at the home and spoke positively about the staff who cared for them.

People were involved in their care and we saw staff to be caring and attentive. People benefitted from staff working effectively with health and social care professionals.

People enjoyed the food and had plenty of choice. People’s nutritional needs were met.

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.

Auditing had been used effectively to identify and address issues.

Complaints about the service were managed well.

People, their relatives and staff felt involved in the service and there were systems in place to promote this involvement.

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

Rating at last inspection

The last rating for this service was Good. Published 19 December 2017.

Why we inspected

The inspection was prompted by the date of the last inspection.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Knowle Court on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 1 November 2017 and was unannounced. The service was previously inspected on 12 July 2016 and was at that time not meeting the regulations related to safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. We found improvements had been made at this inspection to meet the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Knowle Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Knowle Court provides accommodation and care for up to 22 older people, some of whom may be living with dementia. The home is situated in a quiet village on the outskirts of Huddersfield. Accommodation is in single and double bedrooms. On the day of our inspection there were 22 people living in the home.

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. At the time of this inspection the service had a registered manager who was also registered as the provider of the service, which was owned by himself and his family. In this report they are referred to as the registered provider. A manager was also employed.

People told us they felt safe. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence. Robust emergency plans were in place in the event of a fire or the need to evacuate the building.

We found improvements had been made in the management of medicines.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Sufficient staff were on duty to provide a good level of interaction and safe recruitment and selection processes were in place.

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; however some mental capacity assessments required clarification about the specific decision to be made and some best interest processes had not been evidenced.

We made a recommendation about good practice where people may lack mental capacity to consent to certain decisions.

Staff told us they felt supported. Records showed they had received an induction, role specific training and regular supervision and appraisal. This meant staff were supported to fulfil their role effectively.

People told us they enjoyed their meals. People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being.

The service worked in partnership with community professionals and used good practice guidance to ensure staff had the information they needed to provide good quality care.

Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs. People told us staff were caring and we observed staff interacting with people in a caring, respectful manner. Observation of the staff showed that they knew people well and could anticipate their needs.

Individual needs were assessed and met through the development of detailed personalised care plans which considered people’s equality and diversity needs and preferences. People and their representatives were involved in planning their care and people’s needs were reviewed as soon as their situation changed.

Activities were provided at the service, so people were supported to live fulfilling lives.

Plans were in place to ensure people were supported at the end of their lives in line with their wishes.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

The registered provider had an effective system of governance in place and they had taken action to improve the quality and safety of the service. Everyone at the home knew their roles and welcomed feedback on how to improve the service.

The home was welcoming and comfortable and people told us they liked the family atmosphere of the home. The registered provider and the manager were available in the home to provide support and had an overview of the service. They knew the needs of people who used the service and people, relatives and staff were positive about their input.

People who used the service and their relatives were asked for their views about the service and these were acted on.

Knowle Court provides accommodation for up to 22 older people who require residential care. The service does not provide nursing care. The home was situated in a quiet village on the outskirts of Huddersfield. There were transport links into Huddersfield close by.

The service had a registered manager in place and they have been registered with the Care Quality Commission since December 2010. 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 managers also owned the service. The service also employed two further managers.

We found that although risks had been identified there was no assessment of the risks for any of the people who used the service, so that staff were well informed on how to look after people safely. No one using the service had an individual personal emergency evacuation plans (PEEPs) in place and there were no numbers or identifying features on people’s bedroom doors. This could cause difficulty in an emergency situation. Fire drills were taking place but had not captured every member of staff in the last year.

Accidents and incidents were recorded and any actions to be taken were noted.

We saw there was sufficient numbers of staff on duty to keep people safe however staff did appear stretched at lunch time. The service followed safe staff recruitment practices. However, there was one record missing in each staff file we looked at for example one person had only one reference, another person had no identification.

People’s medicines were managed and administered safely. However no medicine audits took place other than weekly stock balances and one controlled drug stated there were five in the home yet we were told these had been returned to the pharmacy. There was no record of this being returned. The registered manager investigated this after the inspection and provided evidence to show this controlled drug had been returned to the pharmacy in September 2015.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety.

Staff were trained in a range of topics and also received specific training to meet people’s individual needs for example dementia training. All staff underwent an induction period. Staff had a basic understanding of the requirements of the Mental Capacity Act (MCA) 2005 and associated legislation under the Deprivation of Liberty Safeguards (DoLS). We discussed refresher training with the registered provider. On arrival there was some query as to how many people were subject to a DoLS and staff were not aware of who had a DoLS in place.

Staff received regular supervision observations such as competencies; however face to face meetings were not taking place regularly. Staff’s annual appraisals were due at the time of inspection.

We observed a lunch time meal and saw everyone was having shepherd’s pie, we did not see evidence of choice for the main course. We were told that there was an option of pasta bake for those who did not want shepherd’s pie but we did not see this available and everyone was given the same meal apart from one person who required finger food. After the inspection the registered manager provided evidence of a page from a book where two meals were recorded and names of wanted what meal underneath, this showed everyone had chosen shepherd's pie. Vegetables were served in separate serving dishes and people could help themselves to these or were provided with support if needed. The cook did not have information regarding people’s special dietary requirements in the kitchen.

The premises were clean and tidy and had dementia friendly signage. The bathrooms were clean but they were used to store hoists and there were also a number of wheelchairs and pressure cushions and a garden parasol stored in the stairwell. The registered manager said that the fire safety officer had not been concerned by this. However, they had not received a written report following this fire inspection. The registered manager stated they only received reports from the fire officer if there were issues.

People’s day to day health needs were met and they had access to a range of professionals.

People were looked after by kind and caring staff who knew them well. People and their relatives were all positive about the care that was delivered and the attitude of all staff. Staff were sensitive to people’s needs and were prompt to provide assistance when needed. People’s privacy and dignity were promoted. People were supported to maintain their independence.

One person was using an advocate at the time of inspection.

Care plans documented people’s end of life wishes and preferences.

Care plans provided information about people so staff knew how they wished to be cared for. However, the evaluation of the care plan stated ‘care plan remains relevant’ going back to 2013. We questioned how they knew the care plan remained relevant. A manager said they updated the care plans every six month or more often if needed, we saw evidence that this was taking place, some people’s care plans had changed three times in one month. The care plans remaining relevant from 2013 was misleading. The care plans also contained information going back many years which could confuse people, we discussed archiving with the registered manager.

We saw a two weekly activity timetable on display. However we feel there was a lack of stimulation throughout the day and people were left sleeping in their chairs most of the time.

We looked at the compliments and complaints received by the service. There were a large number of thank you cards from people living at the service and their relatives but these were not dated and it made it impossible to know whether they were recently received. We spoke to the registered manager about this and they told us that they were working on capturing any comments from people, both positive and negative.

The registered manager had developed a quality assurance system and gathered information about the quality of their service from a variety of sources. However this process was ineffective as they did not highlight any of the issues we raised.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people's relatives and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care records showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care, wherever possible. People told us they were included in making decisions about how their care and support was provided. From speaking with staff they were able to demonstrate a good understanding of people's care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

People who used the service were safe because the provider had in place effective recruitment and selection procedures.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. We saw that there was some good humoured banter between several people living at the home and staff.

People looked well cared for and we observed good care practices taking place. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

"They look after us very well".

"We make friends here".

"We like it when we have entertainment, we had a quiz, it was really good".

Visiting relatives told us that they were very happy with the care provided. Staff told us that they really enjoy working at the home.

We saw that people who lived at the home had a friendly and caring relationship with each other and with the staff.

We saw that each person had a care file which included clear and detailed care plans. We saw care staff working in line with the care plans, offering sensitive and empathetic care. People told us that staff teat them with respect and are considerate of their privacy and dignity.

We saw that people enjoyed appetising and nutritious food, The lunchtime meal was served in tureens for people to help themselves.

Medications were managed safely.

The home had not received any complaints but a system was in place for managing concerns and complaints.

Record keeping was of a high standard.

We saw a large number of thank you cards. In one of these a relative had written "All you ever hear about is bad homes, you never see any praise for good homes. Well this home is excellent". The person who wrote this had also contacted the Commission to tell us of their views.