Archived: Knyveton Hall Rest Home

Updated 15 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 26 July and 2 August 2018 and was unannounced. An adult social care inspector and an assistant inspection undertook the first day of the inspection. Two adult social care inspectors and a Specialist advisor with current clinical knowledge of older people’s care, completed the inspection.

We used the information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and the improvements they plan to make. We reviewed all the other information we held about the service, including previous inspection reports and any notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law. We also contacted the local authority commissioners of the service to establish their view of the service.

As part of the inspection we spoke with eight people who lived at the home to find out about their experiences of the care and support they received. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with 5 staff members, the deputy manager and the registered manager. In addition, we spoke with two visitors to people living in the home, a GP and a district nurse.

We looked at five people’s care plans; these included risk assessments and medicine records. We also looked at records relating to the management of the service including audits, maintenance records, and six staff recruitment, training and supervision files.

Updated 15 November 2018

This unannounced inspection took place on 26 July and 2 August 2018. Both days were unannounced. The aim of the inspection was to carry out a comprehensive review of the service and to follow up on the seven requirement notices that were issued at the previous inspection in November 2017.

Knyveton Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate a maximum of 39 people who require support with personal care. There were 28 people living in the home at the time of our inspection.

Accommodation is provided in individual bedrooms on the ground, first and second floors. Some rooms have ensuite facilities. There is a large lounge and a dining room on the ground floor.

The service was led by 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 the last inspection we identified that management systems in the service were not effective and this had resulted in seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, acting in accordance with the Mental Capacity Act 2005, the management of risk and of medicines, receiving and acting on complaints, staff support and training, record keeping and good governance. Required notifications had also not always been submitted to CQC. The service was rated as inadequate in relation to the question: is the service safe? Rated as requires improvement with regard to the questions is it effective? Is it responsive? Is well led? And was rated good for is the service caring? At that inspection the service received a rating of requires improvement overall.

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 is the service safe? Is the service effective? Is the service responsive? And is the service well led? to at least good. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our last inspection had been made.

The registered manager had taken ownership of the concerns and had employed a specialist care home consultant to support the work required to improve the service. At this inspection we found that improvements had been made in all areas, and that all except two of the regulations had been complied with. We found that there were still shortfalls in the management of medicines and auditing processes which had not identified the issues noted at this inspection. The registered manager gave us assurances that work to complete improvements was ongoing and agreed to keep us informed when outstanding actions were completed. This is the second time that the service has been rated as Requires Improvement overall. However, the registered manager has demonstrated that they are making and will continue to make the required improvements and this is recognised in the improved ratings for three of the four areas which were previously rated inadequate or requires improvement. You can see what action we told the provider to take at the back of the full version of this report.

All the people we spoke with told us they felt safe and well cared for. Visitors, staff and health professionals confirmed that they had observed improvements in the service. We received only positive comments about Knyveton Hall throughout our inspection.

People told us their care and support needs were met and that the staff were kind, caring and respectful. Staff spoke knowledgeably about people’s needs and how to support them. They confirmed that management changes since the last inspection had been positive and that they had completed a number of training courses which had provided them with better understanding skills to care for people.

People were protected from abuse and neglect. Staff knew how to raise concerns about poor practice and suspected wrongdoing under the provider’s whistleblowing procedures.

People’s rights were protected because the staff acted in accordance with the Mental Capacity Act 2005, including the deprivation of liberty safeguards. Where people could give consent to aspects of their care, staff sought this before providing assistance. If there were concerns that people would not be able to consent to their care, staff assessed their mental capacity. Where they were found to lack mental capacity, a decision was made and recorded regarding the care to be provided in the person’s best interests.

Staff worked in line with the requirements of the Mental Capacity Act 2005. The registered manager understood the requirements of the Deprivation of Liberty Safeguards.

There were sufficient staff on duty to keep people safe and provide the care they needed. Staff had the training and supervision they needed to perform their roles effectively.

Robust recruitment processes helped ensure that only suitable staff began working at the service. These included obtaining references and a Disclosure and Barring Service (DBS) check before candidates started working with people.

Staff were positive about their roles and told us they were well supported by the registered provider and registered manager.