Background to this inspection
Updated
8 December 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.
This comprehensive inspection took place on 11 October 2018 and was unannounced.
It was carried out by an inspection manager and one adult social care inspector.
We used information the provider sent us in the Provider Information Return. 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 improvements they plan to make. We reviewed the PIR and other information we held about the service as part of our inspection. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send CQC within required timescales. We also contacted the local authority contracts and safeguarding teams. We used the information they provided when planning the inspection.
During this inspection we carried out general observations. We also spoke with the local authority contracts and safeguarding teams. We used the information they provided when planning this inspection. We also spoke with a vocational training assessor and an independent quality auditor employed by the provider.
During our visit we spoke with nine people, four relatives, the deputy manager, two nurses, a senior care assistant, two care assistants, an activities coordinator and a kitchen assistant. The registered manager was not on duty during the inspection. We looked at care records for three people, three staff recruitment records, four medicines records, and a variety of records relating to the quality and management of the service.
Updated
8 December 2018
Thomas Knight is a care home that provides accommodation and nursing care for a maximum of 54 people, some of whom are living with dementia. 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. Thomas Knight accommodated 53 people at the time of the inspection.
At our last inspection in September 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
People who were able to speak with us told us they felt safe living at Thomas Knight. A number of people were living with dementia and were less able to communicate but we observed they appeared relaxed and comfortable in their surroundings.
Checks on the safety of the premises and equipment were carried out although timescales set by the provider were not always met meaning some checks had been missed. Documentation did not always detail the location or exact item checked. We did not, however, see any unsafe equipment and we spoke with the deputy manager who sent us an updated checklist with realistic timescales and more detail regarding the location and type of equipment checked, following our inspection. Risks to people were assessed and plans put in place to mitigate these.
Staff had received training in the safeguarding of vulnerable adults and knew the procedures to follow in the event of concerns. We found the whistleblowing policy had been used when staff had concerns about aspects of care they felt should be investigated.
Safe recruitment procedures were followed which helped protect people from abuse. There were suitable numbers of staff on duty and a stable team, including nursing staff. There was no agency staff use.
Safe procedures remained in place for the management of medicines. There were some gaps in Medicine administration records [MARs] which we were told were usually picked up daily but some had been missed. We have made a recommendation about this.
Staff received regular training, appraisal and supervision, and told us they felt well supported in their roles. Checks on nurses registration status were carried out on a regular basis to ensure they remained registered to practise.
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. There was variation in the quality and detail of records relating to capacity issues and we spoke with the deputy manager about this. They agreed they should be reviewed and improved where necessary. We have made a recommendation about this.
People were supported with eating and drinking, professional advice was sought where there were concerns regarding their nutrition. People had access to a variety of health professionals and were supported to attend routine hospital appointments for the management of long term health conditions.
Staff were very caring and courteous in their interactions with people. We observed numerous examples of kind and compassionate care. Staff knew people well and used this knowledge to support people very effectively during periods of distress.
Person centred care plans were in place which were detailed and contained information about people’s individual needs, preferences and wishes. These were up to date and regularly reviewed.
A complaints procedure was in place and complaints had been responded to in line with the company policy.
A range of activities were available, and there was a dog living in the home who was very popular with people living there.
A new registered manager had been appointed since the last inspection. Staff told us they felt well supported by the manager and deputy who they said were approachable and listened to them.
Robust governance systems were in place which clearly outlined action to be taken, timescales for completion, and who was accountable to ensuring it was complete. This meant a clear audit trail was in place.
A number of improvements had been made since the last inspection and the managers were working closely with the management of their sister home. There was an increased focus on sharing best practice and learning from incidents across the two homes.