Archived: Thomas Knight Care Home

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.

An inspection was carried out in March 2014 and we found two breaches to our regulations regarding respecting and involving people, and safety and suitability of premises. The service was inspected on 1 and 7 October 2014 and these breaches had been met. No further breaches were found, but improvements to the premises were ongoing which were incomplete.

This inspection was carried out on 14 and 18 July 2016. The inspection was carried out by one inspector.

A registered manager was in post. 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. They were supported by a clinical lead who was also a registered nurse.

Procedures were in place for the safeguarding of vulnerable adults, and staff training had been provided which was up to date. Staff told us they knew how to report concerns of a safeguarding nature and where concerns had been raised we found that the service had taken appropriate action to prevent reoccurrence.

Behavioural disturbance and distress were well managed and staff demonstrated skill and empathy when supporting people. Care plans outlined how staff should support people in a consistent way.

There were suitable numbers of staff on duty and they were effectively deployed to ensure maximum supervision of people. Safe recruitment procedures were followed which helped to protect people from abuse.

A number of safety checks to the building and premises were in place. We found that risk assessments had not been carried out related to glass fronted cabinets. The manager told us they would address this immediately. Improvements had been made to the design and layout of the building, and dementia friendly design had been used to good effect. Appropriate procedures were in place to minimise the risk of the spread of infection.

Individual risks to people were assessed including falls and nutritional risks, these were regularly reviewed and updated. A record of accidents and incidents was maintained and these were regularly reviewed to monitor for patterns or trends.

Medicines were managed safely and regular audits took place to ensure compliance with the home's medicine procedures. The competency of staff to administer medicines was assessed on a regular basis.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service was operating within the principles of the MCA 2005 and applications to deprive people of their liberty in line with legal requirements.

Staff received regular training, supervision and appraisals. This meant that their learning, development and support needs were considered by the provider. The health needs of people were met. They had access to a range of health professionals. Visiting professionals were happy with the response of staff during their visit, and found the staff organised and efficient.

Staff were caring. There were numerous examples of positive interactions between staff and people. People displayed positive signs of psychological well-being and were mainly relaxed and happy during our visit.

Person centred care plans were in place, and these were personalised, detailed and were reviewed monthly.

There was a complaints procedure in place which was prominently displayed. There were a number of feedback mechanisms to obtain the views from people, relatives and staff. These included meetings and surveys. The registered manager carried out a number of audits and checks to monitor the quality of the service. The provider also arranged regular quality monitoring checks by an external consultant to ensure high standards of care were maintained.

We carried out a desktop review on 6 August 2014. A desk top review considers information only and did not require a visit to the service. We found that a manager was now in place and had registered with the Care Quality Commission on 10 February 2014. We concluded that having a registered manager in place helped ensure that people had their needs met because the service was managed by an appropriate person.

We found that people's representatives felt involved in the care. One relative told us, "We are quite happy now with the care, we are kept informed of things that happen. We would go to the manager if we had any concerns. We can't always make the meetings. The new manager introduced herself to us, shook our hands, that is good, we were very pleased with this." They added; "We have had a letter asking for photographs, I think they are going to put a memory jogger or something together."

The registered person had not ensured that people's dignity and participation in decision making were consistently respected and the way people were supported at mealtimes could be improved.

We found that care was assessed and delivered safely and that a new activities organiser had been recruited. As a result more social activity was being organised on a regular basis and we observed that people with dementia care needs were included in this.

We found staff understood the vulnerability of people and how to safeguard them from abuse through the procedures for raising concerns.

We saw that some improvements to the premises had been made and others were underway but some maintenance and safety arrangements had not been addressed. A relative commented, "The home is much nicer now. They have transformed it, it smells cleaner. The bedrooms are much cleaner, the laundry is better, things are not going missing so much."

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, though people we spoke with had mixed views about the care they experienced. The people we spoke with were positive as were two of the visitors. One person said, "The staff are great, they are very thoughtful." A relative said they had raised their dissatisfaction over a period of time and had lost faith in the home, despite a new manager being in post.

We saw that the premises were safe, had been improved in some areas since our last visit and we were told about further improvements to be made.

Staff were being safely recruited because the appropriate information and background checks were sought.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. A staff training programme was in place and individual records contained evidence of training provided. We saw that a programme of staff appraisal and one to one supervisions had been introduced and staff confirmed they had begun to attend one to one meetings.

We found the record keeping had improved since our last inspection. These were being stored securely, were well organised and accessible.

We found people were cared for and people told us they were well looked after. One person said, "Nothing is too much bother for the girls."

People were provided with a choice of suitable and nutritious food and drink.

Staff recruitment procedures were not sufficiently robust.

We concluded that there were sufficient staff employed at the home.

We found that the majority of staff had not received a supervision for over six months and there was no evidence of staff appraisals. In addition staff training needs were not being met.

New equipment had been made available and the premises were clean and tidy but the quality of the environment varied. Some areas did not support people well in finding their way around and we could not find evidence that some potential risks to safety had been fully assessed.

We saw there was a complaints procedure and people told us they would be comfortable raising any concerns. One person said, "I would be quite happy complaining if I needed to."

The manager had consulted some people about the quality of the service and introduced quality audits.

We found there was a choice of suitable food and people told us they had plenty to eat and drink. People said, 'They make me a good breakfast' and 'There's always plenty to drink; I like tea and I can have as much milk as I want.'

We found there were not always sufficient quantities of necessary equipment. Where equipment was available, this was not always safe or suitable for its purpose.

One relative told us, 'I think they are short staffed sometimes' but we found there were enough experienced staff to meet people's needs.

We found that people were not protected against the risks of unsafe and inappropriate care and treatment because records held about people were not always accurate.

In this report the name of two registered managers appear who were not in post, and not managing the regulatory activities at this location, at the time of the inspection. Their names appear because they were still registered managers on our register at the time.