Archived: The Knells Country House

We found the following examples of good practice:

¿ Systems were in place to help prevent people and staff from catching and spreading infections. People and staff had been tested and there had been no known cases of Covid-19 at the home.

¿ There was sufficient personal protective equipment (PPE) such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. The registered manager had made their own video for staff on using PPE and handwashing. One member of staff told us, “We have been shown very well how to do everything.”

¿ The layout of the home promoted social distancing. There were various rooms including a conservatory where people could sit. A balcony area had been built outside where people could see their visitors safely. Additional cleaning was being carried out.

¿ Staff supported people’s emotional and social wellbeing. Staff acted as social buddies to help people keep in contact with relatives using a range of technology.

¿ Infection control audits were carried out. The registered manager spoke positively about the hard work and dedication staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing.

People’s experience of using this service: People said they were very happy at this home and had many positive comments about the “kind, helpful staff” team. They said it was a “lovely, lovely home” and “nothing could be better”. Relatives said the home was incomparable to other services and described the staff as “wonderful” and “caring”.

People said they felt safe at the home. There were enough staff to support them whenever they needed it. People said staff responded very quickly when they requested assistance.

The home was clean, warm and comfortable. Staff knew how to protect people from avoidable harm. People at risk of falls or poor health were provided with the assistance and equipment they needed. People’s medicines were managed safely.

Before people moved to the home their needs were assessed to make sure the home could provide the right care. Staff said they had good training and support to care for people in the right way. Staff worked well with other health agencies and people were supported to access health services.

Staff cared for people effectively and responded quickly to any changes in people’s well-being. People said the meals were very good. Staff encouraged people to eat and drink enough and they had lots of choices about their meals.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said there were always interesting activities to take part in and the chance to go out into their local community. There was a friendly, welcoming atmosphere in the home and warm engagement between people and staff.

People said the home was well-managed. They were asked for their views at meetings and said suggestions were always listened to. Staff said the management team were open, approachable and supportive.

The provider carried out checks to ensure the quality and safety of the service. They were committed to continuous improvements of the service.

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

Rating at last inspection: Good (report published in November 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This unannounced inspection took place on 1 November 2016. We last inspected this service in October 2014 during which we found that the provider met all the regulations in force at that time. Since then there has been no incidents or concerns raised that needed investigation.

The Knells Country House provides care and accommodation for up to 22 older people some of who may live with dementia. It is situated in a rural setting not far from the centre of Carlisle. It is an older property, which has been adapted and extended with accommodation on two floors accessed by a passenger lift and stair lift.

At the time of our visit there was a registered manager 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 and associated Regulations about how the service is run.

People who used this service were safe. The staff knew how to identify if a person was at risk of abuse and the action to take to protect people from harm. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. Staff had completed training in the protection of vulnerable people.

Staffing levels were good. The records we looked at showed that staffing levels were planned around the needs of people who lived in the home. We saw that staffing levels were increased at certain times during the day when the work load was at the highest level. People were recruited safely which ensured only suitable people were employed at The Knells.

We found that peoples' medicines were managed well through a computerised system and in line with their prescriptions. Healthcare needs were met through advice from the mental health team, peoples’ doctors and consultants where necessary. Dental, optical, chiropody and dietician services were accessed when required.

People were provided with sufficient food and drink in order to maintain good levels of nutrition and hydration. People told us “We have a choice of meals and if there is anything we don’t like we can choose something else” and “The food is excellent and all home cooked”. Dietary needs and nutrition were well managed.

People had their care and support needs assessed and kept under review. Staff responded quickly when people’s needs changed, which helped to ensure their individual needs were appropriately met.

We saw that people were treated with kindness and respect. They were included in planning and agreeing to the support they received. The care staff knew the people they were supporting well and respected the choices they made about their care. The staff knew how people communicated and gave them support to make and express choices about their lives. People were encouraged to follow activities of their choice both in the home and out in the wider community if they wished.

The registered manager set high standards and the focus of the service was on promoting people’s choices and rights. The registered manager and the staff team had a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, (DoLS). They understood how to protect the rights of people who needed support to make important decisions about their lives.

The provider had policies and procedures in place to deal with any concerns or complaints. There had been no complaints to record. There was an appropriate internal quality audit system in place to monitor the quality of the service provided.

The home was managed by a registered manager who was experienced and qualified to run the service. Staff felt well supported by the registered manager who promoted strong values and a person centred culture. Staff said they were pleased to work in such a good home and were supported in understanding the values of the service.

'I love it here. I was so lonely at home on my own and I could not be happier'.

'I am very well looked after thank you. I go downstairs for my breakfast and lunch but have my tea in my room'.

Relatives said,

I am very happy with the care my relative receives. I chose this home because she was unable to do so at the time. I have never regretted it. She has really settled down well'.

We saw, throughout our visit, that people were treated with respect and their dignity was preserved. Staff were constantly chatting to people whilst they were providing support.

Each person had an up to date care plan which evidenced that every person was fully assessed prior to moving in to The Knells. This ensured that the service was able to provide an appropriate level of care and support.

Medicines were managed well and safely. All staff who administered medicines had been appropriately trained.

Risk assessments were in place and reviewed each month with the care plans.

The home had a full set of policies and procedures in place and records were up to date and securely stored in lockable facilities.

We found that staff interacted well with the people living in the home and that there was a warm and friendly atmosphere throughout our visit.

Each person was fully assessed prior to moving in and care records were informative and up to date. The staff knew people well and were seen treating them with respect and as individuals. Some people had difficulty in communicating but the staff understood their needs and met them in an appropriate manner.