4 August 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 inspection took place on 17 and 18 May 2018 and was unannounced. The inspection team consisted of two inspectors and an expert by experience who had experience of a loved one living with dementia. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information contained within the provider's website.
Throughout the inspection we observed how staff interacted and cared for people during the day, including mealtimes, during activities and when medicines were administered. We spoke with seven people, the recently appointed general manager, the company secretary, two activity co-ordinators, five care staff and one registered nurse.
We reviewed six people's care records, which contained comprehensive assessments, care plans and risk assessments. We looked at six staff recruitment files, training logs and supervision files. We examined the provider's records, which demonstrated how people's care reviews, staff supervisions, appraisals and required training were arranged. We also looked at the provider's policies, procedures and other records relating to the management of the service, such as staff rotas, health and safety audits, medicine management audits, infection control audits, emergency contingency plans and minutes of staff meetings. We considered how people, relatives' and staff members’ comments were used to drive improvements in the service.
4 August 2018
This inspection took place on 17 and 18 May 2018 and was unannounced. During our previous inspection on 8 July 2017, we found a continuing breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although the service had made some improvements to the provision of appropriate training for staff, further improvements were needed in order for the service to fully meet the requirements of this regulation.
During this inspection, we checked whether the provider had maintained the improvements they had made. We found the provider had made and sustained the required improvements and there was no longer a breach of Regulations.
Knellwood is a care home for up to 52 people who require nursing and personal care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 48 people living at the home.
The service had 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. The registered manager was not available for us to speak with on the day of inspection.
There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally. The provider was in the process of trialling the deployment of extra staff at busy times to see if that further improved the quality of care.
The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting. Risks to people were assessed and action was taken to minimise any avoidable harm to people.
There were systems and processes in place to ensure medicines were managed safely in accordance with current guidance and regulations. Staff were sufficiently trained and regularly assessed for their competency of administering medication.
Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally where this was required. The management team analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.
People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet individual's’ needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.
The management team and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.
People experienced good continuity and consistency of care from staff who were kind and compassionate. The management team had created an inclusive and open culture at the home. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them.
People's’ independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.
Practical arrangements including staff rotas were organised so that staff had time to listen to people, build relationships and trust, answer their questions, provide information, and involve people in decisions.
The service was responsive and involved people in developing their support plans where possible which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.
Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.
The service was well managed and well-led by the management team who provided clear and direct leadership, which inspired staff to provide good quality care. The safety and quality of the support people received was effectively monitored and any identified shortfalls were acted upon to drive continuous improvement of the service.