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Inspection carried out on 7 August 2017

During a routine inspection

Brendoncare Knightwood is registered to provide accommodation and support for up to 20 people. It is a self-contained unit within a larger close care centre with 30 two bedroom apartments and seven bungalows. Until December 2015 Brendoncare Knightwood provided intermediate care for people discharged from hospital to enable them to have a short term rehabilitation service before they returned to their own homes. The service was registered to provide nursing care. During December 2015 the service changed its purpose and name and became a care home without nursing. When we inspected there were 17 people permanently in residence and two people were receiving short term care.

The service is now known as ‘The Court’ and so this will be the term used throughout this report.

The inspection took place on 7 August 2017 and was unannounced. A further announced visit took place on 11 August 2017 to complete the inspection.

We last visited in February 2016. We said at that time the service required improvements. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not always sufficient staff on duty at the weekends or during the night to meet people's needs in a timely way. Staff were unable to demonstrate they were applying prescribed topical creams as directed which put people at a risk of being

uncomfortable or of their health deteriorating and people were not provided with activities which reflected their personal preferences and interests. The provider sent in an action plan following this inspection to describe how they were going to improve. At this inspection we found the required improvements had been made and we rated the service as Good.

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 2008 and associated Regulations about how the service is run. The registered manager had helped to add stability and consistency to the service and led by example by being approachable and by listening and acting on people’s views.

At this inspection we found the service was supporting people safely, effectively and in a caring manner. Staff were kind and caring. Staff respected people's preferred routines and activities provided were geared towards people's needs and interests.

People were protected from abuse and avoidable harm. Risk to people's health and welfare were managed appropriately. Environmental risks were regularly considered and managed well.

There were generally sufficient numbers of suitably trained and safely recruited staff to meet peoples' needs. Staff received appropriate training and support.

The service worked well with health care professionals and followed their guidance when they needed support with people's health care needs.

People liked the food and were supported to have a diet which suited their needs and preferences. Staff ensured they sought consent before supporting people with their care and adhered to the Mental Capacity Act 2005.

People were given information about what the service could offer and staff were able to provide appropriate support because people's needs were clearly assessed and updated when a change had taken place. Care records contained a lot of information about what was important to people and their wishes and preferences. Staff knew what people’s preferences were which helped to ensure the care provided was personalised to suit them.

People were encouraged to provide feedback about the quality of the service and complaints were responded to quickly. Robust quality assurance processes helped to ensure the service maintained good standards which met people's needs and expectations.

Inspection carried out on 10 February 2016

During a routine inspection

Brendoncare Knightwood is registered to provide accommodation and support for up to 20 people. It is a self contained unit within a larger close care centre with 30 two bedroom apartments and seven bungalows. Until December 2015 Brendoncare Knightwood provided intermediate care for people discharged from hospital to enable them to have a short term rehabilitation service before they returned to their own homes. The service was registered to provide nursing care .

During December 2015 the service changed its purpose and name and became a care home without nursing. It is now called Dame Sheila Court. As the registered name of the location remains Brendoncare Knightwood this is what the service will be called throughout this report. The registered provider is applying to alter the regulated activities Brendoncare Knightwood provides to reflect the change of use.

Although staff have training in caring for people living with dementia Brendoncare Knightwood does not provide secure accommodation within the unit , so may not be appropriate for people with a cognitive impairment who feel compelled to walk about. Everyone living or staying at Brendoncare Knightwood had capacity to consent to their care and support and staff ensured they consulted them during the planning of their care.

At the time of our visit seven people were living at Brendoncare Knightwood, some of whom were receiving respite care.

The inspection took place on 10 February 2016. It was unannounced and carried out by one inspector. A further visit by one inspector was carried out on 16 February 2016 to complete the inspection.

At our last inspection in September 2014 we found the service had met all standards of care and quality we assessed, although the service was being used for a different purpose at this time.

There had been no registered manager in post since April 2015, although the service had been continuously managed. 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 this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not always sufficient staff on duty at the weekends or during the night to meet people's needs in a timely way. Staff were unable to demonstrate they were applying prescribed topical creams as directed which put people at a risk of being uncomfortable or of their health deteriorating and people were not provided with activities which reflected their personal preferences and interests. You can see what action we told the provider to take at the back of the full version of this report.

People were broadly satisfied with the care and support provided, describing the service as comfortable and saying the staff were mostly good. People also told us however at times they could be better informed about aspects of the service.

There were a number of other improvements needed before the service could consistently meet its stated aims and objectives of providing care and support where people were put "at the heart of everything we do" This included ensuring safeguarding processes were always followed in a timely way by reporting any allegations to Hampshire County Council and CQC.

Staff had access to a wide range of training to help them to work effectively and staff recruitment processes were thorough which helped to ensure only suitable staff were employed. There were clear policies and procedures in place which staff followed to help to ensure medicines were managed safely. People's nutritional needs were known and respected and people told us the choice and the quality of the food was very good.

The service worked well and cooperated with health care p

Inspection carried out on 23 September 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection of Brendoncare Knightwood (the service) in order to follow up a requirement we made following our last inspection of the service on 5 November 2013. On that occasion we found there had not always been a sufficient number of staff with appropriate mix of skills and experience, available to meet people’s needs.

On this occasion we found there were arrangements in place that ensured staffing levels were sufficient to meet people’s needs.

At the time of our inspection there were nineteen people accommodated at the service, sixteen were in receipt of intermediate care and three were receiving a respite service. We spoke with twelve people of the nineteen people in order to hear what they had to say about the deployment of staff at the service.

We also spoke with a six staff including the senior nurse manager and three visitors to obtain their opinions about the staffing of the service.

During our inspection we spent 45 minutes in the service’s dining room and observed the routine during the lunch meal.

We also looked at records and documents concerned with the deployment of staff such as training records, rotas and data about the dependency levels of people who used the service.

The evidence we gathered against the outcome we inspected helped us answer our key question.

Is the service safe?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The service is safe because there are enough qualified, skilled and experienced staff available to meet people’s needs.

Inspection carried out on 5 November 2013

During a routine inspection

When we visited there were sixteen people using the service. Fourteen of these were receiving an intermediate care service and two were having a respite stay. Overall, people were positive about their care and treatment and the skills and knowledge of the staff. People told us ‘its excellent’, ‘I think this place is meeting standards’ and ‘staff are very caring’. We saw examples of care being delivered sensitively and in a friendly and person centred manner. People felt involved in decisions relating to their care and treatment. We found the service placed a strong emphasis on the central place of nutrition to the recovery process and people were mostly protected against the risk of inadequate nutrient or hydration.

The service had suitable arrangements for monitoring the quality of care so that people were protected against the risks of inappropriate or unsafe care and treatment. We observed that the nature of the unit presented staff with a number of challenges in relation to ensuring effective transfer of care processes from the acute hospitals and this had an impact on the continuity of care for some people using the service. We found the provider had not taken appropriate steps to ensure that there were a sufficient number of suitably qualified and experienced staff available to meet people’s needs at all times and improvements are needed.

Inspection carried out on 30 January 2013

During a routine inspection

We looked at care plans for four people. We observed people being supported by staff, spoke with five people in private, and one relative. We saw that people's privacy, dignity and independence were respected.

We spoke with five staff, including nurses, carers, a rehabilitation assistant and a volunteer. Three staff told us the strength of the service was the good team work. One member of staff said they enjoyed "providing holistic care for people".

All five people told us they liked it at Brendoncare Knightwood. People said “It’s really nice here”, "It’s marvellous”, and “The staff are good”.

Individual needs of people were assessed and were continually reviewed, and care plans updated. People experienced care, treatment and support that met their needs and protected their rights.

We looked at safeguarding arrangements for staff training, talked to staff and people who used the service, and reviewed care plans. We found that people were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff rotas, staff training records, observation of staff supporting people and discussion with people demonstrated that there were enough qualified, skilled and experienced staff to meet people's needs.

The provider had in place effective systems to assess and monitor the quality of service, which sought people's views, and learnt from investigations into incidents.

Inspection carried out on 23 November 2011

During a routine inspection

People told us that staff were friendly and helpful and worked hard to give them the

support and care they needed. Some people told us they were able to express their views and wishes and staff would listen to them.

Some people told us they were able to express their views and wishes and staff would listen to them. They told us they enjoyed the meals provided at the home.

There were some social activities arranged for people to take part in. However some

people, specifically those admitted for respite care, felt that there was little provided at the home to stimulate them.

Reports under our old system of regulation (including those from before CQC was created)