Archived: The Knowls

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because they had a range of policies and procedures in place to protect the people who lived in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

The care and support plans we looked at contained clear information about identified risks and how risks should be managed. Examples included supporting people to access the community and maintaining independent living skills. We saw that a plan of care had been developed to manage any identified risks in the least restrictive way. This meant that people could be supported with activities with reduced risks to themselves or to the people who supported them.

We saw that certain restrictions were in place to minimise risks to the people who lived at the home. Examples included access to the home and some areas within the home. We saw that people were only able to access the kitchen with staff support. The care plans we read contained completed assessments and detailed the rationale for this. We did however observe that staff supported people to make drinks and snacks when they requested. Visitors could only access the home when they were let in by staff. They were required to sign the visitors’ book when they arrived at and left the home.

We observed that staff supported people to access the community in accordance with their plan of care. We saw that people were supported by appropriate numbers of staff.

Staff were able to provide safe, appropriate and personalised care to the people who lived at the home. Each person had a plan which described the care and support they required and how staff should provide it. These plans also included who the important people in their life were, how people communicated, daily routines, preferences and how they made decisions. Each person was allocated a keyworker who they would meet with on a regular basis. We saw the keyworker was involved in the review of people's care needs and preferences with other professionals.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw that all medicines had been stored securely and had only been administered by senior staff who had received training in the management and administration of medication. Clear protocols were in place for the administration of ‘as required’ medicines. This meant that people received appropriate medication when needed and ensured that people received a consistent approach from the staff who supported them.

There were sufficient numbers of suitably qualified, skilled and experienced staff on duty to meet the needs of the people who lived at the home. When we visited ten people lived at the home. The staff we spoke with confirmed there were sufficient numbers of staff on duty to meet the needs of the people they supported. The manager told us staffing levels were increased where needed to meet the social needs of the people at the home.

Is the service effective?

We found the service to be effective because people's care treatment and support achieved good outcomes. We also found that people's rights and choices were respected by staff.

Staff told us that they attended a handover meeting at the start of every shift. They said that this provided them with current information about the people they supported. We saw that staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to activities of daily living. This meant that the effectiveness of people’s care plans could be fully reviewed.

We observed that staff were competent and professional in their interactions with people who lived at the home. There was a stable staff team which meant that people were supported by staff who knew them well. The atmosphere in the home was relaxed and staff interacted with people in a kind and respectful manner.

Staff used a range of methods to assist people to make choices about their day to day lives. Examples included objects of reference and photographs. Care and support plans contained photographs of the important people in people's lives. These included family members, health care professionals and key members of staff. Photographs had also been used to show any specialised equipment used by each person. This not only provided clear information for staff but meant that information was more accessible to the people who lived at the home.

People were supported in promoting their independence and community involvement. People were supported to engage in the local community in a variety of ways. Examples included trips out, holidays, shopping trips and work placements.

Is the service caring?

Staff interactions were kind and professional and people appeared very comfortable with the staff who supported them.

We observed staff were skilled in recognising and responding to changes in people’s behaviour. The staff we spoke with had a very good understanding about the needs and preferences of the people they supported. They understood and responded to people’s needs and requests where individuals were unable to make their wishes known verbally. This demonstrated that staff knew people well.

Is the service responsive?

The service was responsive to people's needs. Staff had up to date guidance on how to support each individual. We read the care plans of two people who lived at the home. These contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure they reflected people's up to date needs and preferences.

People’s health care needs were monitored and responded to appropriately. Information about people’s health needs and contact with health and social care professionals had been recorded. We were informed that the service received good support from health and social care professionals and there were no problems obtaining their input for people when required.

Is the service well led?

The service was well led because there were systems in place which monitored the quality of the service provided. The service was proactive in seeking the views of the people who lived at the home and their representatives. We saw that the service responded to any comments or suggestions made.

The service was managed by a person who had been registered by the Commission. The registered manager regularly provided 'hands-on' care. This meant they remained up to date with the needs and preferences of the people who lived at the home. The staff we spoke with told us they received the training and support they needed. They told us the manager responded to training requests and that they found them "very approachable."

We found procedures were in place to minimise any risks to the people who lived at the home. Regular internal audits had been carried out which monitored the on-going health and safety of people. Internal audits included checks on the home's fire systems, environment, care planning and the management of people's medicines.

Staff interactions were kind and professional and people appeared very comfortable with the staff who supported them. We saw that staff were very skilled in recognising and responding to changes in people's behaviour which may indicate that they were unhappy or becoming distressed. The staff we spoke with had a very good understanding about the needs and preferences of the people they supported.

The staff we spoke with demonstrated a good understanding of how to support people to make decisions and of the procedures to follow where an individual lacked the capacity to consent to their care and treatment. This meant that people's human rights were protected.

The home followed appropriate procedures for the management and administration of medicines. This meant that people received their prescribed medicines when they needed them.

Staff felt well supported and systems were in place to ensure that staff received up to date training appropriate to their role and the people they supported.

Systems were in place to monitor and improve the quality of the service people received.

People appeared very comfortable in the presence of staff and it was evident staff knew people well. Staff were observed being kind, caring and patient when they supported people.

Each person who lived at the home was allocated a keyworker. We saw records which showed that regular meetings had been held with each individual, their representative and their key worker. Regular house meetings also took place. The meetings provided people with opportunities to express a view about life at the home, the care they received and social events.

We saw that the home respected the diverse needs of people who lived at the home. An example of this was respecting the dietary preferences and routines of an individual based on their religious beliefs.

We observed that staff responded quickly to any requests for assistance. They were skilled in recognising and responding to people's needs where the individuals were unable to communicate their needs verbally. Throughout the day we observed that staff spent quality time with people which enabled them to enjoy their chosen activity.