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Knights' Grove Care Home Outstanding

Reports


Inspection carried out on 5 December 2018

During a routine inspection

This comprehensive inspection took place on 5 and 12 December 2018. The first day was unannounced.

Knights Grove is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Knights Grove can accommodate up to 56 older people in purpose-built premises and specialises in providing care and support for people living with dementia. Nursing care is provided. There were 54 people living or staying there when we inspected.

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.’

The atmosphere throughout the home was exceptionally positive, welcoming and homely. Feedback from people who used the service, their relatives and staff was consistently very positive and the management at the home exceeded people’s expectations. They were also full of praise for the staff. Many people gave us instances of exceptional care they had received or told us about occasions where staff had gone the extra mile to ensure people continued to live fulfilling, happy lives.

People received a consistently high standard of care because staff and management put people first and at the heart of the service, while continuously looking for new ways to improve their care and quality of life.

Without exception, the staff we spoke with during our inspection spoke positively about the registered manager and the management team. They confirmed that they felt very well supported which in turn motivated them to do a good job.

Care was personalised and met individual needs. In many cases, we were told, it exceeded people’s expectations. Staff knew people very well, cared about them and understood their care and support needs as well as the risks people faced, and were motivated to support them to live full lives. There was no sense of task-oriented practice in the home.

We saw that people were relaxed in the company of staff throughout our visits. Feedback from people, relatives and visitors was that staff provided outstanding care and support and went the “extra mile" to ensure that people felt cared for. Peoples needs were regularly assessed and reviewed in detail and action was taken to respond to people’s changing needs.

The service supported people nearing the end of life to have a comfortable and dignified death by working closely with health care services and through consulting people about end of life wishes. Staff talked with pride about the care they were able to give to people in their final days.

There was a very strong emphasis on the provision of activities that were meaningful to the people living in the home. People told us they were happy with how they spent their time. Staff told us how they believed that being fulfilled and entertained promoted people’s overall wellbeing. The home was fantastically decorated for the Christmas season there was an air of excitement and expectation. Staff told us how many of them had come to the home on their days off to make sure everyone’s bedrooms were decorated, if they wanted this, and that all areas of the home had a wonderful festive feel to them.

Staff took great pride in creating an atmosphere that welcomed people and promoted their independence whilst respecting their privacy and dignity. Peoples wishes were respected with the daily choices they made or were supported to make. Visitors valued the relationships they and their loved ones had with the staff team and told us they always felt welcome.

People had help from, safely recruited and appropriately trained, staff. Staff also understood

Inspection carried out on 4 May 2016

During a routine inspection

This inspection took place on 4 May 2016 and was unannounced. The home provides accommodation for up to 56 older people with residential or nursing care needs. There were 50 people living at the home when we visited. All areas of the home were accessible via lifts and there were various lounges, dining rooms and accessible outdoor space suitable for the people living at the home. All bedrooms were for used for single occupancy and had en-suite facilities.

The home did not have 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 provider had arranged for an experienced temporary manager to act as manager whilst the longer term management arrangements were determined.

Some individual risks had not been identified, assessed and action taken to manage the risk. Other individual and environmental risks were appropriately managed.

Medicines were safely managed however, systems did not ensure people were assessed for pain or other as required medicines at frequent intervals.

People and relatives were positive about the service they received. They praised the staff and the care provided. People received personalised care from staff who understood their needs and they were supported to make choices.

People liked living at the home and felt it was run well. Staff understood their roles, were happy in their work and worked well as a team. There was an open and transparent culture. The provider encouraged staff feedback and visitors were welcomed. Complaints, when received, were investigated and responded to. Quality assurance processes were in place to assess key aspects of the service. Where these had identified a need for improvement action had or was being taken.

Staff treated people with kindness and compassion and formed caring relationships with them and their relatives. Staff protected people’s privacy, promoted their independence and involved them in planning the care and support they received. People were also positive about meals and the support they received to ensure they had a nutritious diet.

People felt safe at the home. Care staff knew how to prevent, identify and report abuse. Staff followed legislation designed to protect people’s rights and freedom to help make sure decisions were only taken in the best interests of people.

Safe recruitment procedures were in place and staff were suitably trained and appropriately supported in their role and available in sufficient numbers to meet people’s needs.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly. A range of activities were provided suited to people’s individual needs and preferences.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

Inspection carried out on 8 April 2014

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

Our inspection team was made up of an inspector and a specialist advisor in nursing care. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints and feedback from professionals. This reduces the risks to people and helps the service to improve.

Staff were trained to comply with policies and guidance in relation to safeguarding vulnerable adults, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). This means that people will be safeguarded as required.

The service is clean and hygienic. There is an appointed lead for infection prevention and control and staff had completed annual training in this topic. This reduces the risk of infections.

Is the service effective?

People’s health and care needs are assessed and regularly monitored. Care plans are reviewed and reflect people’s current needs. Specialist dietary, medical, and behaviour needs are identified in care plans.

Staff follow guidance detailed in care plans, and discussed at handover meetings. Care for people with dementia is based on recognised good practice guidelines.

Is the service caring?

Staff were compassionate and attentive. People using the service and their visitors were complimentary about the attitude of staff. We saw that all staff showed patience and gave encouragement when supporting people. One person said, “The staff are caring and the food is good.” We were also told, “The staff know how to treat people. If people aren’t feeling well, they understand.”

People’s preferences, interests, aspirations and diverse needs are recorded and care and support is provided in accordance with people’s wishes.

Is the service responsive?

People’s needs are assessed prior to admission the service responds promptly when their support needs change. The visiting healthcare professional said the service sought medical advice when necessary and staff followed instructions when providing treatment and care.

Complaints and incidents are investigated and managed in a timely way. People can be assured that action is taken as necessary to improve the service.

Is the service well-led?

The service work is well led and works well with other agencies. There is an effective quality management system to manage risks and share and learn from incidents. The service’s audit programme includes regular reviews of documentation and health and safety. Any shortfalls or areas for improvement are identified and addressed. There is good communication within the service, with regular staff meetings so staff are well informed and supported.

Staff told us they understood their roles and responsibilities and worked well as a team. This helps to ensure that people receive a good quality service at all times.

Inspection carried out on 30 October 2013

During a routine inspection

There were 38 people using the service at the time of this inspection, which focused mainly on the first and second floors. During this visit we met people who used the service and spoke with the Registered Manager, Head of Care and eight members of staff. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with two relatives and observed the care and support being given and how staff interacted with people.

A visitor told us the care staff ”Love mum to bits. They know her and they care”. We observed that staff approached people sensitively, informed by knowledge of peoples’ current needs. However, we found that the planning and delivery of care and treatment did not always ensure peoples welfare and safety or that their individual needs would be met. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Another relative told us they had seen improvements since the new manager started in post. We saw evidence that learning from incidents / investigations took place and appropriate changes were being implemented. The provider had taken steps to ensure that that staff received appropriate training, supervision and appraisal. These improvements will need to be embedded in practice and sustained.

Inspection carried out on 10, 13 June 2013

During a routine inspection

In this report the names 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 of this inspection. We have advised the provider of what they need to do to remove the individual’s names from our register.

We spoke with three people who used the service and three relatives, the Regional Support Manager, the Head of Care, and 11 members of staff. We observed that staff interacted with people who used the service in a friendly, respectful and professional manner. One person told us: “You wouldn’t wish for a better place”. A person’s relative told us that “apart from a blip recently”, they had been “very happy with the care provided”. Another relative told us they had “absolutely no qualms about the care”.

A person who used the service told us: “There are more than enough staff and they treat me well”. A relative said: “It is better now with staff in the lounges and more going on. I don’t worry now”. However, we found that robust arrangements were not in place to ensure that staff received appropriate training, supervision and appraisal. People were protected from the risk of abuse and there was evidence that learning from incidents / investigations took place and appropriate changes were implemented. The service had developed and was working to an improvement plan.

Inspection carried out on 28 December 2012

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

During this visit we met some of the people who used the service and spoke with the registered manager and six members of staff. We used different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with two relatives, observed the care and support being given and how staff interacted with people.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff took time to talk with people and demonstrated their knowledge of care plans and people’s needs. A person’s relatives told us the person “Has settled and calls it home”. There were enough qualified, skilled and experienced staff to meet people’s needs. Additional staff were available to improve interactions with people using the service. Staff told us that the revised staffing levels meant there was an improved continuity of care for people and that the atmosphere in the home was now “Happier, more relaxed” and “Calmer”.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

Inspection carried out on 4, 7, 10 August 2012

During an inspection in response to concerns

Many of the people using the service were not able to verbally communicate with us. We therefore spent time observing the care provided and people’s interactions with staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Interactions we observed between staff and people showed people were treated with respect. We spoke with four relatives, who confirmed that staff treated people with respect. We spoke with one relative who told us their husband was always “well treated”, for example staff ensured that he was clean and well dressed. Another relative told us staff “handle challenging behaviour well”.

We observed four people in a lounge area. Two people were watching television and talking with each other. Another person slept and the fourth person was either asleep or sat passively in their chair. When staff came into the room their interactions with the people were either task focussed or were of a neutral nature such as saying ‘hello.’ From our observations in a lounge area before lunch, we observed little interaction with staff and people using the service. Staff were engaged with other tasks such as paperwork outside of the lounge area. We observed that mealtimes were organised to enable staff to provide support to people eating in the dining areas or in their own rooms. We saw staff answering call bells in a timely manner.

Two relatives said they had some concerns about staffing levels at night. Another relative told us that while overall care needs were met, staff did not have “time for the nicer things”. They added that they had “no complaints” about the staff, who they said “work hard and are very nice”. When we asked about activities and social interaction, another relative said they felt that staff “do their best and want to do more, but don’t get the time”. The relative also said that they thought activities were “hard to do” for many of the people who used the service. Relatives’ concerns about staffing levels had been raised at a residents’ and relatives’ meeting. A relative told us that relatives meetings took place but that “not a lot gets done”. Another relative said that the new manager had been sympathetic to their concerns.

Inspection carried out on 26 August 2011

During an inspection in response to concerns

Many of the people using the service were not able to verbally communicate with us. We therefore spent time observing the care provided and people’s interactions with staff. We also spoke with people who were visiting their relatives in the home, who confirmed that staff treated people with respect.

We observed that staff explained to people about the support being provided, for example when assisting them to move to other areas of the home.

People we spoke with told us that the service was meeting their relative’s needs. They said that people received personal care and medical attention when they required it. They confirmed that there were enough staff and that staff had the right knowledge and skills to support people. They said staff responded promptly when people requested assistance and that staffing in the home had recently improved.

People told us that they could raise any concerns and were confident they would be responded to appropriately. They said that visitors were always made to feel welcome.