Background to this inspection
Updated
12 September 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.
A comprehensive inspection took place on 7 and 10 August 2018 and was unannounced on day one and announced on day two. On day one, the inspection team consisted of one adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On day two, the inspection team consisted of one adult social care inspector.
On both days of the inspection there were 27 people living at Knowle Manor. We spoke with the registered manager, a deputy manager, an assistant manager, five care workers, domestic workers, kitchen and laundry staff members and seven people who used the service.
We looked at two people’s care plans in detail and a further four care plans for specific information. We inspected six staff members supervision and appraisals and we looked at staff training documents. We sampled four people’s medication administration records and four people’s topical medication administration. We reviewed documents and records that related to the management of the service, which included quality management records, audits, risk assessments and policies and procedures.
We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
As part of the inspection we reviewed information we held about the home and requested feedback from other stakeholders. These included Healthwatch, the local authority safeguarding team and local authority commissioning and contracts department. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
Updated
12 September 2018
A comprehensive inspection took place on 7 and 10 August 2018 and was unannounced on day one and announced on day two. Knowle Manor is a ‘care home’ and registered to provide accommodation and personal care for up to 29 older people. Most bedrooms were en-suite with also communal bath and shower rooms located in each floor. There are well appointed communal lounge and dining areas, a spacious garden area and a small inner courtyard. On both days of our inspection there were 27 people living at Knowle Manor. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission(CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the last inspection in November 2015 the home was rated as ‘Good’.
There was a registered manager in place at the time of the inspection. 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 administration of people’s creams was not robust. The registered manager told us a new creams administration system had recently been introduced, but ‘teething’ problems still needed work. Not all staff had received training in the administration of medicines and staff competency had not been checked.
Staff received training and support required to meet people’s needs, although, some training was overdue. The registered manager was aware and in the process of addressing this. The registered manager told us they had not recruited any new staff members in over two years, but recruitment procedures were in place. We found people were cared for, or supported by, sufficient numbers of staff, although the registered manager told us they were going to review the staffing level to make sure they were appropriate.
People’s care plans contained sufficient and relevant information to enable staff to provide consistent, person centred care and support. We received mixed views about the activities, but we saw there was opportunity for people to be involved in a range of activities within the home and the local community, although, outings were limited. From the activities we saw people were smiling and engaging in a positive way.
People told us they felt safe in the home. Staff had a good understanding of safeguarding vulnerable adults and systems and processes were in place to protect people from the risk of harm. Risks to people were identified and managed safely and accident and incidents were analysed accurately. Infection control management was robust and the home was clean, tidy and odour free.
People’s mealtime experience was good. One person did say the meals were not hot enough. We were told there was only one hot plate working but a new one had been purchased and was in the process of being fitted. People had access to healthcare services to make sure their needs were met.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were able to individualise their bedrooms and communal areas were comfortably furnished and homely. Staff were aware of people’s care and support needs, they treated people with kindness and had a good rapport with people. People told us they liked living at Knowle Manor and they were well cared for. Staff understood how to treat people with dignity and respect. People were supported to remain independent and advocacy services were available if required. People’s end of their life wishes were recorded in their care plans.
People and staff found the management team approachable and said they listened to them. We found some of the quality assurance systems needed to be improved to ensure people received a consistent quality service. For example, the medication audit had not identified the concerns found with the administration of people’s creams.
There had been no recent complaints, but a complaints procedure was in place and people told us they would raise any concerns with the registered manager.