The Knowles

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement and there was a breach of regulation. At this assessment the rating has changed to good. The provider was no longer in breach of regulation. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff understood the importance of learning from incidents, and they knew how to record and what to escalate. Processes ensured any learning was communicated to staff through staff meetings or at handovers, so staff had the right information to support people.

People’s care plans were updated if needed following an accident/incident. Staff comments included, “We fill out an accident form on paper which is taken to the team leader and uploaded onto the system.” “We have a morning briefing for handover, everyone working will join in, the team leader will explain any concerns or updates; practically anything from a professional visiting or anyone to monitor for example if they are unwell.”

The registered manager reviewed accidents and incidents at the home and analysed those for any emerging patterns or trends. Actions recorded what interventions had been made at the time and post incident, for example calling 999 or seeking additional external health support. The provider told us they learnt lessons from inspections undertaken at their other homes. They told us this was valuable to support improvement at The Knowles and their other homes. The provider also told us they sought external consultants to inspect their services against CQC criteria to help identify any areas for improved practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Pre-admission assessments were completed to ensure the home could meet people’s needs safely. This included staff assessing people’s suitability to live in the care home. One staff member told us, “The manager will tell us of any new residents, we go through the care plan and review their needs such as their nutrition, mobility, personal care, any medical conditions and needs.”

Another staff member told us a person was admitted to hospital, and they had been reassessed by the occupation therapy team during their stay. The assessment found the person required less support with mobilising. The staff member showed us the person’s care plan which had been updated, meaning staff could now support the person’s increased independence.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider respected people’s rights when delivering care and treatment, however the documentation in relation to mental capacity assessments and best interest decisions needed to be improved. People’s capacity to make their own decisions had been considered, however this had not been recorded for each separate decision. Capacity assessments had limited information about how people had been supported to understand the decision to be made, what questions they were asked and how staff tried to support the person to understand. In some cases, we saw a decision had been made which was in the person’s best interests. Whilst this had involved people who knew the person well there was a lack of information of why the decision had been made in the person’s best interest.

Without exception, people and relatives said The Knowles was a safe place to live. One relative said, “I feel 100% sure that my [person] is safe here. The staff are switched on so much; they know at what time they go to the bathroom at night and if they don’t get a signal from the sensory mat at around that time, they check.” A person said, “I feel safe because they are very nice staff. They are always there, and we see the same staff.”

Staff knew how to protect people from abuse and who they would report concerns to both internally and externally. One staff member said, “Safeguarding means making sure people are safe and protected and concerns were reported.”

Staff demonstrated a good understanding of respecting people’s wishes and decisions which included when a person lacked mental capacity. One staff member said, “I ask the person if they are happy for me to support and offer them choices so they can be as independent as possible. If they were unable to advise me, I would check their care plan to see how they would like support. If they refused, I would leave and approach them at a later time and try again."

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and relatives felt risks were managed. One person described how risks were managed for them, saying, “They are aware that there is a fire risk and looked at ways of getting me out if there was one. They have recognised that this is a risk.” Some people at times displayed behaviours to communicate their emotions and distress. Positive behavioural support plans (PBS) were in place for staff to follow. These plans aim to provide person centred information about the behaviours the person may present when anxious and guide staff on personalised, distraction and coping strategies to follow. We found in the PBS plans viewed they did not always contain this important information.

Where people had become distressed staff had not always recorded how they supported the person. Records were not analysed to help understand potential triggers for people’s individual needs. This meant staff may not be able to respond safely and effectively during periods of distress. However, during our inspection we saw people become distressed and staff meeting people’s emotional needs.

Staff told us care plans informed them about people’s risks. However, we found an identified risk had not been recorded in 1 person’s care plan. For example, some people had been assessed by the Speech and language therapy team (SALT), however important information such as choking risks to 1 individual’s plan we saw had not been recorded. The registered manager assured us at the end of our inspection and said choking risks had been updated to one person’s care plan. Where people required modified diets and fluids, clearer fluid and nutrition records were needed to accurately reflect how those risks were managed safely by staff.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

At the last inspection we found fire safety checks had not identified fire safety measures remained effective. At this inspection, we saw premises and safety checks were now regularly undertaken and where issues had been found, these were rectified. The provider was no longer in breach of legal regulation; however, we found some fire doors required adjustment during our visit to ensure they remained effective in the event of an emergency. We discussed our findings with the provider, maintenance person and operations manager. They were confident they regularly checked fire safety measures, and they had identified where improvements were needed. Checks confirmed this but we recommended a consistent approach to how they tested fire doors.

Checks on water quality, equipment, the environment and maintenance issues were completed. However, on the first floor we saw damage to an internal wall that could impact on fire safety effectiveness. This was rectified while we were at the home. The provider told us about the ongoing refurbishment plans which included the outdoor space so people could spend time outside, engaged in their hobbies and interests.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Majority of people and relatives said staffing levels met their needs. Comments included, “It takes 2 care staff to look after them and even [person] says they are excellent” and “I can’t fault the staff. There’s never been a time when they haven’t been there when you needed them.” However, 1 person said, “I don’t think they have enough staff here, if you ask for something, you don’t get it.”

The provider assessed the staffing levels needed to meet the needs of all the people using the service. Staff raised no concerns to us around staffing levels. The provider undertook appropriate checks before staff stated working at the service. Systems were in place to check the suitability of staff before they commenced employment. These included obtaining references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer.

Staff told us they received the support they needed to deliver safe care which included an induction, meetings about their performance and appraisals and support to develop their roles.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider assessed and managed the risk of infection.

Staff were seen to wear appropriate personal protective equipment (PPE) in key areas of the home. Guidance for staff and visitors was in place to promote good infection control practices. For example, in relation to handwashing. Bins in communal bathrooms were foot operated and were emptied when required. Stocks of PPE were available throughout the home and gloves were latex free, minimising any possible harm to people or visitors if they needed to be worn.

Managers undertook checks on staff’s infection prevention practice, so they could be assured people received safe care. Refurbishment of the home was ongoing and improvements to some décor would help maintain an environment that supported safe infection control. Staff told us shower rooms and bathrooms had recently been updated.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People told us they received their medicines when required. We found improvements were required in the way some people’s medicines were administered and recorded. In those examples, we could not be confident people received their medicines safely and as prescribed. However, people had not come to harm. For example, we checked if people’s medicines were stored safely. We found daily room and refrigerator checks in the medicines room were made and were within safe range.

We identified 1 person’s eye drops were stored in the fridge, however guidance stated once opened, store at room temperature. Senior staff were not able to provide a rationale for storing this medicine in the fridge, and there was no risk assessment undertaken to consider the safety of doing this. There was no audit trail to confirm staff had contacted the manufacturer or a pharmacist to discuss the storage of the person’s medicines and confirm this was safe and appropriate, especially when staff said this was the person’s preference.

We found some patch medicines were not applied correctly to the skin, which could cause skin irritations, or for the medicine not to be effective. Staff who administered these medicines were not aware they had to rotate where the patch medicines were applied, to reduce risks to people. A rotational patch body map chart was completed, but this did not accurately show the different skin sites used. We told the registered manager and provider about these issues and following our visit, confirmed actions were taken to improve staff practice. Processes to make sure people received their medicines were completed, such as regular audits and we found some of those audits had identified improvements to staff practice. Where people required medicines on an ‘as and when required’ basis, information guided staff to administer these safely.