Knighton Manor Limited

Knighton Manor Limited provides residential care for 21 people with a learning disability and/or mental health disorder and a range of complex needs, which included physical disabilities and behaviour that challenges.

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

Knighton Manor Limited does not conform to Building the Right Support and Registering the Right Support guidance. The service accommodates up to 21 people in one adapted building. At the time of our inspection 15 people were in residence.

At the last inspection on 23 and 24 February 2017 we identified that Knighton Manor Limited did not have a registered manager in post. This was a breach of their condition of registration and a requirement notice was issued. A registered manager is now in post.

Knighton Manor Limited had 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.

People’s safety was promoted by observant staff that were present in communal areas which enabled them to provide assistance and support when needed. There was a pro-active approach to promoting people’s safety and independence which was reflected in people’s risk assessments and care plans. People were supported by staff that had been recruited and had checks undertaken to ensure they were suitable for their role. People’s medicine was managed safely and people received their medicine on time.

People’s needs were assessed to ensure the service and staff could meet their needs before they moved to Knighton Manor Limited. People’s needs were met by staff that had the skills and training to provide good quality care. People’s health care needs were monitored, which included their dietary needs and people were supported to access health care services within the community. People were supported to have maximum choice and control of their lives and staff support them in the least restrict way possible; the policies and systems in the service supported this practice.

People were supported by staff that were attentive towards their needs. Staff provided the care and support people required and recognised the importance of promoting people’s independence. Family members were encouraged to visit their relatives and staff supported people to visit their relatives. The registered manager and staff had received thank you cards and letters from people’s relatives about the support and care provided.

People’s views about their care and support were sought and used to develop care plans. A range of documents, including minutes of meetings, fire evacuation plans and the complaints procedure had been produced in easy read, using large prints supported by symbols to assist people in understanding the information. Additional documents detailing people’s care, which included health action plans, was also produced in a way to promote people’s understanding.

The management team, which included the registered manager and two deputy managers, provided staff with support and guidance they needed. Systems were in place to monitor the quality of the care being provided, which included seeking the views of those using the service and their family members. A range of audits were undertaken to evidence the quality of the care and the accuracy of records used to record people’s care and support. There was an open and transparent approach to the management of the service, which included regular team meetings where information was shared and ideas for improvement sought and discussed.

The previous comprehensive inspection, which commenced on the 24 February 2015 found the service to be compliant with the regulations.

Care Home

The inspection of the service took place on the 23 and 24 February 2017 and was unannounced. Knighton Manor Limited provides residential care for 21 people with a learning disability and/or mental health disorder and a range of complex needs, which included physical disabilities and behaviour that challenges. At the time of our inspection there were 19 people in residence. The service provides accommodation over two floors, with access to the first floor being via a passenger lift and stairwells.

A registered manager was not in post. The manager facilitated 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 manager informed us they would submit an application to CQC to register as the manager.

We found there to be an open and collaborative approach between those using the service and staff. People’s safety and well-being was promoted through the pro-active management of risk. This was achieved through the sharing of information and agreed strategies for promoting people’s choices and in their day to day lives. Information was provided in a format which enabled people to understand the contents of information. There was a proactive approach in providing people using the service with the knowledge and information as to how they could report concerns about safety and well-being. This included policies and procedures which promoted safety.

People’s medicine was managed safely and managed by staff who had received training. Audits were undertaken on a range of topics, which included medicines and maintenance of the environment to ensure people’s safety was promoted and maintained.

We found people’s safety, welfare and needs were met as there were sufficient staff employed, who had the relevant experience and training and were enthusiastic in providing a high level of care and support to people. Staff were regularly supervised and had their competence to perform aspects of their role assessed. Communication between the management team and staff was open and enabled the proactive sharing of information which had a positive impact on people’s lives.

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 contributed to the development of meal choices with staff support. People’s needs with regards to their diet were respected and supported, which included dietary requirements to support individual health needs. People were supported, where necessary, in the promotion of their health and welfare by attending routine and specialist appointments with health care professionals.

The manager and staff were committed to meeting the needs of people by encouraging people to share their views and opinions. People’s care plans however did not reflect people’s goals and aspirations, and the role of staff in providing the necessary support for these to be achieved. People took part in a range of activities within the service and within the wider community, which included visiting family and friends.

The registered person to ensure themselves of the quality of the service provided people using the service and their representatives with opportunities to comment on and influence the service being provided. People spoke positively and recorded their views about the staff and the staff’s commitment to providing good quality care. The management team responded openly and positively where shortfalls were identified and worked collectively to bring about improvement.

We found a breach of Regulation 5 of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

Supported Living

The inspection of the service took place on 27 February, 1 and 2 March 2017 and was announced. This meant the provider knew we would be carrying out an inspection. Knighton Manor Limited provides support to 20 people with a learning disability / and or mental health needs, and a range of complex needs, which included physical disabilities and behaviour that challenges. People resided within individual properties or within a complex of apartments, referred to as ‘supported living’.

A registered manager was not in post. The manager facilitated 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.

People’s views and experiences about the quality of the service being provided were mixed. Representatives of young people, who had transferred to the services of Knighton Manor Limited from the parental home or residential college; and who required significant care and support, raised concerns about the quality of care and the safety of their relatives. They told us they had been provided with very limited written documentation about the services to be provided by Knighton Manor Limited. They informed us that a majority of information had been provided verbally. We found the lack of written documentation and formalised communication systems and opportunities for structured reviews of people’s packages of care had contributed to people’s representatives concerns. This had resulted in them having a lack of confidence in the provider and manager to deliver good quality care reflective of their expectations. Improvements to people’s safety and quality of care and support provided had been noted by people’s representatives in recent weeks and they told us they were cautiously optimistic that continued improvements would be made.

People, who had been receiving support through adult services for some time and had transferred to the services of Knighton Manor Limited, moving into the supported living complex from the family home or a residential care home had in many instances had staff transfer with them. This had meant they continued to be supported by staff who knew them and who they were familiar with. People’s records showed people were receiving the support they needed in safe way and by staff who had the appropriate skills and knowledge.

People’s records and care plans did not clearly identify the services being commissioned and the hours allocated to ensure people’s needs were met. This meant it was not apparent as to what support and care was being provided at any specified time, which meant people and their representatives were unsure as to the support being provided. The provider informed us upon people commencing with the service; commissioners in some instances had reviewed people’s packages of care, which had resulted in the commissioned packages of care being reduced.

Staff we spoke with were knowledgeable about the people they supported and had a clear understanding as to their role in supporting people to maintain and increase their independence. Staff told us they had undertaken a range of training which provided them with guidance as to how to meet people’s needs. Staff told us people’s care plans were regularly reviewed and updated with information provided by the person themselves and through their own observations, to ensure people’s needs were reflected.

Systems to enable the registered person to ensure themselves of the quality of the service being provided to people using the service and their representatives were not robust. We were saw a small number of questionnaires seeking people’s views had been completed and returned. The provider and manager were aware improvements needed to be made through the provision of information and improved communication. The manager was working to the action plan put into place by commissioners to bring about improvements.

We found a breach of Regulation 5 of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection focused on two different service types which operate from the same premises. The first being a residential care home and the second being a service offering support to people living in their own homes. This inspection report has been written for both service types under the separate headings of care home and supported living.

Care Home

The inspection of the residential home took place on the 24 and 25 February 2015 and was unannounced.

Knighton Manor Limited provides residential care for 21 people with a learning disability and/or mental health disorder. At the time of our inspection there were 17 people in residence. The service provides accommodation over two floors, with access to the first floor being via a passenger lift and stairwells.

A registered manager was in post, however they were not at work on the day of the inspection. The assistant manager facilitated 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.

Staff were confident that if they had any concerns about people’s safety, health or welfare then they would know what action to take, which would include reporting their concerns to the provider, management team or to relevant external agencies.

Staff had received training which reflected the needs of people who used the service which enabled them to provide care in a safe manner. This included supporting people when their behaviour became challenging, meeting their individual needs and through the appropriate use of equipment and techniques to move people safely. We found people received their medication in a timely and safe manner by staff who had been trained in the administration of medication.

We saw people accessing a range of community activities independently or with the support of staff. People’s needs had been risk assessed to promote their safety and independence and we saw there were sufficient staff to support people in going out and those who remained at the service.

Our discussions with staff told us that they received on going support and development through supervision, appraisal and the accessing of training. The training staff accessed reflected the needs of people who used the service which meant people received effective care and support. Records confirmed staff had received training in a wide range of topics.

People were protected under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLs) we found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions. Staff we spoke with told us about their role in supporting people to maintain control and make decisions which affected their day to day lives.

People at risk of poor nutrition had assessments and plans of care in place for the promotion of their health. Meetings involving people who use the service were held to enable them to comment on meals provided and to influence the menu.

People’s health and welfare was promoted and they were referred to relevant health care professionals in a timely manner to meet their health needs. Information gathered from a health care professional and our observations showed there to be a positive working relationship between professionals and the service, which impacted on the quality of care people received.

People were comfortable and relaxed in the company of staff. People were able to access community facilities independently or with support from staff. We observed people being encouraged to make decisions about their day and records showed people’s comments and views were documented in daily records and within the minutes of meetings.

People were supported by staff who were responsive to their needs and requests for support. Staff were able to respond to people’s requests to go out into the community, which included shopping and attending health care appointments.

People we spoke with were confident that any concerns they had would be responded to appropriately. Records showed that the service within the last twelve months, had received one complaint from a person who used the service. This had been documented and included the outcome and response to the complainant.

There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment which was well maintained and safe. Audits and checks were effectively used to ensure people’s safety and demonstrate that their needs were being met.

People using the service and staff had the opportunity to influence the service by attending meetings and sharing their views. The provider sought the views of people who used the service and their relatives through the distribution of surveys, which were collated and used to develop the service.

Supported Living

The inspection of the supported living service took place on the 2 March 2015 and was announced. This meant the provider knew we would be carrying out an inspection.

The provider was given 5 days’ notice to enable them to advise people who use the service.

Knighton Manor Limited provides support to 8 people who resided within 5 individual properties referred to as ‘supported living’.

A registered manager was in post, however they were not at work on the day of the inspection. The assistant manager and a team leader facilitated 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.

Staff had received training which reflected the needs of people who used the service which enabled them to provide care in a safe manner. This included supporting people when their behaviour became challenging, meeting their individual needs and through the appropriate use of equipment and techniques to move people safely. We found people received their medication in a timely and safe manner by staff who had been trained in the administration of medication.

Staff told us that they received on-going support and development through supervision, appraisal and the accessing of training. The training staff accessed reflected the needs of people who used the service which meant people received effective care and support. Records confirmed staff had received training in a wide range of topics.

People were supported by staff who were responsive to their needs and requests for support. People’s packages of care detailed the number of staff required and hours provided to each person, which had been identified through the assessment process. People’s plans of care were tailored to meet their individual needs and reflected their personal support and access to community resources.

A person we spoke with was knowledgeable about who they would report concerns to and in what circumstances. They were aware of contact numbers for the provider and external agencies.

People using the service and their relatives were encouraged to share their views about the service and were involved in the reviewing and development of plans of care. The provider sought the views of people who used the service and their relatives through the distribution of surveys, which were collated and used to develop the service.

All the people we spoke with were generally satisfied with the service they received. They told us care workers treated them with respect and involved them in decisions about their care. During our inspection, we saw the registered manager and care workers talking to visitors about the care the person using the service was receiving. The visitors told us the person was much happier since they had been using the service.

We saw that people were involved in menu planning and had a choice of meals. People's cultural and dietary needs and preferences were met. Care workers knew who needed support to eat and drink and they provided this support one-to-one.

The registered manager was introducing new systems to assess and monitor the quality of the service. She was able to identify where improvements were needed and what improvements had already been made as a result of assessment and monitoring. We saw that people using the service met regularly and their views about the service were taken into account. Those acting on behalf of people using the service were also asked to attend meetings so they could contribute to decisions about the service.

When we asked people about activities at the service, both said they enjoyed what was offered. One said, 'I really really enjoyed making this," (the item made at the afternoon activity). "I feel proud.' They also commented that they were enjoying doing activities with other people. Because activities were being planned, they were being done in small groups instead of just with individuals. The other person told us they liked going out. They said they had enough opportunities to go out with support from care workers.

Both people we spoke with said care workers supported them to take medication. Both said they knew what medication they took and what it was for.

The people we spoke with knew which care workers were working at the time of our visit. They also knew who was due to work later that day. This showed the provider gave people using the service information about the people employed to support them. They told us there had not been many changes in staffing. They said they thought there were enough staff to meet their needs.

The people we spoke with both said they attended residents' meetings. These meetings were arranged so that people using the service could give their views about how the service is run. One person commented, "I voiced my opinions across." Both people we spoke with thought their views had been taken into account and that managers had made changes as a result of their comments. One of the people we spoke with had completed a satisfaction survey. She said she knew what had been done as a result of the survey.

The people we spoke with were generally satisfied with the care they received. One person told us, 'I love it here. I like the daytime activities I do here.' The people we spoke with told us they knew what information was in their plans of care. We looked at one person's plan of care with them. They showed us that they had agreed to receive care in the way stated in written plans. We found that the quality of people's care records was variable. Some plans of care had important information missing. One person told us, 'It's just with me having that difficult need; they really can't meet my needs here.' People thought that staff were qualified and able to provide care to an appropriate standard. One person told us 'They're very kind and helpful. They know what I like to do.'

The people we spoke with said they felt safe using the service. One person said, 'I feel nice and safe here.' They told us they were confident they could report concerns and that managers would take appropriate action.

The people we spoke with told us they knew what medication they took. They could explain to us why they were taking the medication. We saw that there needed to be improvements in the administration and recording of medication.

We asked two people using the service how the provider took their views into account. One person told us that staff sometimes asked them for their views, but they had never formally been asked, for example to complete a survey. The other person showed us a survey they had been given to complete. They told us they thought any of the management team would listen to their views. Neither person had been asked to attend the regular meetings for people using the service. Both said they would like to contribute. This showed that people were confident they could give their views, but the provider had not taken steps to tell them how their views would be used to improve the service, or to ensure that people who could not easily attend meetings could make a contribution.

We observed two members of staff administering medication to people using the service. We saw that one tablet being administered was physically handled by one member of staff. We observed that one member of staff prepared individuals medicines into a plastic pot and then a second member of staff went into the dining room and gave the person using the service their medicines. The medication administration record was then signed by the first member of staff, although they had not actually witnessed the medicine being taken by this person.

The Royal Pharmaceutical Society guidelines for the handling of medicines in social care states that, 'it is important not to physically handle medicines during administration.' They also state that 'there is a potential for error when medicines are prepared and given to another member of staff to take to the person in another part of the care home. The person who prepares the medicine and signs the record should also witness the person taking it.'

We observed positive interaction between staff and people using the service. Staff were approachable and friendly and we saw one person using the service making choices around the food that was being prepared for them. This person told us, 'I love it here, I can do what I want and I go out a lot. I am applying for jobs and the staff are helping me.'