The Knights Care Home

We found the following examples of good practice.

People living at The Knights and staff were tested regularly for COVID-19, in line with government guidance. The service followed guidance for isolation when positive results were confirmed.

The service was clean and maintained. Domestic staff were employed to ensure levels of cleanliness and hygiene remained high. Staff followed written schedules for cleaning each area of the home. Completion of cleaning was monitored by senior staff.

Staff had received training around COVID-19 and how to work safely in a care home environment during the pandemic. We observed staff used personal protective equipment (PPE) appropriately. The service had ample stocks of PPE.

The provider’s infection control policy and procedures helped to ensure the service adopted best practice which followed current guidance. The provider used audits to monitor compliance with their polices.

The service facilitated safe visiting in line with current guidance. The service also supported people to maintain contact with their loved ones via telephone and video calls. This helped to aid people’s emotional and psychological wellbeing.

The Knights provides accommodation for up to 31 people. The home is situated close to the centre of St Annes on Sea. Accommodation within the home is situated on three floors. There is a passenger lift and stair case providing access to the upper floors. The service has two lounges and a dining room situated on the ground floor. A limited number of car parking spaces are available to the front of the building on a private forecourt. At the time of our inspection visit there were 19 people who lived at the home.

People’s experience of using this service and what we found

The manager and staff had a good understanding of supporting people safely during the current pandemic. A relative said, “Absolutely fantastic especially since COVID ‘kicked in’.” All the staff have been so supportive bearing in mind we cannot visit.” Also, a staff member said, “We have had that much infection control guidance and training and covid guidance we are confident in getting it right.” Staff demonstrated a good awareness of protecting people from harm or abuse. They were patient and responded to people’s needs quickly. Staff followed correct procedures to ensure people received their medicines safely as prescribed. Recruitment processes were thorough to ensure suitable staff were employed. Risk assessments were completed and reviewed to promote people's safety. The management team had a good system to ensure sufficient staff would be deployed appropriately to keep people safe.

The management team provided multiple opportunities to assist people, visitors and staff to feed back their experiences of living and working at the home. They had extensive auditing systems to maintain ongoing oversight of the home. Staff said they worked well as a team and people commented the home was well managed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 04 April 2018).

Why we inspected

We wanted to assure ourselves the service remained safe since our last inspection and continued to be led well under the new manager.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Knights Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection carried out on 01 November 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

When we undertook our inspection visit the registered manager had recently left the service. 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 service had appointed a new manager who had submitted an application to be registered with the Care Quality Commission (CQC). This was being dealt with by CQC’s registration team when the inspection visit took place.

People who lived at the home told us they were happy, felt safe and were treated with kindness at all times. Comments received included, “I get on with all the staff they are very caring and show a genuine interest in you.” And, “The staff do a really good job and I feel safe in their care.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at times they needed them.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place to live. We found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place. People who lived at the home told us they were happy with the standard of hygiene in place.

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’s care and support had been planned with them. They told us they had been consulted and listened to about how their care would be delivered.

Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People were supported to have access to healthcare professionals and their healthcare needs had been met. A visiting healthcare professional spoke highly about the care provided by the manager and her staff.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives. They told us staff who supported them treated them with respect and dignity.

The service had information with regards to support from an external advocate should this be required by people they supported.

People who lived at the home told us they enjoyed a variety of activities which were organised for their entertainment.

The service had a complaints procedure which was on display in the hallway for people’s attention. The people we spoke with told us they were happy with the service and had no complaints.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits, resident meetings and satisfaction surveys to seek their views about the service provided.

Further information is in the detailed findings below

At the last inspection on 06 April 2016 we asked the provider to take action to make improvements because we found multiple breaches of legal requirements. This was in relation to safeguarding people from unsafe care, poor management of medicines, abuse and improper treatment, risk assessment to people’s health and safety, person centred care, premises and equipment; infection control; consent and capacity and governance of the home. The provider sent us an action plan saying they would meet the legal requirements by 30 September 2016. During our inspection visit on 01 November 2016 we found these actions had been completed.

The Knights provides accommodation for up to 31 people, who require help with personal care needs. The home is situated close to the centre of St Annes on Sea and is within easy reach of public transport, the beach and local amenities. Accommodation within the home is situated on three floors. There is a passenger lift providing access to the upper floors. Communal areas, such as lounges and a dining room are available. A limited number of car parking spaces are available to the front of the building on a private forecourt, and on road parking is also permitted. At the time of our inspection visit there were 22 people who lived at the home.

There was a registered manager in place. 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 who lived at the home told us staff who supported them were kind, caring, polite and professional in their approach to their work. Comments received included, “You hear some bad things about care homes but this one is very good.” And, “I cannot find fault with anything. The staff do everything I ask.”

Staff knew people they supported and provided a personalised service. The service operated a keyworker system. This is where a member of care staff is allocated to each person and acts as a focal point and will try and ensure the person’s personal requirements are not overlooked. One person who lived at the home said, “Yes I know my keyworker they make sure I am looked after.”

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at the recruitment of two recently appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about the support needs of people in their care.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without being rushed. Comments received included, “The staff are so caring and responsive when I need help.” And, “I think there is enough staff around, I don’t have to wait long if I need them.”

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. No offensive odours were observed by the inspectors. We spoke with six people who lived at the home who all said they were happy with the standard of hygiene at the home. One person said, “My room is lovely and clean. The cleaner does a good job.”

We found equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments received included,”I like my food and get plenty to eat.” And, “You have drinks and snacks all day long.”

People told us they enjoyed the activities organised by the service. These were arranged both individually and in groups.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

We found people had access to healthcare professionals and their healthcare needs were met. People who lived at the home confirmed the service responded promptly if they felt unwell.

We observed staff supporting people with their care during the inspection visit. We saw they were kind, caring, patient and attentive.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.

The service was last inspected 27 September 2013. At that inspection we found the service was meeting the legal requirements in force at the time. We made some recommendations for the provider to consider which included ensuring hand written medicine administration records were double signed to avoid transcription errors. We also recommended the provider to ensure they obtained two references before staff were appointed to work at the home. We checked to see if these recommendations had been taken on board and found the home had followed the recommendations.

The Knights provides accommodation for up to 31 people, who require help with personal care needs. The home is situated close to the centre of St Anne’s on Sea and is within easy reach of public transport, the beach and local amenities. Accommodation within the home is situated on three floors.

There is a passenger lift and stair case providing access to the upper floors. Comfortable communal areas, such as lounges and a dining room are available. A limited number of car parking spaces are available to the front of the building on a private forecourt, but on road parking is also permitted.

The registered manager was present throughout our 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 and associated regulations about how the service is run.

At the time of this inspection there were 18 people who lived at The Knights.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that some staff had received training in safeguarding adults and demonstrated a good understanding about what abuse meant.

We found safeguarding incidents had been recorded. The provider had recorded accidents and incidents and documented the support people were getting after experiencing falls. We found evidence staff had sought advice from health professionals.

We found people’s medication was being managed safely however plans [protocols] for “as and when medication (PRN) were not robust”. Staff had received appropriate medication training.

We found there was a building fire risk assessment on the premises.

People had Personal emergency evacuation plans (PEEPS) which were meant to enable safe evacuation in case of emergency however we found these were not accurately completed and did not give accurate detail on whether people could walk independently, require assistance from staff and where people would be evacuated to.

Staff were suitably recruited and there were enough staff to ensure that people's needs were safely met. There was scope within the staffing levels to keep checks on people's welfare and, when necessary, to provide extra care and support.

We found evidence of staff disciplinary actions being recorded.

The staff showed awareness of Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. However we found the knowledge was not sufficiently turned into action when planning for care and supporting people on a daily basis. Staff were provided with effective support, induction, supervision, appraisal and training.

We found that people’s health care needs were not effectively assessed on admission to the service.

Consent was not always sought from people. The home did not consistently involve people in decisions made around the care they received. Care plans did not evidence people’s involvement. However the home had a key worker policy in place. The service did not regularly seek people’s opinions on the quality of care and service being provided. Evidence on surveys could not be relied on as dates had been altered on surveys before our inspection.

We found evidence of management systems in the home however quality assurance was not effective in order to protect people living at the service from risk. Areas needing improvements were identified by audits however these were not always followed by appropriate action.

People felt they received a good service and spoke highly of their care workers. They told us the staff were kind, caring and respectful. Many people appreciated having their privacy and independence whilst being secure in the knowledge that staff were available when they needed them.

We found the service had effective systems to deal with complaints about care and treatment. However we found people did not feel their suggestions were taken into consideration.

Staff were positive however they reported a negative culture existed among the staff team.

The quality of people's care and the service were continuously monitored to ensure the provider's standards were maintained however management were not prompt in resolving maintenance around the service and audits were not always used to improve the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included; Regulation 9- person centred care, Regulation 11 – Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 (4) (b) (5) Safeguarding service users from abuse and improper treatment, Regulation 15 – Premises and Equipment, Regulation 17-Good governance, You can see what action we have taken at the end of this report.

Comments received included:

'The girls (staff) are marvellous. The young fellows are too. The food is delicious and the surroundings are very comfortable. What more can you ask for?'

One person told us he often stayed at the home for respite care. He commented, 'They (the staff) are very helpful. The 'grub' is always good. They cannot do enough for us. I have no complaints whatsoever. If I wasn't happy with the service I wouldn't keep coming back, would I?'

'This place is perfect. I cannot think of anything I would change.'

"The Knights is the best. It is really very well organised and friendly. I am comfortable here. It is warm and homely."

During our inspection we looked at standards relating to care and welfare and how the quality of service was assessed and monitored. We also checked the management of medications, meal provision and how staff were recruited and supported. We did not identify any concerns in any of the outcome areas we assessed.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "You can't beat this place.' And, 'I can't think of anything that isn't right'.

We spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and dignity.