Knights Court Nursing Home

Knights Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom may also have dementia. There were 57 people living in the home when we visited.

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

There was a welcoming and relaxed atmosphere in the home. We observed positive interactions between people and staff. Staff engaged with people in a meaningful way. People and relatives praised the friendly atmosphere in the home and described staff as caring and respectful.

Our previous inspection found there were deficiencies in relation to falls management in the home. During this inspection, we observed that the service had taken action to address this and made significant improvement.

People told us they felt safe living in the home. People were protected from the risk of avoidable harm. The service had systems and processes in place for safeguarding people and managing incidents and accidents.

Medicines were managed safely.

The home was well maintained, clean and tidy. The service had taken measures to help prevent and control the spread of COVID -19 and other infections. There was a record of essential maintenance carried out.

There were enough staff to assist people. People's needs were assessed regularly to make sure the service was able to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The home had good working relationships with local health and social care agencies to support the needs and well-being of the people who live there.

Our previous inspection found accessing and locating information in people’s care records was sometimes difficult and time-consuming. Since the last inspection, the service reviewed all care records and amended these so that they were comprehensive and user-friendly.

The registered manager had good oversight of the home and an open culture was evident. Staff spoke positively about the registered manager and the support they received. They told us the registered manager was caring and approachable.

Monitoring and auditing systems were in place to check the quality and safety of people's care. These were robust and were consistently carried out. The registered manager sought feedback from people and relatives and made improvements where necessary.

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

Rating at last inspection

The last rating for this service was requires improvement (published 6 September 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that medicines care plans were reviewed to make them person centred. During this inspection we found the provider had acted on this recommendation and made improvements.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Knights Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom may also have dementia. There were 51 people living in the home when we visited.

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

During this inspection, we found improvement was required in relation to some aspects of falls management. The provider had a system to record and respond to accidents and incidents. However, there was not enough information about what steps should be taken to reduce the likelihood of the accident/incident occurring again. There were occasions where service users had repeated falls and we were not assured that the provider consistently sought advice from professionals in order to mitigate the risk of repeated falls. We have found a breach of regulation in relation to this.

Medicines were being managed safely at the home. However, we noted that care plans for medicines were not always person centred. We have made a recommendation in respect of this.

Arrangements were in place to protect people from abuse. Staff had received training on how to safeguard people from abuse and were aware of the procedure to follow if they suspected that people were subject to abuse.

The majority of staff we spoke with told us that they did not think there were sufficient staffing levels. They told us that whilst they were able to safely meet people’s needs, there were occasions where there were not enough staff. We discussed staffing levels with management, and they informed us that there were sufficient numbers of staff and confirmed that they assessed this using their dependency tool. Staff had been carefully recruited and essential pre-employment checks had been carried out.

The home was well maintained, clean and tidy. The service had taken measures to help prevent and control the spread of COVID -19 and other infections. There was a record of essential maintenance carried out. Fire safety arrangements were in place.

People's care plans included details of the support people needed. However, we found accessing and locating information within people’s care records was difficult and time-consuming. Management advised that they were in the process of reviewing these and archiving information so that care plans were user friendly.

Management and senior staff monitored the quality of the services provided via regular checks and audits. The results of the last satisfaction survey indicated that people and their representatives were generally satisfied with the care and services provided.

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

Rating at last inspection

The last rating for this service was good (published 15 August 2018).

Why we inspected

We received concerns in relation to safeguarding people from the risk of abuse and their safety. As a result of this, the Local Authority placed a temporary suspension of new placements whilst the provider made necessary improvements. As a result, we undertook a focused inspection to review the key questions of safe, and well-led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

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 COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Knights Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom may also have dementia. There were 73 people living in the home when we visited.

The home was previously owned by another organisation but was taken over by MMCG (2) Limited. The home was registered with the CQC in July 2017. This inspection on 10 July 2018 was the first inspection for the service under new management.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. On the day of our inspection we observed people were well cared for and appeared relaxed and comfortable in the presence of staff. We observed positive engagement between staff and people. Staff were respectful to people and showed a good understanding of each person’s needs and abilities.

The majority of people we spoke with told us they felt safe in the home and around staff and this was confirmed by relatives we spoke with. There were systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.

Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised. We also looked at how the skin integrity of people was managed at the home and found that appropriate documentation was in place and the home took necessary action involving relevant parties.

Medicines were managed safely and staff were appropriately trained. However, we found that the home needed to improve record keeping in relation to topical creams applied by staff and we made a recommendation in respect of this.

The majority of people and relatives we spoke with told us that they did not think there were sufficient staffing levels. However, the majority of staff we spoke with told us there were sufficient numbers of staff to safely meet people’s individual care needs. We discussed staffing levels with management in detail and they informed us that there were sufficient numbers of staff and confirmed that they assessed this using their dependency tool. They also advised us of the improvements they had made and were in the process of making in relation to staffing.

On the day of our inspection, we found the home was clean. There was an infection control policy and measures were in place for infection prevention and control. However, on the day of the inspection, we observed that two soiled catheter bags had been left in one person’s room. We immediately raised this with a care worker who took appropriate action. We also discussed this incident with the quality and compliance manager who advised that she would carry out an immediate investigation. After the inspection, the manager sent us their investigation report which set out the action the home had taken as well as steps taken to ensure such an incident did not occur again which included further staff training and management checks.

People’s needs were regularly assessed to ensure the home was able to provide treatment and care appropriate to people’s individual needs. Staff received ongoing training and spoke positively about the training they received. Regular planned supervisions and appraisals ensured staff performance was monitored. All staff we spoke with told us they were well supported by management at the home and said that morale in the home was good.

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. The home operated within the principles of the Mental Capacity Act 2005 (MCA).

Where people were unable to leave the home because they would not be safe leaving on their own, the home had made applications for the relevant authorisations called Deprivation of Liberty Safeguards (DoLS).

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes and preferred routines.

There were mixed comments about food provided in the home. The home had a four weekly menu and it included a variety of different types of foods. There were alternatives for people to choose from if they did not want to eat what was on the menu. During the inspection, we observed people having their lunch in the dining area on one unit. We saw that there was a relaxed atmosphere. Where people required support to eat, staff sat next to them in a respectful manner and took time to assist them to eat.

In January 2018 the Food Standards Agency carried out a check of food safety and hygiene and awarded the service three out of five stars, rating the service as “generally satisfactory”. We discussed this with the registered manager who advised that following the inspection the home had taken action to address the issues raised.

Some people in the home had low weight and a low body mass index. We saw there was clear information about how to support these people with their nutritional needs, preferences and clear guidance for staff detailing how to encourage the person to eat.

The home had a varied activities programme which was devised monthly. Activities included reggae music marathon, knitting circle, reminiscing 1940’s and prize bingo. The home arranged a monthly entertainer and celebrated calendar events such as Easter, Christmas, St George’s Day and St Patrick’s Day.

Accidents and incidents were documented and action was taken to prevent future incidences from happening.

Procedures were in place for receiving, handling and responding to comments and complaints. We saw evidence that complaints had been dealt with appropriately in accordance with the policy.

There was a clear management structure in place and staff told us morale within the home was positive and staff worked well with one another. Staff told us management were approachable and there was an open and transparent culture. They said communication in the home was good and they were informed of changes through staff and handover meetings.

Management consistently carried out comprehensive checks and audits to monitor and improve the quality and safety of the home and took appropriate action when areas for improvement were identified.