Brendoncare Knightwood

Brendoncare Knightwood is a residential care home registered to provide care and support to up to 20 people. The service provides care for older people. At the time of our inspection there were 20 people receiving care and support at the home.

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

People told us they were safe living at Brendoncare Knightwood. Staff supported people to live independent lives. People had risk assessments in place for their care and support needs and staff knew them well. Environmental safety checks were in place and the provider was in the process of ensuring clarity with transfer to an electronic monitoring system.

There were enough staff on duty. There was a recruitment process in place. However, this was not always followed, we have made a recommendation to the provider about recruitment. Staff had the necessary skills to carry out their role effectively and regular training and updates kept their skills refreshed. Staff knew how to recognise the signs of abuse and who to report to, they told us they were confident the manager would take them seriously and follow them up.

Infection control procedures were robust, the home was clean, tidy and hygiene practices were good. Staff had received training in infection, prevention and control. Medicines were managed safely. The environment was designed so people could move around independently and safely. Staff told us they received enough training to do their job, the manager had plans to introduce workshops and refreshers which was welcomed by staff.

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. People living at Brendoncare Knightwood were able to give their consent and had the capacity to make decisions. The manager was clear in their responsibilities of how to support people when there was a concern regarding capacity.

People told us staff were kind and caring. Staff spoke affectionately about people. Dignity and respect was obvious within observations and conversations between people and staff. People’s needs regarding eating and drinking were assessed. We received overwhelmingly positive reviews about the food at Brendoncare Knightwood. People had access to healthcare as needed and referrals were made in a timely manner.

People had personalised care plans in place, they were reviewed regularly, promoting independence for people. Staff told us this was important to focus on the abilities of people. People were given the opportunity to discuss their end of life needs and wishes. The team at Brendoncare Knightwood had received praise on their end of life care for people.

People knew how to make a complaint, records showed concerns and complaints had been dealt with satisfactorily. There was a complaints policy in place, and it was being updated to reflect changes within the organisation. People’s communication needs were recorded.

Brendoncare Knightwood was well led, we received positive feedback about the management of the home. Quality assurances systems operated effectively and enabled the home to drive continual improvement. The manager was supported by staff who understood their roles and responsibilities. The manager understood legal requirements to notify CQC of certain events which took place in the home. Relationships with external health and social care professionals were maintained and working well.

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 9 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The service is now known as ‘The Court’ and so this will be the term used throughout this report.

The inspection took place on 7 August 2017 and was unannounced. A further announced visit took place on 11 August 2017 to complete the inspection.

We last visited in February 2016. We said at that time the service required improvements. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not always sufficient staff on duty at the weekends or during the night to meet people's needs in a timely way. Staff were unable to demonstrate they were applying prescribed topical creams as directed which put people at a risk of being

uncomfortable or of their health deteriorating and people were not provided with activities which reflected their personal preferences and interests. The provider sent in an action plan following this inspection to describe how they were going to improve. At this inspection we found the required improvements had been made and we rated the service as Good.

There was a registered manager in post. 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 registered manager had helped to add stability and consistency to the service and led by example by being approachable and by listening and acting on people’s views.

At this inspection we found the service was supporting people safely, effectively and in a caring manner. Staff were kind and caring. Staff respected people's preferred routines and activities provided were geared towards people's needs and interests.

People were protected from abuse and avoidable harm. Risk to people's health and welfare were managed appropriately. Environmental risks were regularly considered and managed well.

There were generally sufficient numbers of suitably trained and safely recruited staff to meet peoples' needs. Staff received appropriate training and support.

The service worked well with health care professionals and followed their guidance when they needed support with people's health care needs.

People liked the food and were supported to have a diet which suited their needs and preferences. Staff ensured they sought consent before supporting people with their care and adhered to the Mental Capacity Act 2005.

People were given information about what the service could offer and staff were able to provide appropriate support because people's needs were clearly assessed and updated when a change had taken place. Care records contained a lot of information about what was important to people and their wishes and preferences. Staff knew what people’s preferences were which helped to ensure the care provided was personalised to suit them.

People were encouraged to provide feedback about the quality of the service and complaints were responded to quickly. Robust quality assurance processes helped to ensure the service maintained good standards which met people's needs and expectations.

During December 2015 the service changed its purpose and name and became a care home without nursing. It is now called Dame Sheila Court. As the registered name of the location remains Brendoncare Knightwood this is what the service will be called throughout this report. The registered provider is applying to alter the regulated activities Brendoncare Knightwood provides to reflect the change of use.

Although staff have training in caring for people living with dementia Brendoncare Knightwood does not provide secure accommodation within the unit , so may not be appropriate for people with a cognitive impairment who feel compelled to walk about. Everyone living or staying at Brendoncare Knightwood had capacity to consent to their care and support and staff ensured they consulted them during the planning of their care.

At the time of our visit seven people were living at Brendoncare Knightwood, some of whom were receiving respite care.

The inspection took place on 10 February 2016. It was unannounced and carried out by one inspector. A further visit by one inspector was carried out on 16 February 2016 to complete the inspection.

At our last inspection in September 2014 we found the service had met all standards of care and quality we assessed, although the service was being used for a different purpose at this time.

There had been no registered manager in post since April 2015, although the service had been continuously managed. 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.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not always sufficient staff on duty at the weekends or during the night to meet people's needs in a timely way. Staff were unable to demonstrate they were applying prescribed topical creams as directed which put people at a risk of being uncomfortable or of their health deteriorating and people were not provided with activities which reflected their personal preferences and interests. You can see what action we told the provider to take at the back of the full version of this report.

People were broadly satisfied with the care and support provided, describing the service as comfortable and saying the staff were mostly good. People also told us however at times they could be better informed about aspects of the service.

There were a number of other improvements needed before the service could consistently meet its stated aims and objectives of providing care and support where people were put "at the heart of everything we do" This included ensuring safeguarding processes were always followed in a timely way by reporting any allegations to Hampshire County Council and CQC.

Staff had access to a wide range of training to help them to work effectively and staff recruitment processes were thorough which helped to ensure only suitable staff were employed. There were clear policies and procedures in place which staff followed to help to ensure medicines were managed safely. People's nutritional needs were known and respected and people told us the choice and the quality of the food was very good.

The service worked well and cooperated with health care professionals to ensure any health needs were addressed promptly.

The environment was clean and well maintained and there were good quality monitoring systems in place, although some shortfalls which had been identified through these quality monitoring processes had yet to be addressed.

On this occasion we found there were arrangements in place that ensured staffing levels were sufficient to meet people's needs.

At the time of our inspection there were nineteen people accommodated at the service, sixteen were in receipt of intermediate care and three were receiving a respite service. We spoke with twelve people of the nineteen people in order to hear what they had to say about the deployment of staff at the service.

We also spoke with a six staff including the senior nurse manager and three visitors to obtain their opinions about the staffing of the service.

During our inspection we spent 45 minutes in the service's dining room and observed the routine during the lunch meal.

We also looked at records and documents concerned with the deployment of staff such as training records, rotas and data about the dependency levels of people who used the service.

The evidence we gathered against the outcome we inspected helped us answer our key question.

Is the service safe?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The service is safe because there are enough qualified, skilled and experienced staff available to meet people's needs.

The service had suitable arrangements for monitoring the quality of care so that people were protected against the risks of inappropriate or unsafe care and treatment. We observed that the nature of the unit presented staff with a number of challenges in relation to ensuring effective transfer of care processes from the acute hospitals and this had an impact on the continuity of care for some people using the service. We found the provider had not taken appropriate steps to ensure that there were a sufficient number of suitably qualified and experienced staff available to meet people's needs at all times and improvements are needed.

We spoke with five staff, including nurses, carers, a rehabilitation assistant and a volunteer. Three staff told us the strength of the service was the good team work. One member of staff said they enjoyed "providing holistic care for people".

All five people told us they liked it at Brendoncare Knightwood. People said 'It's really nice here', "It's marvellous', and 'The staff are good'.

Individual needs of people were assessed and were continually reviewed, and care plans updated. People experienced care, treatment and support that met their needs and protected their rights.

We looked at safeguarding arrangements for staff training, talked to staff and people who used the service, and reviewed care plans. We found that people were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff rotas, staff training records, observation of staff supporting people and discussion with people demonstrated that there were enough qualified, skilled and experienced staff to meet people's needs.

The provider had in place effective systems to assess and monitor the quality of service, which sought people's views, and learnt from investigations into incidents.