Background to this inspection
Updated
16 December 2020
The inspection
This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12, (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on a specific concern we had about risks relating to people choking.
Inspection team
The inspection was carried out by one inspector.
Service and service type
Knoll House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Notice of inspection
We gave 24 hours’ notice of the inspection to ensure we could manage the risks related to COVID-19.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We reviewed four people’s care records. We also reviewed records relating to the management of the service such as meeting minutes, training records and audits. We carried out a short visit to the service to complete observations. We spoke with the registered manager.
After the inspection
We spoke with three staff via video calls. We requested feedback from one health professional.
Updated
16 December 2020
About the service
Knoll House is a detached bungalow situated in the extensive grounds of Somerset Court which
is owned by the provider. The home accommodates seven people who have autism and complex support needs. At the time of the inspection seven people were living at the home.
The service had not originally been developed and designed in line with the Registering the Right Support guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Knoll House. The registered manager had personalised the service to reflect the Registering the Right Support Guidance.
People’s experience of using this service and what we found
Risks relating to people choking were not being safely managed. People had guidelines in place detailing how staff should support them, however these were not always followed, which put people at risk.
The governance systems in place had not identified shortfalls in the management of risks.
Medicines were managed safely. People were protected from potential abuse. Staff felt confident to raise concerns and were aware of external agencies they could contact.
There were enough staff available to meet people’s needs. Staff were recruited safely.
People’s relatives and staff commented positively about the management of the home. People were involved in the running of their home. Staff told us there was good moral and a positive team culture.
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 January 2020).
Why we inspected
The inspection was prompted in part due to concerns received about a choking incident. A decision was made for us to inspect and examine those risks.
The information CQC received about the incident investigation indicated concerns about the management of choking. This inspection examined those risks along with infection control and the management of health-related risks.
We inspected and found there was a concern with risks relating to choking so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. Please see the safe and well led sections of this full report.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
During the inspection the registered manager and provider submitted an action plan to describe the action they had taken to mitigate the risks we identified.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Knoll House on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment and governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.