Thomas Knight Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The provider had not always ensured lessons learned were shared and acted on effectively, and governance arrangements were not always effective. The provider and registered manager had not always ensured there were effective governance in place to ensure safe and effective care at all times. We therefore found the service was therefore in breach of regulation 17 (good governance). The provider was able to demonstrate some recent improvements, for instance beginning analysis of falls, incidents and people’s weights, but this had only happened after prompting by external stakeholders. The provider had yet to demonstrate they could effectively audit and scrutinize their own service to maintain and improve standards. Feedback was mixed about the responsiveness of leadership and the availability of staff. The provider was open to feedback and they shared their policies and staffing arrangements promptly.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders demonstrated a shared understanding of what was important to people and how to go about providing compassionate care. Equality and diversity were respected and supported.

Processes had not always helped ensure there was a shared vision and strategy and that staff in all areas knew how to help achieve this. Governance and oversight processes were not always effectively linked to plans to ensure long term continuous improvement.

There was mixed feedback about how open staff felt they could be with leaders. Some felt they had not always been listened to when they had raised issues or suggestions in the past. Some felt the leadership was extremely responsive. We received similarly mixed feedback from external partners.

The provider made regular visits to the service (at least weekly) and was supported by the previous registered manager (now in an advisory capacity) and the current registered manager. There were regular staff meetings and opportunities to raise matters with leaders. The registered manager had enrolled on a local authority-led leadership course to help maintain and improve their skills.

Not all staff we spoke with felt able to raise concerns or that their suggestions and comments would be effectively acted on. We received similarly mixed feedback from external professionals, although some (and some staff) were extremely positive about the supportive nature of the leadership.

The provider had up to date safeguarding and whistleblowing policies in place. There were a range of means of capturing staff feedback, from staff meetings, informal provider walkarounds and handover meetings between shifts (albeit there were times when some staff did not feel able to speak up).

Some staff told us about how the provider had been flexible when their personal circumstances required it. Others felt less supported and were reluctant to seek support.

Processes were in place to ensure recruitment practices were fair and equitable. There were policies in place to support staff with protected characteristics.

Leaders were responsive to feedback from external partners but has not always recognised opportunities to bring good practice into the home and to effectively scrutinize their own service. Some senior leaders acknowledged there needed to be a more targeted and documented approach to how they audited and analysed aspects of the service. They had worked with external partners to begin this process and were receptive to signposting. Their governance and auditing model at the time of inspection was not working effectively and there was further work to do in this area.

The provider and registered manager had not always ensured there were effective governance in place to ensure safe and effective care at all times. Documented analysis of incidents had only started in the previous month, at the request of other stakeholders, and there was a lack of formal auditing documentation to identify issues and demonstrate improvements. Concerns regarding the environment, staff being bare below elbow, safeguarding responses, and medicines record keeping, could reasonably have been addressed prior to our visit, had there been effective governance processes in place. We therefore found the service was therefore in breach of regulation 17 (good governance). Responsibilities around governance were not always clear. The provider, registered manager, previous registered manager and practice improvement lead shared these responsibilities, but they had not proved effective in the areas we identified.

People’s experience of the provider’s partnership working was limited, as they largely were not party to it. They raised no concerns and benefitted from the provider’s approach, although the provider could do more to engage people and relatives and ensure they played a fuller part in developing the service and its action plan.

Staff worked well with a range of external partners, particularly health colleagues, to ensure people’s immediate needs were met. They knew who to go to for specific help and advice, for example behavioural specialist teams, or external nursing support.

We received mixed feedback from partners. Some were extremely positive about how well the service liaised with them and raised matters proactively although others had a more balanced experience, with time when getting information was not as straightforward.

The provider worked well with known health and social care links, although more could be done to improve and explore community links, and links that would bring new ideas and opportunities for activities into the service.

Staff and leaders had welcomed recent changes put in place to try and improve the service. Where the provider saw a positive news story about dementia care good practice (in this case using robot pets to meet some of the caring, sensory needs people had), they acted on this and tried the practice to good effect.

Evidence of learning and innovation was at times limited and needed more direction. The service had yet to recruit a clinical lead and opportunities for reflecting on and exploring new practices had not always been taken, for instance through champion roles or through reviewing known sources of best practice.