• Care Home
  • Care home

Knellwood

Overall: Good read more about inspection ratings

83 Canterbury Road, Farnborough, Hampshire, GU14 6QN (01252) 542169

Provided and run by:
Farnborough (War Memorial) Housing Society Limited

All Inspections

17 May 2018

During a routine inspection

This inspection took place on 17 and 18 May 2018 and was unannounced. During our previous inspection on 8 July 2017, we found a continuing breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although the service had made some improvements to the provision of appropriate training for staff, further improvements were needed in order for the service to fully meet the requirements of this regulation.

During this inspection, we checked whether the provider had maintained the improvements they had made. We found the provider had made and sustained the required improvements and there was no longer a breach of Regulations.

Knellwood is a care home for up to 52 people who require nursing and personal care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 48 people living at the home.

The service had a registered manager. 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 was not available for us to speak with on the day of inspection.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally. The provider was in the process of trialling the deployment of extra staff at busy times to see if that further improved the quality of care.

The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting. Risks to people were assessed and action was taken to minimise any avoidable harm to people.

There were systems and processes in place to ensure medicines were managed safely in accordance with current guidance and regulations. Staff were sufficiently trained and regularly assessed for their competency of administering medication.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally where this was required. The management team analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet individual's’ needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

The management team and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The management team had created an inclusive and open culture at the home. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them.

People's’ independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.

Practical arrangements including staff rotas were organised so that staff had time to listen to people, build relationships and trust, answer their questions, provide information, and involve people in decisions.

The service was responsive and involved people in developing their support plans where possible which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The service was well managed and well-led by the management team who provided clear and direct leadership, which inspired staff to provide good quality care. The safety and quality of the support people received was effectively monitored and any identified shortfalls were acted upon to drive continuous improvement of the service.

8 July 2017

During an inspection looking at part of the service

We undertook an unannounced comprehensive inspection at Knellwood on 06 and 07 December 2016 where a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found. Not all staff had received training or training updates in line with nationally recognised standards. There were gaps in staff training records for first aid, infection control, equality and diversity, The Mental Capacity Act (2005), moving and handling, safeguarding and control of substances hazardous to health (COSHH).

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. The provider wrote to us on 23 May 2017 to inform us they had completed all the improvements listed on their action plan.

We carried out a focused inspection on the 08 July 2017 to check whether that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Knellwood’ on our website at www.cqc.org.uk.'

Knellwood is a care home with nursing providing a service for up to 52 older people, some of whom may be living with dementia. There were 44 people living at the service when we carried out the inspection.

The service had a registered manager. 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 our focused inspection on 8 July, we found that some staff still had not received all the training required by legislation and recommended as best practice by the Department of Health and Skills for Care (SfC), for staff working care homes with nursing. Some staff had not received training in first aid, infection control and equality and diversity. Other staff required training updates in first aid to help ensure their skills and knowledge were current. This meant that people were potentially put at risk as staff had not received suitable training to deliver basic life support in an emergency situation or work effectively to reduce the risk of spreading infections.

The provider had made improvements to ensure that the content of their mandatory training for staff was in line with legalisation and best practice. The provider was due to introduce a new reoccurring programme of refresher training which would give staff access to regular training updates for subjects covered in their training induction. The course had yet to be implemented and therefore we could not comment on its effectiveness during this inspection, but we will look at this during our next comprehensive inspection.

Staff had received improved access to training in, safeguarding, The Mental Capacity Act 2005, food hygiene, moving and handling and control of substances hazardous to health.

Training was classroom based and the registered manger believed in the benefits of providing real life experiences during training to promote empathic care in staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

6 December 2016

During a routine inspection

This inspection took place on 6 and 7 December 2016 and was unannounced. We last inspected the service in June 2015. At that inspection we found the service was in breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, they had failed to complete all the required recruitment checks for new staff. At this inspection we found the provider had taken appropriate action and was no longer in breach of the regulation. New recruitment procedures had been implemented and recruitment checks were being made to ensure staff were suitable to work with people living at the service.

Knellwood is a care home with nursing providing a service for up to 52 older people, some of whom may be living with dementia. At the time of our inspection there were 49 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the 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. The registered manager was present and assisted us during this inspection.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk.

People were protected from environmental risks to their safety. Premises risk assessments and health and safety audits were carried out regularly and any issues identified were dealt with quickly. Furniture and fixtures were of good quality and well maintained.

People received care and support from staff who knew them well. They received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans were reviewed monthly or as changes occurred.

People received effective health care and support. They saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure those rights were promoted.

Meals were nutritious and varied. People told us they enjoyed the meals at the service and confirmed they were given choices.

People were treated with care and kindness. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity and always asked their consent before providing care.

People were aware of how to make a complaint and told us they would speak to the registered manager or one of the staff. They told us they could approach management and staff with any concerns and felt they would listen and take action. People benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work.

People living at the service felt there was a good atmosphere and thought they were provided with a comfortable and homely environment to live in. People living at the service, relatives, staff and health professionals felt the service was well-managed. Staff told us the management were open with them and communicated what was happening at the service and with the people living there.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff had not always received appropriate training and training updates that were necessary to enable them to carry out the duties they were employed to perform. You can see what action we told the provider to take at the back of the full version of this report..

9 and 10 June 2015

During an inspection looking at part of the service

The inspection took place on 9 and 10 June 2015 and was unannounced. Knellwood provides residential and nursing care for up to 52 older people, including people living with dementia, and those requiring respite support. At the time of our inspection 49 people were living in the home.

The home consisted of three wings. Two wings had three floors, and the main part of the building had two floors. Lifts and stairs provided access to all floors. People had unrestricted access around the home. The reception area was manned by a receptionist, and included the nurses station.

The home had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on 9 November 2013 we asked the provider to take action to make improvements to ensure people’s records were accurate and up to date, and that people were treated respectfully. At this inspection we found these improvements had been made.

People were at risk of potential harm, because the provider’s recruitment policy had not been followed. Some checks, such as identity, criminal records checks and registration with professional bodies, had been completed satisfactorily. However, the provider had not ensured that gaps in applicants’ employment history had always been identified or investigated, or explanations recorded. Evidence of suitable conduct in previous relevant employment positions had not always been requested. There was a risk that staff employed may not be of suitable character to safely support people.

Staff understood and supported people to make decisions about their health and wellbeing. They understood the process of mental capacity assessment and best interest decision-making if they were concerned that the person lacked capacity to make specific decisions. However, records did not reflect others that had the legal power to make decisions on people's behalf. We have made a recommendation that the provider refers to the principles of the Mental Capacity Act 2005 Code of Practice for guidance in relation to this matter.

Where people’s liberty was judged to be restricted, the registered manager had followed the requirements of the Deprivation of Liberty Safeguards to lawfully detain people for their own protection.

People were protected from the risk of abuse. Staff understood and followed guidance to recognise and address safeguarding concerns. Risks that may affect people’s or others’ safety had been identified, and actions ensured potential hazards were managed to reduce the risk of harm.

People received their prescribed medicines safely. Medicines were stored and administered safely. Medicine administration records were complete, and checks ensured that any errors or gaps were identified and addressed promptly.

There were sufficient staff available to meet people’s identified needs. The registered manager reviewed people’s needs, and responded to staff comments, to ensure staffing levels were adjusted in accordance with people’s changing needs.

People were supported by staff with the appropriate skills and training to meet their needs. Managers reviewed staff understanding of training topics through assessment, discussion and quizzes to ensure training was effective. They reviewed staff performance through an appraisal system.

Staff ensured people received appropriate dietary support. People identified at risk of malnutrition or dehydration were monitored to ensure they maintained a sufficient dietary and fluid intake. Staff liaised effectively with health professionals and community support agencies to promote people’s health and wellbeing in the home, on discharge from hospital, and when returning to their own home from respite care.

We found that people’s views were mostly respected during our inspection. Staff listened to people’s comments, and acted on their requests. Information shared prior to admission was documented to record people’s wishes and preferences, and reviewed with them or those they chose to represent them.

Staff acted in a caring manner towards people. They greeted people cheerfully, and reassured people if they were anxious. They promoted people’s dignity and independence, and respected their privacy. A range of activities and events in the home and local community ensured people had the opportunity to engage in social activities as they wished.

People’s needs were understood and met. Records ensured staff were informed of changes to people’s care and support needs. Risks had been identified and appropriate actions taken to promote people’s health and wellbeing. Although people’s needs and wishes had been assessed with them prior to their admission to the home, people did not always feel involved in reviews of their care needs.

People and those important to them had the opportunity to discuss concerns with staff or management. The formal complaints procedure was displayed to ensure people were informed of the process. People and their relatives told us any issues were usually resolved promptly.

People, relatives and staff felt the home was well-led, and lived up to the provider’s values. The registered manager was respected and appreciated. They did not always have sufficient time to drive all improvement tasks identified in a timely manner, as the role of deputy manager had not been filled at the time of our inspection. The registered manager had therefore prioritised actions that impacted on people’s care needs.

The registered manager, Bursar, and provider’s board of trustees completed audits to ensure people experienced quality care. They were supported by the community specialist nurse through monthly monitoring of indicators of care quality factors, such as the number of falls, infections or pressure ulcers people experienced. Any areas of improvement were identified and addressed through planned actions.

Records were securely stored. Staff access to electronic records was controlled according to role and responsibility. Only those authorised to do so could access confidential records.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

9 November 2013

During a routine inspection

People told us they thought their care was good and met their needs. One person told us 'I am grateful to be here and the staff helpful, we have a great laugh'. Another person said 'the staff seem to know how I am and I know they tell the nurse straight away if I am not feeling too good'. We spoke with two relatives who said they were very happy with the care provided at the home. They told us the staff were welcoming and their relative was happy.

During our visit we reviewed care plans and associated records. All of the care plans contained up to date information about the care and support people required. However some of the information was unclear. For example when a person was considered at risk of pressure ulcer development a standard assessment form was used but this information this did not always transfer to a care plan. This may have meant staff did not receive clear information about the care and support they should provide.

The provider kept a record of accidents to people but did not monitor these for trends in terms of location or time of day. For example, falls to people were a common accident to affect people. From the information recorded it would have been possible to monitor these for frequency and severity in terms of time of day and location. This meant it was not possible to identify risks to of falls occurring at key periods and therefore to implement risk reduction programmes.

29 January 2013

During a routine inspection

As part of our inspection we spoke with two people who used the service and a relative of a person who used the service. All three people told us they were very pleased with the home and they felt the staff were nice and caring. We also spoke with five staff members who told us they felt supported by the management and were aware of the service's safeguarding and whistleblowing procedures.

We found that people's views and their preferences had been sought by the staff on a daily basis and had been recorded within their care plans. We found that detailed risk assessments had been completed for each person and these had been regularly reviewed and updated.

The safeguarding policy was up to date and staff had been trained in safeguarding procedures.

The service's medicines policy was being followed and medicines records had been accurate.

The service had been following their recruitment policy and all required documentation had been obtained from people prior to their employment.

The service had procedures in place to obtain feedback from people who used the home, their relatives and staff members and the service had notified the Care Quality Commission (CQC) where this had been required.

7 December 2011

During a routine inspection

Some people we spoke with had memory difficulties and some had early stages of dementia. We spoke with over 20 residents and most people had views about the service. Generally, people felt safe and well cared for and they said that the food and accommodation were good. Nearly everyone said that staff were kind and that they were treated with courtesy and respect. Some people told us that they would like more say in the day to day activities at the home and also more information about what events were happening at the home.