The Knoll

We found the following examples of good practice.

The registered manager and staff were committed to keeping people safe. At the start of the pandemic the registered manager moved into the service to oversee care provided to people and to support staff.

The registered manager implemented protocols before the government issued advice on restricting visitors to keep people safe. As the easement of lock-down commenced the registered manager had put systems in place for people to safely receive visitors. They had implemented health checks and screening forms for all visitors, including professional visitors and had identified space and areas for visiting to happen safely whilst mitigating the risks to others.

When visits in person were not able to go ahead, people kept in touch with their relatives through video calls and telephone calls. People had also been supported to talk to their advocates via video calling.

Staff were provided with the appropriate training and PPE to keep them and people safe. Infection control measures and cleaning regimes had been increased.

When people needed support from health professionals the registered manager supported them to do so safely through the use of video calls, social distancing and provided masks and support from staff if they needed to attend appointments in person.

The registered manager supported people’s well-being with activities and had utilised resources sent to them from day centres.

Further information is in the detailed findings below.

The Knoll is a ‘care home without nursing’. People in care homes receive accommodation and 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.

The service is registered to provide care and accommodation for up to seven people who may be living with a learning disability, mental health condition and/or physical disability. There were seven people living in the service on both days of the inspection. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice and promotion of independence. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection, the service was rated good and at this inspection, we found the service remains 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.

People received safe care and support. Staff knew how to support people and protect them from the risk of harm. The service had a safe, robust recruitment system and employed sufficient numbers of staff to meet people’s assessed, and changing needs. There was a good medication system in place and the records were of a good standard. Staff had been trained and had their competency to administer medication assessed. People received their medication safely as prescribed. Infection control measures were in place and staff were trained and demonstrated a good knowledge of infection control procedures. The environment was well maintained, clean and hygienic.

People’s needs had been fully assessed and their support plans updated when their needs changed. Staff were well trained and received formal and informal supervision and knew how to care for people effectively. People had a choice of sufficient food and drinks, which they had helped to shop for and people chose what they wanted to eat and drink on a daily basis. Staff ensured people’s healthcare needs were met. They worked well in partnership with other professionals to ensure that people received the healthcare they needed.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. Appropriate assessments had been carried out in line with legislation. Where people were deprived of their liberty, the service had made appropriate requests for authorisation. People’s independence was encouraged and supported while minimising risks to help keep them safe.

Staff were kind and caring and listened to what people had to say. They treated people with dignity and respect and ensured they had the privacy they needed. People and their families were kept fully involved in decision-making. Advocacy services were available if needed. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People received personalised support that was responsive to their needs. They had good community links and enjoyed a range of indoor and outdoor activities. The support plans and daily notes were detailed and informative. There was a good pictorial system in place for dealing with complaints and people had confidence that their complaints would be dealt with appropriately.

People and their families knew the registered manager well and had confidence in them. Staff felt well supported by the registered manager and discussed issues with them on a daily basis. There was an effective quality assurance system in place. The service recognised the need for improvements and ensured people received a good quality service. Confidential information was stored safely in line with data security standards.

Further information is in the detailed findings below.

We carried out a desk top review and found that the provider had taken action to make improvements.

We spoke with three staff and a visiting professional. We found that there were systems in place for supporting people with any nutrition and hydration needs. We saw that staff cooperated with other providers. We found that there were systems to keep people records safe. We found that improvements had been made to infection control systems. We found that not all maintenance systems were consistently being followed and felt this could pose a risk to people.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We looked at three care plan files and found that people's individual needs had been considered and plans detailed the support required.

We found that some systems were not in place to reduce the risk and spread of infection.

We spoke with three staff who told us that the service had enough staff available.

We found that people were made aware of the complaints system. This was provided in a format that met their needs.