Archived: Brighton & Hove City Council - Knoll House

Knoll House provides personal care and support for up to 20 people. Care and support is provided to adults, but predominantly to people over 65 years of age.

Knoll House provides short term rehabilitation for a period of usually two to three weeks but can be up to six weeks. People primarily stay at Knoll House following discharge from hospital, or to prevent an unnecessary admission to hospital. People were supported as part of a rehabilitation programme to help them to regain independence which enabled them to return home. There were 11 people receiving a service at the time of our inspection.

People’s experience of using this service:

Knoll House was going through a period of change and uncertainty. Previously daily support had been provided on site by the multi-disciplinary team consisting of, GPs social work team, social care staff and medical and nursing staff including occupational therapy staff. The registered manager told us recent changes to the service meant, “People were not being referred to the service, therefore beds are remaining empty. I don’t know the future for the service.”

People at Knoll House received an individualised and effective caring service. People were treated with exceptional kindness and compassion. We received positive feedback about the support that staff provided and how people were encouraged to regain the skills to continue to live independently. Staff worked positively to promote people’s health and ensure good outcomes for their physical and mental wellbeing.

There was a strong recognition that people were individuals and the care and support provided ensured that their needs were met which resulted in positive and improved outcomes for people. Respect for people’s privacy and dignity was at the heart of the service provision.

Staff were well trained and skilled and encouraged positive risk taking. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards enabling people to regain essential life skills. Risks associated with people's care needs had been assessed by the management team, and informed plans of care to ensure people’s safety

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to make choices and staff supported people in the least restrictive way as possible. Staff were aware of the legislation to protect people’s rights in making decisions. This practice was kept under review.

Accidents and incidents were monitored to identify and address any patterns or themes. Learning from incidents was shared with the staff team. Records demonstrated that when an incident or accident occurred staff reported these to their management team to monitor.

Staff received supervision in line with the provider’s policy, staff felt supported and able to request a supervision if they needed one. Staff told us they were able to speak to their management team as they operated an open-door approach.

People had good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address people’s health care needs. Staff followed guidance provided to support people with their care.

Rating at last inspection: Good [report published 26 September 2016]

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Knoll House provides personal care and support for up to 20 people. Care and support is provided to adults, but predominantly to people over 65 years of age. It provides short-term rehabilitation for a period of usually two to three weeks, but can be for up to six weeks. People primarily stay at Knoll House following discharge from hospital, or to prevent an unnecessary admission to hospital. The ethos of Knoll House is to support people to regain their independence and promote independent living skills. Help provided at Knoll House included assistance with personal care, mobility, kitchen assessments, including meal and hot drink preparation, mobility practice, home and/or access visits to assess people’s home environment, stoma education and catheter care.

The short-term rehabilitation is a joint partnership between Brighton and Hove City Council and the Sussex Community NHS Trust who work together to provide co-ordinated care. Consultants for elderly care, GPs and a community mental health nurse visit the service. On the premises people receive support from a social work team, social care staff, medical and nursing staff, physiotherapy and occupational therapy staff. There are a high level of admissions and discharges due to the short-term nature of the service, and there are no long term placements. There were 18 people living in the service on the day of our inspection.

Knoll House is a two story building with a passenger lift for level access throughout the building. All the bedrooms are single occupancy with ensuite facilities. All lounges have kitchen and dining facilities. People are also able to use a conservatory and landscaped garden area. A separate kitchen and gym area is available for people to be supported to work towards their agreed goals for independence.

There was a registered manager for the service. 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 last inspection was carried out on 23 September 2015. We found a number of areas of practice which required improvement. This was in relation to not all the care staff had received training or guidance on Deprivation of Liberty Safeguards( DoLS), and were not aware who had a DoLS agreed. Where people had been assessed at risk of developing pressure sores, the equipment identified to be used had not been regularly checked to ensure it remained at the right setting to meet people’s individual needs. Medicines were kept securely and within their recommended temperature ranges, except for one medicine awaiting disposal that was required by law to be stored in a specific way. Whilst the effectiveness of medicines were appropriately monitored and relevant care plans were available to support the management of most people who lived in the service, the care plan and medicines administration record (MAR) used to record the administration of medicines for one person were not consistent. Some people had food and fluid intake charts being completed. However, records were not all accurately maintained to detail what people ate or drunk, to fully inform the nursing staff. Not all the care staff demonstrated knowledge of people’s individual dietary requirements. The information which had been detailed in individual care plans for staff to follow was variable, had not always been fully completed and did not always give clear guidance for care staff to follow. Where care had changed it was not always possible to identify when this had occurred and the rational for the change. People also told us they would have liked more opportunities to join in social activities. The provider drew up an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection. At this inspection we found the provider had followed their action plan, improvements had been made and the regulations were now being met.

The service was going through a significant period of review, where the provider and local stakeholders were looking at the service provision, what was needed and how the service would best be provided in the future. Staff told us this had led to a number of staff changes since the last inspection.

People told us they felt safe. They knew who they could talk with if they had any concerns. They felt they could raise concerns and they would be listened to. People were supported by care staff who were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

The service was clean. One person told us, “Excellent housekeeping.” Another person told us, “It is extremely clean and the housekeepers are nice and chatty.” There was a maintenance programme in place which ensured repairs were carried out in a timely way. Regular checks had been completed to ensure equipment and services were in good working order.

People and their relatives told us there were adequate care staff on duty to meet their care and support needs. One person told us, “When I press the bell for help I’ve never been made to feel a nuisance.” Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff.

People's individual care and support needs were assessed before they moved into the service. People had a care and support plan and risk assessments in place. These were detailed and gave clear guidance for care staff to follow. Charts in place to monitor people’s food and fluid intake and to ensure that pressure relieving equipment was set to meet people’s individual requirements had been consistently completed. Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They felt they knew people’s care and support needs and were kept informed of any changes. Senior staff used handover notes between shifts which gave them up-to-date information on people’s care needs. One person told us, “I can get up when I want, I’ve even been asked if I want a lie in.” Comments received by staff in the service this year included, ‘The care and help from Knoll House was great. They helped show me how to cope with things like holding a kettle and live independently,’ and ‘For all your care and commitment and help. I so appreciated everything. I fly today.’

People told us they had felt involved in making decisions about their care and treatment and felt listened to. Comments received by staff in the service this year included, ‘You have all looked after me so well that I have no words to thank you enough. A simple ‘thank you’ seems inadequate and you all have been absolutely great.’ Staff were kind and caring. Comments received during the inspection included, “There is nothing else we could ask for” and “Their really helpful and friendly and share information.”

People were treated with respect and dignity by the staff, and were spoken with and supported in a sensitive, respectful and professional manner. People’s healthcare needs were monitored and they had access to health care professionals when needed. People spoke well about the support they had received as part of their rehabilitation. A relative told us, “This is the best continuation of care that we have experienced without doubt.” Comments received by staff in the service this year included,’ So much appreciate all the professionalism, patience and dedication but above all the 100% smiling faces and atmosphere of Knoll House. This is something I know you will take forward ’and‘ Thank you for your kindness and support helping my mum on her next leg of life’s journey.’

People’s nutritional needs had been assessed and they had a selection of choices of dishes to select from at each meal. People said the food was good and plentiful. Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.

People and their representatives were asked to complete a satisfaction questionnaire at the end of their stay. We could see people were able to comment on and be involved with the service provided to influence service delivery. The registered manager told us that senior staff carried out a range of internal audits, and records confirmed this. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and relatives could discuss any issues they may have.

Below is a summary of what we have found. The summary is based on our observations during the inspection. 20 people were resident in the service at the time of our inspection. We observed the care provided, looked at supporting care documentation, staff records and records relating to the management of the service. We spoke individually with the operations manager, the registered manager (who is referred to as manager in the report), the deputy manager, two registered nurses, a physiotherapist assistant, an occupational therapist, a senior social worker, two lead care workers, and three care workers, one of whom was one of the provider's bank staff. We spoke with eight people who used the service.

Is the service safe?

People were treated with respect and dignity by the care workers. People told us they were safe in the service. Comments received included,' I feel very safe. It's lovely,' 'Feel safe here,' and 'Feel very safe here.'

Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people's best interests. Where possible, people had been asked for their consent for any care or treatment.

There was a system in place to make sure that the provider, management and care staff learnt from events such as incidents and accidents, complaints, and concerns.

Staff had been provided with training to undertake their roles in the service, systems developed and recording and monitoring systems put in place. This helped to ensure people were not put at any unnecessary risk.

A staff rota was in place, which had taken into account people's care needs when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs had been reviewed and where possible people and their representatives had been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and support needs had been identified and guidance for staff to follow was in place. People were able to move around the service freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and offered encouragement when supporting people. Comments received included,'Like a five star hotel. If you want, you ask, you receive,' 'I can't fault anything,' 'Very nice here,' 'Very friendly here,' 'We have what we want, not what they want,' 'Excellent home. I can't sing their praises high enough,' and 'The overall service is very good.'

People had been asked to complete quality assurance satisfaction surveys.

People's preferences, interests, aspirations and diverse needs had been recorded. People told us care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had been supported as part of their rehabilitation to meet their agreed goals. People told us they had guidance and regular support from the physiotherapists, and occupational therapists. These specialists had worked with them to improve their mobility prior to returning home. They told us of the exercises they were being supported to undertake. Comments received included, 'I saw the physio today,' 'I have been for a walk today. I get a walk every day,' and 'Exercising every day.'

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. Two complaints had been received since the last inspection, which had been responded to appropriately. People told us they had not had to raise any concerns, and they were aware who to speak with if they had any concerns and that they felt they would be listened to. Comments received included, 'No complaints here,' and 'Not had any worries or concerns.' People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

The service had quality assurance systems to develop and improve the service provided, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.

This told us that people were able to express their views and were involved in making decisions about their care and treatment. People told us they felt they were well cared for by staff who understood their care needs. They said staff were very caring and responsive to their care needs. Comments received included "I like being here. I had a fall that's why I'm here but I'm getting better," "Staff are so very good" and "Everything you ask for to be done, it's done".

Infection control policies and procedures were in place to protect people.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording of medicines.

People were protected from unsafe or unsuitable equipment.

There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service.

Systems were in place to review and monitor the quality of the care provided.

The records for the management of the home were accurate and complete and kept securely.

People were able to express their views and were involved in making decisions about their care and treatment.

People told us they felt they were well cared for by staff and that the staff were very caring and responsive to their care needs. Care was provided by care workers who understood their care needs and that their privacy and dignity were respected.

The records for the management of the home were not in all cases accurate and complete or kept securely.

All the care staff we spoke with told us that they had been going through a significant period of change in the home. This was due to the change in regulated activities being undertaken by the service, which had lead to changes in staffing, levels of responsibilities between staff groups and changes in systems within the home.