The Knole

Updated 4 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Knole is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Knole is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR) from March 2022. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and gathered feedback from 3 relatives about their experience of the care provided. We spoke with 14 members of staff including the registered manager, deputy manager, a care team leader, 10 project workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included a sample of 3 people's care records and a variety of records relating to the management of the service, including a review of some policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at policy and quality assurance records.

Updated 4 March 2023

About the service

The Knole is a residential care home providing personal care to up to 15 people in one adapted building. At the time of our inspection there were 15 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: We received mixed feedback from professionals about the assessment and management of risk for people with more complex and profound needs. We found the provider had measures in place to mitigate risk and ensure, where appropriate, lessons were learned, and action was taken.

The environment did not meet the principles of Right support, right care, right culture as there were more than 6 people living in one communal home. However, despite the large environment, consideration had been given to the principles and people’s care and support was provided in a safe and clean environment with consideration to their sensory and physical needs.

People were supported to take part in activities and gain voluntary and paid employment.

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

People were supported to take their medicines in accordance with their individual needs and preferences.

We received mixed feedback from staff about staffing levels within the home on a weekend. The registered manager provided examples of how staffing levels including skills and numbers had been adjusted in accordance with people’s needs. This remains an area for improvement.

Right Care: Staff actively promoted equality and diversity in their support to people. They understood people’s cultural needs and were able to provide culturally appropriate care.

Right Culture: We received mixed feedback from staff about the culture of the home. Some staff told us they did not feel respected, supported and valued by the management team. Measures were in place to make the necessary improvements and an agreed timeline for improvements had been implemented.

Quality assurance processes included a variety of audits. The registered manager had an oversight of the service, but more time was needed to make the necessary improvements in relation to the staff and professional feedback.

People received good quality care, support and treatment from trained staff who were able to meet their needs.

The registered manager regularly evaluated the quality of support given, involving the person, their families and other professionals as appropriate.

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 23 October 2019).

Why we inspected

We received concerns in relation to the management of safeguarding concerns, staff skill, training and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Knole on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.