We carried out a review of the data available to us about The Knole on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Knole, you can give feedback on this 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.
The Knole is a residential care home providing care and support to 14 people at the time of the inspection. The service can support up to 15 people in one adapted building.
We found the following examples of good practice.
¿ During a recent COVID-19 outbreak in the service, the provider followed their contingency plan for an outbreak to ensure people were supported by adequate numbers of staff.
¿ Staff ensured the service was regularly cleaned and the environment was adequately ventilated. Increased cleaning hours had been introduced since the start of the pandemic. Cleaners now worked seven days a week.
¿ Staff and people had been tested for COVID-19 in accordance with national guidance.
¿ Staff used the Personal Protective Equipment (PPE) provided appropriately.
¿ Arrangements had been made for visitors to be screened before entering the care home.
¿ A room had been made available for staff to change clothes at the start and end of each shift and for the facilities for the donning and doffing of PPE.
¿ People were supported to remain occupied when they had to isolate in their rooms after testing positive for COVID-19
¿ Staff were supported both financially and emotionally when working through the outbreak or when they had to isolate at home.
¿ The most recent audit has resulted in plans for a gazebo to be built in the garden to support the resumption of visiting.
¿ Managers and senior staff were supported through regular communication with peers in the provider organisation.
¿ Staff were provided with regular updates and guidance on working during the pandemic.
¿ Information was made available in a suitable format for people using the service to help them understand changes in response to the pandemic.
¿ Lessons were learned from how an outbreak of COVID-19 was managed at another service operated by the provider.
The Knole is a residential care home providing care and support to 13 people at the time of the inspection. The service can support up to 15 people in one adapted building.
People’s experience of using this service and what we found
Through implementing a person-centred model of therapeutic care and support the service had developed an outstandingly caring person centred culture which placed a strong emphasis on developing positive relationships with people and supporting them emotionally. Staff excelled at supporting people, regardless of their history and life choices as individuals worthy of respect and compassion.
The service was responsive to people’s individual beliefs, preferences and needs.
People were safeguarded from the risk of abuse and those associated with their care. People were supported by sufficient numbers of staff.
We found the environment of the care home was clean, had been well maintained and was adapted for its purpose.
Staff received support to develop knowledge and skills for their role. There were arrangements in place for people and their representatives to raise concerns about the service.
People's individual needs and wishes were known to staff who had achieved positive relationships with them. People were involved in the planning and review of their care. People were supported to maintain contact with their friends and relatives.
Within the structures and boundaries of therapeutic care, 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.
Quality monitoring systems were in operation. The registered manager was visible and accessible to people and their visitors.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Knole is a home run by a Christian charity working with men who have offended or at risk of offending. Their aim is to provide assistance and support for people so that they can lead crime free lives. The service is registered to provide care and accommodation for up to 9 people. At the time of our inspection the service was providing support to 8 people.
A registered manager was in post at the time of inspection. 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.
Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk. People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.
Safe recruitment procedures ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. People received effective support from staff who had the skills and knowledge to meet their needs. Staff demonstrated a good understanding of abuse and knew the correct action to take if they were concerned about a person being at risk.
People's rights were being upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. Where appropriate people's support plans held information about their mental capacity and Deprivation of Liberty Safeguards (DoLS) being applied for.
People were supported to maintain good health and had access to external health care professionals when required. People’s care records demonstrated that their healthcare needs had been assessed and were kept under review.
People were supported by a small experienced team. Enabling relationships had been established between staff and the people they supported. Support plans were in place to enhance people’s independence and this ethos was promoted by the service and staff members.
A number of positive comments were provided by people about the level of care they received; “I was wary at first as it was a new environment. This location is a transition and is helping me to adjust. I have no problems with the staff. They listen and do not rush you”; “All the staff are good. I felt welcomed. I’ve been given a second chance”; “We’re well looked after”; “They help me with my finances. I’m motivated and they encourage me. We can go to the staff anytime. They give us something to look forward. They’re always here for us 24/7.”
People received care that was personal to them and staff assisted them with the things they made the choices to do. People told us they were content living in the service and received the support they required.
The registered manager was passionate about their role. They played an integral role in promoting the provider’s ethos of establishing positive foundations so that people can lead crime–free lives and become contributors to society. There was a positive culture within the service between the people who lived there, the staff and the registered manager.
To ensure continuous improvement the registered manager conducted regular compliance audits. They reviewed issues such as; health and safety, client file and risk management and client activity. The observations identified compliance rates and areas where improvements were required.
When carrying out inspections five key questions are asked: is the service safe, effective, caring, responsive and well led? As this inspection was following up non-compliance in one area, the question we asked was, is the service safe?
Below is a summary of what we found. The summary describes what the staff told us, what we observed and what the records told us.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
We found that the service was safe in terms of how staff gave people their medicines. Staff had received annual medicines training to ensure they were up to date with current practices. A member of staff we spoke with was able to describe how they would follow safe procedures for giving people their medicines. In addition photographs were used to help staff identify a person when giving them their medicines.
The provider had systems in place to cooperate with other services and professionals. This enabled appropriate and safe care to be planned for people on admission to the service. Care records showed other professionals and services were regularly consulted when care was reviewed or risk assessments devised. People were supported to access appropriate health care service to meet their individual needs.
Staff told us they felt supported in their roles and managers were approachable. The provider had induction process which ensured new staff were supported to provide appropriate and safe care to people. Systems were in place for staff to access training, supervision and annual appraisals and to attend regular team meetings. There were opportunities for staff to gain additional qualifications relative to their roles.
We spoke to people and staff to see how safely medicines were managed in the home. Each person completed an assessment to see if they were able to safely self-medicate. During our visit we observed medicines being administered to one person. We found the providers processes and staff training needed improving. We saw medicines were stored safely and checked regularly.
People told us they knew how to make a complaint. The provider had suitable arrangements in place to process and monitor complaints. This included how people could make complaints to external agencies and processes to monitor complaints for potential service improvements.