• Care Home
  • Care home

Archived: Thomas Knight Care Home

Overall: Good read more about inspection ratings

Beaconsfield Street, Blyth, Northumberland, NE24 2DP (01670) 546576

Provided and run by:
Sewa Singh Gill

Important: The provider of this service changed. See new profile

All Inspections

11 October 2018

During a routine inspection

Thomas Knight is a care home that provides accommodation and nursing care for a maximum of 54 people, some of whom are living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Thomas Knight accommodated 53 people at the time of the inspection.

At our last inspection in September 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People who were able to speak with us told us they felt safe living at Thomas Knight. A number of people were living with dementia and were less able to communicate but we observed they appeared relaxed and comfortable in their surroundings.

Checks on the safety of the premises and equipment were carried out although timescales set by the provider were not always met meaning some checks had been missed. Documentation did not always detail the location or exact item checked. We did not, however, see any unsafe equipment and we spoke with the deputy manager who sent us an updated checklist with realistic timescales and more detail regarding the location and type of equipment checked, following our inspection. Risks to people were assessed and plans put in place to mitigate these.

Staff had received training in the safeguarding of vulnerable adults and knew the procedures to follow in the event of concerns. We found the whistleblowing policy had been used when staff had concerns about aspects of care they felt should be investigated.

Safe recruitment procedures were followed which helped protect people from abuse. There were suitable numbers of staff on duty and a stable team, including nursing staff. There was no agency staff use.

Safe procedures remained in place for the management of medicines. There were some gaps in Medicine administration records [MARs] which we were told were usually picked up daily but some had been missed. We have made a recommendation about this.

Staff received regular training, appraisal and supervision, and told us they felt well supported in their roles. Checks on nurses registration status were carried out on a regular basis to ensure they remained registered to practise.

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. There was variation in the quality and detail of records relating to capacity issues and we spoke with the deputy manager about this. They agreed they should be reviewed and improved where necessary. We have made a recommendation about this.

People were supported with eating and drinking, professional advice was sought where there were concerns regarding their nutrition. People had access to a variety of health professionals and were supported to attend routine hospital appointments for the management of long term health conditions.

Staff were very caring and courteous in their interactions with people. We observed numerous examples of kind and compassionate care. Staff knew people well and used this knowledge to support people very effectively during periods of distress.

Person centred care plans were in place which were detailed and contained information about people’s individual needs, preferences and wishes. These were up to date and regularly reviewed.

A complaints procedure was in place and complaints had been responded to in line with the company policy.

A range of activities were available, and there was a dog living in the home who was very popular with people living there.

A new registered manager had been appointed since the last inspection. Staff told us they felt well supported by the manager and deputy who they said were approachable and listened to them.

Robust governance systems were in place which clearly outlined action to be taken, timescales for completion, and who was accountable to ensuring it was complete. This meant a clear audit trail was in place.

A number of improvements had been made since the last inspection and the managers were working closely with the management of their sister home. There was an increased focus on sharing best practice and learning from incidents across the two homes.

14 July 2016

During a routine inspection

Thomas Knight care home is situated in the town of Blyth in Northumberland. The service provides accommodation and personal care for up to 54 older people, some of whom have dementia. Nursing care was also provided. There were 45 people using the service at the time of the inspection.

An inspection was carried out in March 2014 and we found two breaches to our regulations regarding respecting and involving people, and safety and suitability of premises. The service was inspected on 1 and 7 October 2014 and these breaches had been met. No further breaches were found, but improvements to the premises were ongoing which were incomplete.

This inspection was carried out on 14 and 18 July 2016. The inspection was carried out by one inspector.

A registered manager was 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. They were supported by a clinical lead who was also a registered nurse.

Procedures were in place for the safeguarding of vulnerable adults, and staff training had been provided which was up to date. Staff told us they knew how to report concerns of a safeguarding nature and where concerns had been raised we found that the service had taken appropriate action to prevent reoccurrence.

Behavioural disturbance and distress were well managed and staff demonstrated skill and empathy when supporting people. Care plans outlined how staff should support people in a consistent way.

There were suitable numbers of staff on duty and they were effectively deployed to ensure maximum supervision of people. Safe recruitment procedures were followed which helped to protect people from abuse.

A number of safety checks to the building and premises were in place. We found that risk assessments had not been carried out related to glass fronted cabinets. The manager told us they would address this immediately. Improvements had been made to the design and layout of the building, and dementia friendly design had been used to good effect. Appropriate procedures were in place to minimise the risk of the spread of infection.

Individual risks to people were assessed including falls and nutritional risks, these were regularly reviewed and updated. A record of accidents and incidents was maintained and these were regularly reviewed to monitor for patterns or trends.

Medicines were managed safely and regular audits took place to ensure compliance with the home's medicine procedures. The competency of staff to administer medicines was assessed on a regular basis.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service was operating within the principles of the MCA 2005 and applications to deprive people of their liberty in line with legal requirements.

Staff received regular training, supervision and appraisals. This meant that their learning, development and support needs were considered by the provider. The health needs of people were met. They had access to a range of health professionals. Visiting professionals were happy with the response of staff during their visit, and found the staff organised and efficient.

Staff were caring. There were numerous examples of positive interactions between staff and people. People displayed positive signs of psychological well-being and were mainly relaxed and happy during our visit.

Person centred care plans were in place, and these were personalised, detailed and were reviewed monthly.

There was a complaints procedure in place which was prominently displayed. There were a number of feedback mechanisms to obtain the views from people, relatives and staff. These included meetings and surveys. The registered manager carried out a number of audits and checks to monitor the quality of the service. The provider also arranged regular quality monitoring checks by an external consultant to ensure high standards of care were maintained.

1 and 7 October 2014

During a routine inspection

We visited the home unannounced on the 1 October 2014. We carried out a second visit to the home announced on the 7 October 2014 to complete the inspection.

The home was last inspected on 13 March 2014. We found the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; “Respecting and involving service users” and “Safety and suitability of premises.”

At this inspection on the 1 and 7 October 2014, we found improvements had been made and the provider was now meeting both regulations. We considered however, that further improvements were required regarding the safety and suitability of the premises to ensure that all areas of the building were adequately maintained.

Thomas Knight Care Home provides accommodation and personal care for up to 54 older people, some of whom were living with dementia. There were 30 people living at the home on the days of our inspection.

A registered manager was 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.

There were procedures in place to keep people safe. Staff knew what action to take if abuse was suspected. A member of the local authority’s safeguarding team told us however, that there had been a delay in receiving an investigation report from the registered manager about a recent safeguarding concern.

Safe recruitment procedures were followed and staff said that they undertook an induction programme which included shadowing an experienced member of staff.

We observed that the premises were generally well maintained. We noticed however, that some of the window handles were still loose and that the design and décor of the environment did not always meet the needs of the people who lived there.

Relatives told us that people received their medicines at the correct time. We noted that medicines administration records (MARs) were generally completed accurately with only a few gaps in the recording of the administration of medicines. We read however, that two people received their weekly dose of bone disease medicine the day after it was due.  We also read that one person required staff to take her pulse before administering a particular medicine to ensure that the pulse rate was not too low. We noted that there were two gaps in the recording of her pulse. This omission meant that it was not always clear that the medicine was administered safely.

Staff were appropriately trained and told us they had completed training in safe working practices and were training to meet the specific needs of people who lived there, such as those who were living with dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. No applications to deprive people of their liberty had been completed at the time of our inspection. The registered manager told us that she was liaising with the local authority about DoLS applications. We considered that further improvements were required to ensure that people were only deprived of their liberty in a safe and correct way which was authorised by the local authority, in line with legislation.

Staff who worked there were knowledgeable about people’s needs and we saw that care was provided with patience and kindness and people’s privacy and dignity were respected.

We saw that an activities programme was in place. People were supported to access the local community. A complaints process was in place and people told us that they felt able to raise any issues or concerns and action would be taken to resolve these.

A number of checks were carried out by the management team. These included checks on health and safety; care plans; the dining experience; infection control and medicines. We noticed however, that medicines audits were completed only for people who lived on the ground and top floor. A check of medicine systems for people who lived on the middle floor was not carried out. This meant that there were no checks in place for people who lived on this floor to ensure that medicines were being administered as prescribed.

During a check to make sure that the improvements required had been made

When we last inspected this regulation, we told the provider that they were not meeting this essential standard because there was no registered manager at the home.

We carried out a desktop review on 6 August 2014. A desk top review considers information only and did not require a visit to the service. We found that a manager was now in place and had registered with the Care Quality Commission on 10 February 2014. We concluded that having a registered manager in place helped ensure that people had their needs met because the service was managed by an appropriate person.

13 March 2014

During an inspection looking at part of the service

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still registered as manager on our register at the time.

We found that people's representatives felt involved in the care. One relative told us, "We are quite happy now with the care, we are kept informed of things that happen. We would go to the manager if we had any concerns. We can't always make the meetings. The new manager introduced herself to us, shook our hands, that is good, we were very pleased with this." They added; "We have had a letter asking for photographs, I think they are going to put a memory jogger or something together."

The registered person had not ensured that people's dignity and participation in decision making were consistently respected and the way people were supported at mealtimes could be improved.

We found that care was assessed and delivered safely and that a new activities organiser had been recruited. As a result more social activity was being organised on a regular basis and we observed that people with dementia care needs were included in this.

We found staff understood the vulnerability of people and how to safeguard them from abuse through the procedures for raising concerns.

We saw that some improvements to the premises had been made and others were underway but some maintenance and safety arrangements had not been addressed. A relative commented, "The home is much nicer now. They have transformed it, it smells cleaner. The bedrooms are much cleaner, the laundry is better, things are not going missing so much."

30 July and 7 August 2013

During a routine inspection

In this report the names of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, though people we spoke with had mixed views about the care they experienced. The people we spoke with were positive as were two of the visitors. One person said, "The staff are great, they are very thoughtful." A relative said they had raised their dissatisfaction over a period of time and had lost faith in the home, despite a new manager being in post.

We saw that the premises were safe, had been improved in some areas since our last visit and we were told about further improvements to be made.

Staff were being safely recruited because the appropriate information and background checks were sought.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. A staff training programme was in place and individual records contained evidence of training provided. We saw that a programme of staff appraisal and one to one supervisions had been introduced and staff confirmed they had begun to attend one to one meetings.

We found the record keeping had improved since our last inspection. These were being stored securely, were well organised and accessible.

11, 22 April 2013

During a routine inspection

In this report the name of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a registered manager on our register at the time.

We found people were cared for and people told us they were well looked after. One person said, "Nothing is too much bother for the girls."

People were provided with a choice of suitable and nutritious food and drink.

Staff recruitment procedures were not sufficiently robust.

We concluded that there were sufficient staff employed at the home.

We found that the majority of staff had not received a supervision for over six months and there was no evidence of staff appraisals. In addition staff training needs were not being met.

New equipment had been made available and the premises were clean and tidy but the quality of the environment varied. Some areas did not support people well in finding their way around and we could not find evidence that some potential risks to safety had been fully assessed.

We saw there was a complaints procedure and people told us they would be comfortable raising any concerns. One person said, "I would be quite happy complaining if I needed to."

The manager had consulted some people about the quality of the service and introduced quality audits.

18 December 2012

During an inspection looking at part of the service

We spoke with eight people and three relatives to find out their opinions of the service provided. People told us they were happy with the care and support given to them. One person said, 'You might have to wait sometimes, but I feel looked after.' A relative told us, 'The care is beautiful ' fantastic.' We found that, on most occasions, people received care, treatment and support which met their needs and protected their rights.

We found there was a choice of suitable food and people told us they had plenty to eat and drink. People said, 'They make me a good breakfast' and 'There's always plenty to drink; I like tea and I can have as much milk as I want.'

We found there were not always sufficient quantities of necessary equipment. Where equipment was available, this was not always safe or suitable for its purpose.

One relative told us, 'I think they are short staffed sometimes' but we found there were enough experienced staff to meet people's needs.

We found that people were not protected against the risks of unsafe and inappropriate care and treatment because records held about people were not always accurate.

In this report the name of two registered managers appear who were not in post, and not managing the regulatory activities at this location, at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

6 June and 6 July and 12 August 2012

During a routine inspection

We talked to people who lived at the home as well as visitors.

Most of the people who were able to tell us about their experiences were happy with their care. One person said, "I am not that keen, I would rather be at home but I can't live there any more. The food is not like at home."

Other people said,

"It is fine, I have no problems, I would soon let the staff know if I had."

and

"I am treated well, I get enough to eat and drink, I can spend time in my room which is what I prefer, I even have my meals in here."

A relative who was visiting said, "The staff are brilliant, they will do anything for her."

13 March 2012

During an inspection looking at part of the service

A number of people living at the home had dementia and were unable to tell us what they

thought about living there. However, people we spoke with who could communicate

their views, said they liked living at the home. They said they liked the staff and they were helpful.

2 February 2012

During an inspection looking at part of the service

A number of people living at the home had dementia and were unable to tell us what they

thought about living there. However, people we spoke with who could communicate

their views, said they liked living at the home. They said they liked the staff and they were helpful.

17, 19, 20 January 2012

During an inspection in response to concerns

A number of people living at the home had dementia and were unable to tell us what they

thought about living in the home. However, people we spoke with who could communicate

their views said they liked the staff and they were helpful.They also said the food was not very good. This was discussed with management at the time of the inspection.

16 May 2011

During an inspection in response to concerns

A new manager has been appointed to run the home. She is introducing some changes to help ensure the home is being run for the benefit of people living there. Meetings take place and the food has improved as another cook has been employed.