11 October 2018
During a routine 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.