Knappe Cross Care Centre

Updated 10 February 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

The 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

Knappe Cross Care Centre 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. Knappe Cross Care Centre is a care home with 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 inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). 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 3 people who lived at Knappe Cross Care Centre and 10 relatives/friends. We spoke with 8 members of staff including the registered manager and operations manager. We reviewed a range of records. This included 8 peoples care records, medicines administration records (MAR), 4 staff recruitment files, staff training records and other records related to the management of the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us

Updated 10 February 2023

About the service

Knappe Cross Care Centre provides personal and nursing care to up to 42 older people. The home is a detached house set in its own beautiful grounds in the seaside town of Exmouth in the coastal area of East Devon. At the time of our inspection there were 35 people using the service.

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

People were at risk because systems to monitor their well-being were not fully effective, for example the increased monitoring of people at risk due to constipation. In addition, staff were not always proactive in responding to and addressing risks in a timely way.

Medicines were not always managed safely, or in line with the providers medication policy. Risk assessments had not been completed regarding flammable paraffin-based creams; guidance had not been sought from a pharmacist about the effectiveness of crushed medicines given in yogurt; and staff were not consistently following systems for ordering, receiving and storing medicines.

These issues had not been identified by the providers governance systems which meant they were not fully effective. Action previously taken to address concerns about staff practice had not always led to improvements, for example related to medicines administration and recording.

The management team promoted a culture of openness and honesty. They were open and transparent during the inspection and took immediate action in response to concerns raised. This included seeking advice from external health professionals; ensuring staff were aware of the importance of monitoring and recording and arranging relevant training. Improvements were also made to monitoring systems.

The manager had been registered with the CQC for 3 weeks at the time of the inspection. They were being mentored by the operations manager who had previously managed the service. They told us they were well supported by the provider and felt safe and comfortable.

Overall, people and relatives spoke highly of the quality and safety of the service. Comments included, “They do everything to accommodate both of us. They support us with telephone calls morning and afternoon, and when I visit twice a week for a couple of hours. Completely brilliant. They said I am family as well” and, “I have no concerns about [family members’] safety. She has often said that they are good and that she's happy there.”

Staff told us they felt valued and happy working at the service. They felt well supported and were passionate about their role.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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.

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

Rating at last inspection and update

The last rating for this service was good (published 13 September 2017).

Why we inspected

We received concerns in relation to the quality and safety of the support provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to the assessment and mitigation of risks; the safe management of medicines and the effectiveness of governance processes. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.