Knappe Cross Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At the last inspection in December 2022 the provider had not always identified and managed risks to people's safety and wellbeing. At this assessment we found improvements in risk management, but further improvements were still required.

We found there were sufficient staff on duty to meet people’s needs in a timely way. Where people required one to one support to keep them and others safe, we saw mostly that this was happening. Staff showed compassion and were caring in their interactions with people.

Staff told us they felt medicines systems worked well and that they had training and competency checks. They said they felt well supported, and they were knowledgeable about people and their medicines.

Records showed that people received their medicines in the way prescribed for them. For ‘when required’ medicines there were person-centred details in place to guide staff when these might be needed. Improvement was required for the recording of medicines applied as patches, and some care plan details needed checking/cross referencing with the medicine summary sheets. Risk assessments were in place for higher risk medicines to ensure people’s safety.

The environment was clean and infection prevention and control measures promoted people's safety.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe living at the home.

Staff were aware of how to record and respond to accidents and incidents at the time they occurred. This included how and when to seek medical advice. Staff told us how they took action when accidents and incidents occurred. Comments included, “Accidents happen, we make mistakes. Say about it” and “If someone falls, we call the nurse. Put something in the system, but mostly the nurse [would do this].” Staff also told us incidents were discussed during handovers to make sure staff were aware of changes as quickly as possible.

There was an electronic system in place for staff to record accidents and incidents.

The provider had been working with local authority teams to address areas of concern identified through the safeguarding process. This included improving incident, accident, near misses, reporting and recording and looking at themes and trends.

People and relatives gave us mixed feedback about when they first came to the home. Comments included, “It took four or five months to settle in”, “I don’t like it very much. They don’t seem very caring. They put me here and if I do not like it, I can go somewhere else” and “She is more settled than when she first came in. She does like the staff and tells me they are lovely.”

Staff told us about how they supported new people coming into the home. One staff commented, “We are the first face people see. We answer the door, escort to room if new.” Another told us about how information about new people was shared with staff. They said, “If a new resident, they [management team] call a team meeting. This is done there and then. People [staff] not here get a summary/briefing. The information will get emailed out as well.”

One healthcare professional told us they had concerns about the level of complexities of people that had been admitted to Knappe Cross Care Centre in the last year. The operations manager confirmed the registered manager had admitted people with quite complex needs and going forward this would have a higher level of scrutiny to ensure they could meet their needs.

Systems were in place to support people on admission with risk assessments undertaken to ensure people were safe. Care records showed people’s needs and risks were assessed prior to and on admission to the home. However, the provider’s service improvement plan showed that people’s health needs had not always been detailed in their care plans. The management team were reviewing everybody’s care plans and risk assessments at the home to ensure accurate up to date guidance was in place to guide staff.

Some people and relatives expressed concerns about communication with staff whose first language was not English. However, they all said staff were caring and friendly and commented on the good atmosphere at the home. Comments included, “Communication is an issue, and they [staff] struggle to communicate with my mum”, “Care wise, no problems. Language was a problem when she first came. Now she is really settled”, “Language is a little bit difficult. I mostly ask them to repeat themselves” and “The staff are lovely, but communication and language can be a problem, and it’s an issue.” The provider and operations manager were looking at ways they could support staff whose first language is not English to improve their communication skills.

Staff were confident in reporting abuse. They had received safeguarding and whistle blowing training and were encouraged to report any concerns to their line managers. One staff member commented, “We have an app and have to do online training. Any allegations, I would inform the nurse, who will tell us what they have done.”

Staff had completed MCA and DoLS training. However, when spoken with, not all staff were clear about DoLS. We did not identify this had impacted anybody at the service but potentially staff could restrict people unlawfully. We discussed this with the provider and management team, who told us they would work with staff to ensure they had a clearer understanding.

We saw staff deliver care safely and they used appropriate manual handling techniques. We observed people were comfortable in the company of staff. Staff responded to people’s requests and provided them with the support they asked for.

The provider had clear, up to date safeguarding and whistleblowing policies. All staff had access to these on the internet or in accessible folders at the home. We were told the management team were working with staff to ensure they would be confident speaking out to raise concerns.

We saw evidence in people’s care records the last registered manager had applied for DoLS appropriately when people needed this level of protection to keep them safe. Where 1 person had conditions applied, these had been complied with. However, the management team were not able to tell us which people had a DoLS in place. This meant that staff might not be aware if they are restricting people’s liberties in line with the Mental Capacity Act 2005.

Relatives felt the risks were managed and when incidents happened these were investigated, and action taken to prevent recurrence.

Staff spoken with said they were not always involved with developing care plans and risk assessments. One staff member told us, “The management do a risk assessment in [people’s] best interests.”

We observed call bells were answered in a timely manner to ensure people were safe. We observed staff in the dining room during lunch assisting people with their meals. Staff appeared confident and knew people well.

Risks to people were not always well managed. We found 1 person's pressure relieving mattress was not on the correct setting. This placed the person at risk of developing pressure damage to their skin. When we discussed this with the operations manager it was addressed.

We saw one person’s oxygen cylinder had a warning light, an amber-coloured light needing action. This was reviewed and corrected when raised with the operations manager.

Following a speech and language assessment (SALT), 1 person required staff to make an informed decision about the consistency of food they required. This depended on whether the person was alert or drowsy. There was no system in place to ensure the kitchen team were advised daily about what food consistency the person required. Action was taken to address this by the operations manager and new manager.

The provider had a daily system for staff to check people’s pressure relieving mattresses were set correctly. They had also put in place an additional check by the maintenance team to make this check more robust. However, these checks had failed to identify the mattress we found set incorrectly.

The operations manager and a senior staff member were reviewing and updating people’s care planning documents and risk assessments as the local authority whole service process had identified these had not been accurately reflecting people’s needs. At the time of our site visit they had completed over 70% of these and had prioritised people at the highest risk.

People and their relatives, raised no concerns about the environment.

Staff knew the action to take to maintain a safe environment. Staff we spoke with said they had received fire safety training and had information about how to use fire safety equipment.

The operations manager told us about recent problems with their passenger lift, boiler and drains which had all been repaired. They confirmed none of the issues could have been foreseen or prevented.

Staff carrying out health and safety checks were not aware of relevant Health and Safety Executive guidance. We discussed this with the operations manager who told us staff now had had access to this guidance.

We carried out a tour of the service and found the environment was predominantly safe. However, people could have been placed at risk of harm because doors to areas of risk were not locked. For example, an external door was not locked, (the home had a ‘locked door’ policy to protect people) and the door to the boiler room was also unlocked. We raised concerns with the operations manager who took immediate action to ensure these areas were made safe.

We saw there were appropriate systems and processes in place to identify concerns with the environment. However, a visual check was carried out in July 2024 which identified a threadbare join in the lounge carpet. This was a potential trip hazard and no action had been taken to minimise risk to people .

Fire drills and tests had been completed and a fire risk assessment was completed in August 2024. However, the annual fire extinguisher service due in October 2024 had not been carried out . When we discussed this with the operations manager action was taken to address this.

Window restrictors were in place where necessary. These were not tamper proof. We discussed this with the operations manager at the end of our site visits. When we spoke with them at our feedback call, we were told action had been taken to ensure the restrictors were safe.

People we spoke with said they liked the staff, but felt staff were sometimes rushed. One person said, “Staff are reacting quicker to call bells now.” Relatives felt there were enough staff.

Staff we spoke with felt there were usually enough staff in the home to support people. They said it depended upon the team working and confirmed that the provider tried to ensure consistent agency staff worked at the service. Staff said they had received training and had supervisions.

We observed staff were mostly visible and available to meet the care needs of people living at the home. Where people required one to one support to keep them and others safe, we saw mostly that this was happening.

The provider used a dependency tool to assess staffing requirements at the home. The operations manager told us they had maintained higher staffing levels at the home since the start of the local authority safeguarding process.

The staff training record and supervision and appraisal spreadsheet we were given at the start of the assessment were not accurate. Therefore, we could not be assured at this time staff had received the provider’s mandatory training and support. The operations manager addressed this, and a more accurate record was sent to CQC, which showed the majority of staff had completed the providers mandatory training and received supervisions.

People and relatives said the home was clean and well maintained.

Staff were knowledgeable about infection prevention and control and ensured they carried out their tasks safely. Staff confirmed they had access to personal protective equipment.

The home was clean, tidy and mostly free from odours. Ancillary staff were available to support cleaning and laundry within the home.

The provider had infection control policies in place and staff received training in infection prevention and control. An infection control audit was carried out every 3 months to ensure cleanliness was maintained.

Staff signed cleaning schedules when they had cleaned rooms. However, there was no guidance about what they had cleaned in each room and, if there was an ensuite, if this had been cleaned.

Medicines were seen being given in a safe and caring way.

People’s preferences for how they liked to take their medicines were recorded and taken into account.

People had personalised information for ‘when required’ medicines to guide staff when these may be needed.

Staff we spoke with said that they felt well supported, and they were knowledgeable about people and their medicines. They told us they felt the systems in place for medicines worked well.

Staff told us they received training and competency checks, to make sure they gave medicines safely. Records confirmed these had been completed.

Medicines records showed that people received their medicines as prescribed.

When medicines were prescribed ‘when required’ then person-centred details were available to guide staff when these might need to be given.

Risk assessments were in place for higher risk medicines such as blood thinners and flammable medicines.

Handwritten medicine administration records (MAR charts) were checked and signed by a second member of staff.

Patch charts were in place but there were some gaps where the removal of previous patches and site of new patches were not recorded, although we could see where these had been applied from other records.

Some details in people’s care plans did not match with the information held on medicines summary sheets kept with people’s MAR charts. For example, regarding diabetic monitoring, and risks staff needed to be aware of.

Medicines errors were acted upon and reported appropriately.