Archived: Knights Court Nursing Home

Updated 11 March 2015

We carried out an unannounced inspection of Knights Court Nursing Home on 14 July 2014. The inspection team consisted of an inspector, a specialist nursing advisor and an expert by experience. This is a person who has personal experience of using or caring for someone who uses this type of service. The expert by experience for this inspection had experience of caring for a person who lived in a nursing home.

We spoke with eight people living at the service and three visiting relatives. We observed people in the two dementia units using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We spoke with six care workers, an activities coordinator, four nurses, the clinical lead nurse and the registered manager. We also looked around the home and saw the way staff interacted with people. We looked at six people’s care plans as well as a range of records about people’s care and how the service was managed.

Before we visited the home we checked the information we held about the service, including notifications of significant events that the provider had sent to us. No concerns had been raised and the service met the regulations we inspected against at their last inspection on 2 January 2014. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?’

The ratings for this service were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is this service safe’ sections of this report.

Updated 11 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We inspected Knights Court Nursing Home on 14 July 2014. This was an unannounced inspection.

We carried out two inspections during 2013 when we found concerns that required actions. The service met the regulations we inspected against at their last inspection on 2 January 2014.

Knights Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom may also have dementia. There were 52 people living at the home when we visited. The reason for the low number of people using the service was that the local authority placed an embargo on admissions between April and October 2013 following several serious concerns. The registered manager was appointed in July 2013 and registered in March 2014. She ensured that new admissions since October 2013 had been actioned slowly so that there was no risk of further concerns. 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Further concerns about staffing issues were raised anonymously in June 2014. We checked on the issues during this inspection and did not find any evidence to corroborate these concerns.

Staff we spoke with during our visit told us that there had been “great improvements” since the registered manager was appointed. One staff member said, “She is a superb manager, very supportive.” A relative said, “Things have really improved over the last three to four months. The staff have got to know [my relative’s] ways much better and they are now able to communicate with them.” The registered manager made changes in the management structure and responsibilities, and appointed new staff and nurses so that there was an improved level of staffing on all units. The registered manager was aware that there were still challenges to address in order for the service to be able to provide a consistently good level of care. They ensured a gradual increase in new admissions to ensure that staff were able to meet all their needs. The provision of responsive dementia care was not consistent throughout the home, and the provider was making some changes to the environment to address this.

People told us that there were always staff available to help them when needed. Relatives of people who used the service told us that they visited the home at different times and on different days, and the staff always made them feel welcome. They said that staff were caring and treated people with respect, and that their relative was always comfortable and looked well cared for. One relative said, “I would recommend this home.” Another relative said “I wish I could move [another relative] into this home; I would be very happy if [this relative] was here.”

The service was meeting the requirements of the Deprivation of Liberty safeguards (DOLS). The registered manager and staff understood when an application for a DoLS authorisation should be made and how to submit one. The registered manager was aware of the 2014 High Court judgements which widened the scope of the legislation.

Staff told us that they had regular training that provided them with the skills to understand and meet the needs of people who used the service. A new member of staff said they had been given training as part of the induction so that they were able to respond to people’s care needs.

Staff were aware of people’s rights to be involved in decisions and to make choices about their care and treatment. Care plans showed these preferences. People who used the service and their relatives told us that they had agreed their care plans and they were able to make their views known.

Staff treated people with dignity and respect and supported them in a caring way. Three members of staff were ‘Dignity Champions ‘with additional training and responsibility for encouraging other staff to respect people’s dignity.

Care plans for people with dementia provided information on how each person communicated and the best way for staff to support them with their specific needs. All staff completed training in understanding dementia. Our observations in the dementia units showed that people were mostly alert and interested in their surroundings. Staff engaged people in conversation and talked with them while assisting them. However provision of dementia care was not consistent in the two units, due to differences in the environment. In one unit the lounge was divided and chairs arranged in small social groups to encourage socialising and conversation. In the other unit chairs were arranged around the outside of the lounge and people only engaged in conversation when staff spoke to them.