CQC report explained · a nursing home
What the CQC found at Knights Court Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from avoidable harm. Falls management, medicines, staffing, safeguarding, risk assessments and infection control had improved or were managed safely, although some emergency evacuation plans needed updating.
- Effective?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Good
- Inspectors found effective audits, meetings and care record systems. People, relatives and staff described the home as well managed, open and supportive.
What inspectors found, October 2022
Knights Court Nursing Home is rated Good; inspectors found safe, caring support and major improvements since the last inspection.
Inspectors visited on 21 and 27 September 2022. The first day was unannounced. They spoke with people, relatives, staff and care professionals, and checked care records, medicines records, recruitment files, policies and audits.
The home was welcoming and relaxed. People and relatives described staff as kind, caring and respectful. Inspectors found enough staff, safe medicines practice, good infection control and systems to protect people from avoidable harm.
The home had improved its management of falls and reorganised care records since the previous inspection. Inspectors also found strong checks on quality and safety, and an open culture led by the registered manager.
This was a focused inspection of Safe and Well-led. Both were rated Good. The other three ratings were not inspected and were carried over from the previous inspection. The overall rating improved from Requires Improvement to Good.
Falls management improved
The home introduced a post-fall process, reviewed causes and updated care plans and risk assessments. Inspectors found that falls had fallen significantly since the previous inspection.
“Since our previous inspection the service had implemented systems to ensure that following a fall, steps were taken to reduce the likelihood of that person falling again.” from the report
Safe medicines practice
Medicines were given by trained staff and records showed people received them as prescribed. Medicines care plans had also been made more personal and kept up to date.
“The eMAR's we reviewed showed that people were receiving their medicines as prescribed.” from the report
Kind and respectful staff
Inspectors saw positive, meaningful interactions between staff and people. People and relatives praised the friendly atmosphere and described staff as caring and respectful.
“People and relatives praised the friendly atmosphere in the home and described staff as caring and respectful.” from the report
Good oversight
The home used regular audits, clinical reviews and meetings to monitor care, incidents, medicines, staffing and safety. Records were easier to find than at the previous inspection.
“Monitoring and auditing systems were in place to check the quality and safety of people's care.” from the report
Some evacuation plans needed more detail
needs fixingSome emergency evacuation plans did not explain how medical conditions and communication needs could affect evacuation. The registered manager took immediate action to review and update them.
“some of these lacked information on how medical conditions and communication impacted the evacuation in the event of an emergency.” from the report
- 01Have all emergency evacuation plans now been updated to include each person's medical and communication needs?
- 02How are falls reviewed after they happen, and how do you check that actions reduce the chance of another fall?
- 03How often are medicines care plans reviewed when a person's medicines change?
- 04How will you use the results of the 2022 satisfaction survey to make improvements?
- 05What are the current ratings for Effective, Caring and Responsive, which were not inspected during this visit?
This was a focused inspection of Safe and Well-led only; the other ratings were carried over from the previous inspection. This explanation was written from the published report of 14 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2021
Knights Court Nursing Home was rated Requires Improvement; inspectors found a breach over falls management, although medicines, infection control and safeguarding were generally managed safely.
This was a focused inspection on 22 and 28 July 2021. Inspectors looked mainly at Safe and Well-led after concerns about safeguarding and safety. They spoke with people, relatives, staff and care professionals, and reviewed care files, medicines records, incident records, staffing records, audits and policies.
The main concern was falls management. The home recorded 49 falls between January and July 2021. Inspectors found that repeated falls were not always followed by enough personalised action or professional advice to reduce the risk of further falls. This was a breach of Regulation 12.
Medicines were managed safely overall, but some medicines care plans were not personal enough. Care records were also difficult and time-consuming to search. Staff, relatives and management gave mixed views about staffing levels, although inspectors found enough staff on the day of the visit.
The overall rating changed from Good in 2018 to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three areas were not inspected during this visit, so their earlier ratings were used in the overall rating.
Medicines handled safely
Inspectors found that medicines were stored securely and that records showed people received medicines as prescribed. Staff had training and competency checks.
“Medicines were being managed safely at the home.” from the report
Safeguarding arrangements
The home had safeguarding procedures and a log to monitor investigations. Staff understood what to do if they suspected abuse.
“People were protected from the risk of abuse.” from the report
Infection control
Inspectors were assured that the home used protective equipment safely, supported testing and visits, and had arrangements to prevent and manage outbreaks.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Clean and maintained environment
The home was described as clean and tidy, with maintenance and fire safety checks in place.
“The home was well maintained, clean and tidy.” from the report
Repeated falls
seriousThe home did not consistently show that it had taken effective action after repeated falls. Inspectors were not assured that professional advice or other prevention methods had always been sought.
“We could not be assured that the provider consistently took appropriate action to reduce reoccurring falls.” from the report
Care records difficult to use
needs fixingImportant information was not always easy to find. Inspectors said this could cause difficulties for newly employed or agency staff.
“However, we found accessing and locating information within people's care records was difficult and time-consuming.” from the report
Some medicines plans lacked detail
needs fixingSome care plans did not include important instructions about timing, food or medicines for specific conditions. The report recommended reviewing these plans.
“Care plans for medicines were not always person centred.” from the report
Mixed views about staffing
needs fixingMost staff spoken with said there were occasions when there were not enough staff, including when absent staff were not replaced. Management said staffing was sufficient based on people's needs and occupancy.
“The majority of staff we spoke with told us there were occasions when there were not enough staff on duty.” from the report
- 01What personalised changes have been made for people who have had repeated falls?
- 02When does the home seek advice from occupational therapists or the falls prevention service?
- 03How do staff find the current care plan quickly, particularly when a new or agency staff member is on duty?
- 04How are staffing levels checked, and what happens when staff do not attend and cannot be replaced?
- 05Have all staff completed falls prevention training, and how is this training kept up to date?
This was a focused inspection of Safe and Well-led after concerns about safety and safeguarding; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 3 September 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Knights Court Nursing Home
3 rated inspections over 4 years: the service has held its Good rating throughout.
- October 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- August 2018GoodSafe: Requires improvementWell-led: Good
- July 2017
Registered with the Care Quality Commission on 30 July 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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