CQC report explained · a residential care home
What the CQC found at Knowle Hill
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Medicines were managed safely, risks were assessed and the home was clean, although one bed-rail risk assessment was missing from a care record and was added during the inspection.
- Effective?
- Good
- Staff were trained, skilled and supported people's health, nutrition and communication needs. Some people did not know the lunch options in advance, and one dietary record needed more detail, which was updated during the inspection.
- Caring?
- Good
- People and relatives described staff as kind and caring. Inspectors saw staff respect people's dignity, privacy, choices and independence.
- Responsive?
- Good
- Care plans were detailed and personalised, and staff knew people's preferences. However, some people said there were too few activities, and inspectors recommended improving the activity programme.
- Well-led?
- Good
- The home had an experienced manager, positive staff morale and regular checks on quality and safety. People, relatives and staff had opportunities to give feedback.
What inspectors found, November 2019
Rated Good; inspectors found safe, kind and well-managed care, but activities needed improvement.
This was an unannounced inspection on 17 October 2019. Inspectors spoke with people living in the home, relatives, staff, health professionals and visitors. They reviewed care and medicines records, observed daily care, and checked the building.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines practices, clean surroundings and staff who knew people well. People were treated with kindness, dignity and respect.
Some people said there was not enough to do during the day. Inspectors found that regular, planned activities were not yet part of the home's daily service and recommended improvements. Some people also did not know what would be served at lunch until it was served.
The previous inspection had rated the home Requires Improvement and found a breach relating to medicines. This inspection found that improvements had been made and there were no current breaches of regulations.
Safe medicines
Inspectors found that medicines systems had improved since the previous inspection. Records showed people received medicines as prescribed, and staff's competence was checked regularly.
“The records we checked showed people received their medicines as prescribed.” from the report
Kind and respectful staff
People and relatives spoke positively about staff. Inspectors saw staff treat people with dignity, respect privacy and encourage independence.
“Staff treated people with dignity and respect throughout this inspection.” from the report
Personalised care
Care plans included people's life histories, interests and preferences. Staff knew people well and adapted their approach to individual needs.
“People's care plans contained detailed information about their life history and interests; this supported staff to build positive relationships and bonds with them.” from the report
Strong management
The home had regular quality and safety checks, action plans for improvements and a culture where staff could raise concerns.
“The registered manager and senior staff regularly completed a range of checks on the quality and safety of the service provided.” from the report
Too few activities
needs fixingSome people said they did not have enough to do. Inspectors found that regular, planned activities were not yet embedded in daily life and recommended improvements.
“However, regular, planned activity provision was not embedded into the daily service provided.” from the report
Limited information about lunch
minorSome people were satisfied with the food but did not know what would be offered at lunchtime until the meal arrived.
“The food is ok, but you don't know what's on offer for lunch until it gets here” from the report
Short delay during a staff break
minorOne person waited briefly for support while another staff member was on a break. Inspectors asked the manager to review staff deployment at break times.
“We observed a person had to wait for a short period of time to receive support from staff whilst another member of staff was on their break.” from the report
- 01What regular activities are now available each day, and how are they matched to each person's interests?
- 02How are residents told about the lunch choices before lunchtime?
- 03How do you make sure people receive prompt support when staff are taking breaks?
- 04What changes were made after the previous inspection to keep medicines records and checks safe?
This was an unannounced planned inspection covering all five key questions, with care and the premises both looked at. This explanation was written from the published report of 7 November 2019 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, October 2018
Rated Requires Improvement; inspectors found kind, person-centred care, but medicines were not always managed safely and quality checks did not always lead to action.
The inspection was unannounced and took place on 25 September 2018. It was the first inspection since the home moved to this address. Inspectors spoke with people living there, relatives, staff and health professionals. They reviewed care records, medicines records, staff files and quality checks.
People said they felt safe and praised the staff. Inspectors found good standards of care, including support with food, healthcare, choices, activities and complaints. Staff were described as kind and respectful, and care records were mostly person-centred.
The main safety concern was medicines. Records for topical medicines were missing for some people for eight days before the inspection. There were also concerns about medicine opening dates, handwritten records and checking controlled medicines. Staffing levels and the effectiveness of quality audits also needed improvement.
The overall rating was Requires Improvement. Effective, Caring and Responsive were rated Good. Safe and Well-led were rated Requires Improvement. The report identified one breach of the regulations.
Kind and respectful staff
People and relatives were very positive about the staff. Inspectors observed people being treated with dignity and respect.
“People living at Knowle Hill and their relatives spoke very positively about the staff and their caring attitude.” from the report
Personalised care
Care records generally explained people's needs, preferences and interests. Staff knew people well and supported them as individuals.
“People's care records were person centred and were sufficiently detailed to guide staff in providing care to people in accordance with their preferences.” from the report
Activities and community links
The home offered activities suited to people's abilities and interests. Some people were supported with one-to-one activities and community trips.
“People were supported to take part in a variety of activities, both in the home and in the community.” from the report
Training and healthcare support
Staff received relevant training and regular supervision. The home worked with health professionals and made referrals when needed.
“Staff received regular training which supported them to deliver effective care to people.” from the report
Medicine records
seriousTopical medicines were not consistently recorded. Inspectors could not tell whether some medicines had been given as prescribed, creating a risk to people's health.
“At the time of our inspection, no records had been made about the administration of topical medicines to people residing on the lower ground floor for eight days prior to the inspection.” from the report
Staffing levels
needs fixingStaff said staffing levels were too low after the move to the larger building. They said this affected the time available for person-centred care.
“Staff told us they felt staffing levels were too low since the service had moved to its new address in a much bigger building.” from the report
Quality checks did not always lead to action
needs fixingThe home completed audits, but some improvements were not followed through consistently. The medication audit did not check topical medicine records, even though managers knew about the problem.
“However, insufficient action had been taken to address this issue which meant there was an ongoing risk to people's health.” from the report
Some care records needed updating
minorOne care plan had conflicting information after the person's health declined. The record was updated during the inspection.
“However, we saw one care record had not been fully updated following a decline in the person's health.” from the report
- 01How do you now record every administration of topical medicines, and who checks these records?
- 02What changes have been made to staffing levels since the inspection, and how do you cover vacancies or agency use?
- 03How do managers make sure audit findings lead to completed action plans?
- 04How are care plans checked and updated promptly when someone's health or support needs change?
- 05How do staff raise concerns about workload and management support outside staff meetings?
This was an unannounced inspection covering all five CQC questions and included observations, discussions with people and staff, and reviews of care, medicines, recruitment and management records. This explanation was written from the published report of 26 October 2018 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 Knowle Hill
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- November 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2018Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2017
Registered with the Care Quality Commission on 3 October 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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