CQC report explained · a residential care home
What the CQC found at The Knowle Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were not always managed safely. Some training, competency checks and records of medicine times were not up to date or complete.
- Effective?
- Good
- The report does not give a rating or detailed findings for this question.
- Caring?
- Good
- The report does not give a rating for this question. Inspectors found that some staff were kind and respectful, but people's experiences of care varied.
- Responsive?
- Good
- The report does not give a rating for this question. Inspectors found that people's preferences and simple requests were not always respected or met.
- Well-led?
- Requires improvement
- There was not enough oversight of risks, records and incidents. The culture did not always support person-centred care.
What inspectors found, March 2024
Requires Improvement; inspectors found unsafe medicines management and weak oversight, although staffing and some care had improved.
This was an unannounced inspection on 12 and 23 January 2024. One inspector spoke with people living in the home, relatives and staff. They reviewed care records, medicine records and records about safety and management.
The home was rated Requires Improvement for Safe and Well-led. Medicines were not always managed safely. Records did not show when some time-sensitive medicines were given, and some staff did not have up-to-date medicines training or competency checks.
Inspectors also found weak oversight of risks, incomplete incident reporting and care that was not always based on people's preferences. Some people experienced kind care, staffing levels met the provider's assessment, and recruitment checks had been completed.
The home was already rated Requires Improvement at the previous inspection in 2022. Some improvements had been made, including better management of falls risks and cleaning, but the home remained in breach of regulations. The provider must send an action plan, and CQC will monitor progress with the local authority.
Recruitment checks
The home completed the necessary checks before staff started work.
“Staff had been recruited properly. All necessary pre-employment checks had been completed before staff started work.” from the report
Some kind care
Some people and relatives were happy with the care, and inspectors saw staff supporting people kindly and respectfully.
“Some people living in the home and their relatives were happy with the care they received.” from the report
Improvements made
Inspectors found that falls risk management had improved and that earlier cleaning and kitchen work had been completed.
“At this inspection we found the necessary work had been completed.” from the report
Staffing assessment
The number of staff met the provider's assessment of people's needs, although some relatives reported delays at times.
“We found staffing levels were at the level the provider had assessed as necessary.” from the report
Medicine safety
seriousMedicine administration times were not always recorded. Some staff lacked current training or regular competency checks.
“Not all staff had up to date medicines training and not all staff responsible for administering medicines had their competencies checked regularly.” from the report
Person-centred care
needs fixingPeople did not always receive care that respected their preferences. Some people did not have hot water in their bedrooms.
“Not everyone who needed it had hot water in their bedrooms which prevented them from meeting their needs independently” from the report
Weak oversight
seriousThe home did not adequately review falls, care records and other risks. The provider also missed some opportunities to learn from incidents.
“There was not enough oversight and governance of risks.” from the report
Missed notifications
needs fixingNot every incident that should have been reported to CQC or safeguarding authorities had been submitted.
“Not all incidents which were notifiable to CQC and local authority safeguarding had been submitted.” from the report
Call bell delays
needs fixingPeople gave different accounts of how quickly staff responded when they used their buzzers. One person reported waiting a long time.
“When I ring my buzzer I have to wait a long time.” from the report
- 01How are you now recording the exact times for time-sensitive medicines and medicines given around food?
- 02Which staff currently administer medicines, and when were their training and competency checks last completed?
- 03What has been done to ensure every bedroom needing it has hot water?
- 04How are you checking that care records are accurate and that people's preferences and simple requests are being followed?
- 05What changes have been made to review falls, report incidents and learn lessons from them?
This was a focused inspection prompted by concerns about staffing and it rated Safe and Well-led; the report does not give ratings for the other three questions. This explanation was written from the published report of 9 March 2024 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, June 2022
The Knowle Care Home was rated Requires Improvement; inspectors found caring staff but concerns about falls monitoring, records and some staff areas.
The inspection was unannounced and took place on 13 and 14 April 2022. One inspector spoke with staff and relatives, looked around the home and checked care, medicines, safety, maintenance and management records.
The home had trained and caring staff. People received their medicines as prescribed, and the home followed infection control measures in most areas. However, falls were not always monitored properly. Some care records did not match the care given, and some staff-only areas needed cleaning.
The overall rating fell from Good at the previous inspection to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three questions were not inspected during this visit, so their previous ratings were used for the overall rating.
Caring staff
Inspectors found staff were trained and caring. Staff appeared to have time to support people and responded calmly.
“People were supported by trained staff who were caring and compassionate.” from the report
Medicines
Staff who gave medicines were trained and had their skills checked. Medicine records were generally completed properly, and audits identified and acted on gaps.
“Medicine administration records (MAR) had been completed properly.” from the report
Infection control in main areas
Communal areas, bedrooms and bathrooms were clean and tidy. Staff used protective equipment and the home had supplies and disposal facilities available.
“Communal areas of the home, bathrooms and bedrooms were clean and tidy.” from the report
Early management improvements
The manager had been in post for a short time and had started improving care quality, records and communication with people and staff.
“The manager, who had only been in post for a short time, had begun to embed improvements to care quality and record keeping.” from the report
Falls were not always monitored quickly
seriousMore than half of the recorded falls in a five-week period were found during routine checks. Inspectors said people could sometimes have been on the floor for up to two hours.
“Falls records showed 50% of falls people had were only discovered by staff on routine checks.” from the report
Care records did not always match care given
needs fixingInspectors found occasions when electronic records said care had been provided when it had not happened as recorded. They recommended better, timely record keeping.
“We found occasions when electronic care records had not reflected care provided.” from the report
Some staff areas needed cleaning
needs fixingA staff-only corridor, a kitchen door, a drinks trolley and the outside of some pans were dirty or worn. Inspectors said this created a risk of infection or cross-contamination.
“These issues presented a risk of infection or cross contamination.” from the report
Busy teatime period
minorSome staff said they felt stretched while providing the teatime meal. The manager planned to recruit an additional staff member for this period.
“Some staff felt it was too busy during the teatime period due to staff being stretched as they had to provide the teatime meal.” from the report
- 01What changes have been made to prevent people waiting too long after a fall?
- 02How are hourly observations and other falls checks now recorded and reviewed?
- 03How do you check that electronic care records accurately reflect the care given?
- 04Have the staff-only kitchen areas, drinks trolley and pans been cleaned or replaced?
- 05Has extra staffing been introduced for the teatime and early evening period?
This was an unannounced focused inspection of Safe and Well-led; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 22 June 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.
Every inspection of The Knowle Care Home
5 rated inspections over 9 years: the service has slipped, from Good to Requires improvement.
- March 2024Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
- December 2020Inspected but not ratedSafe: GoodWell-led: Good
- February 2019Goodstayed GoodSafe: GoodWell-led: Good
- August 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 17 January 2011.
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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