Knightsbridge Lodge

Updated 28 February 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 28 December 2017, 2 and 3 January 2018, was unannounced and carried out by one inspector. Prior to the inspection visit we reviewed information we held about the service. All statutory notifications, received since the last inspection on 3 and 5 September 2016, were reviewed. These contained information about incidents and events that had taken place, which the provider must legally inform us about. We used information the provider sent us in the Provider Information Return (PIR) to help plan the inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection visit we observed the support being provided to people. We spoke with six people who lived in the home including one relative. We inspected five people’s care files which contained pre-admission assessments, care plans, risk assessments and other relevant care records. We reviewed records and documents relating to the care of people who lacked mental capacity; one of which had authorised Deprivation of Liberty Safeguards (DoLS) in place. We spoke with the registered manager, deputy manager, a senior care assistant, two care assistants, a cook and the activities co-ordinator. We also spoke with two practitioners from the NHS Rapid Response Team and sought the views of two other health care professionals. Two representatives of the provider were present throughout the inspection visit and were present at the inspection feedback.

We looked at records pertaining to the management of the home. These included three staff recruitment files, the staff training record, a selection of audits and two policies. We reviewed the maintenance records and various service certificates. We also reviewed complaint records. We attended two staff handover meetings. We visited all areas, inside and outside of the building, which were accessible to people. We read the compliments which had been forwarded to the staff.

Updated 28 February 2018

This inspection took place on 28 December 2017, 2 and 3 January 2018 and was unannounced.

Our comprehensive inspection on 16, 17 and 18 January 2015 found breaches in legal requirements. These included shortfalls in infection control procedures, unsafe recruitment of staff and a lack of effective quality monitoring processes. An action plan was received and the provider told us these breaches would be met by 31 July 2015.

On 3 and 5 September 2016 we carried out a second comprehensive inspection and found the provider had met the necessary regulations. The rating for the key question, Is the service safe? had improved to at least good. However, further required improvement was needed to the key questions, Is the service effective and well-led? and the overall rating of the home remained Requires Improvement. We made two recommendations to support the provider to improve their quality monitoring processes and the implementation of the Mental Capacity Act 2005 to ensure people were fully protected. We also met with the provider following this inspection. We discussed the fact that this was the second, consecutive time the service had been rated Requires Improvement and to receive assurances that action would be taken to improve the rating of the service to at least Good.

During this inspection on 28 December 2017, 2 and 3 January 2018 we found the recommendations had been acted on and improvements had been made to the key questions, is the service effective and well-led?. The service has been rated Good overall.

Knightsbridge Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Knightsbridge Lodge does not provide nursing care and can accommodate 22 older people in one adapted building. At the time of the inspection 19 people were living there.

Accommodation was over two floors and comprised of a single bedroom with window/s, a sink, heating and bedroom furniture. Additional communal and adapted toilets and bathrooms were on each floor. People also had the use of two lounges and a dining room. Outside there was an enclosed garden with seating areas to both sides of the building. A larger, grassed area with flower borders as well as car parking was at the front of the building. The home had wheelchair access and a passenger lift and stairs allowed access to the second floor.

A registered manager was employed. 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 the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Why the service is rated Good.

There were arrangements for keeping people safe which were consistently adhered to. There was a proactive approach to managing risks, which took into account people’s desire to remain independent. An open and transparent culture helped to protect people from abuse and poor care. There was a willingness to learn from mistakes. People’s rights were protected. The need for specific support, stemming from people’s behaviour was understood and provided. There were systems in place to ensure all equipment, services and the building remained safe. People lived in a clean home where infection control measures were followed. Staff were recruited safely and in enough numbers to meet people’s needs. People’s medicines were managed safely.

People and their relatives gave consistent positive feedback about the care provided. Staff received relevant training and support to be able to support people’s well-being and meet their diverse needs. Care and health needs were assessed, reviewed regularly and referrals were made to other professionals and agencies who could help with these. Where needed people were supported to eat and drink. Any concerns about people’s appetites or weight were addressed.

Staff worked closely with other agencies and services when supporting people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People who lacked mental capacity to make their own decisions were protected from decisions which may not be in their best interest. Adaptions were made to the environment to make people’s lives easier and safer.

People and their relatives were consistent in their feedback about how kind and compassionate the staff were. Staff took time to explore people’s likes, dislikes, preferences and wishes as well as their life history. This meant staff knew people well and could have meaningful conversations with them. People were treated with respect and their dignity and privacy was upheld. Those who mattered to people were welcomed and included into the ‘Knightsbridge Lodge family’. People were listened to and communicated with in ways which enabled them to be included and to participate.

People’s care was planned with them. Where appropriate family members were consulted with and could speak on behalf of their relative. Care planning took into consideration people’s diverse needs as well as their expectations and goals. Care was reviewed and altered in consultation with people. People were provided with information in a way they could understand it.

Arrangements were in place for people and others to raise a complaint and have this listened to and addressed. Managers used complaints and other feedback as an opportunity to reflect on and improve the service provided. Staff worked closely with health care professionals to ensure people had a comfortable and dignified death. People’s specific wishes for this time were met. Relatives were provided with the support they needed at their time of loss.

Improvements in how the service was monitored and in how actions were followed up had led to sustained improvements in systems, processes and practices which helped protect people. Staff were committed to the provider’s visions and values. These were of a caring service which supported people to live well. Managers valued feedback from people, relatives and staff and used this to make improvements and to inform the decisions made about how the service was run. All necessary regulations were complied with.