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 w

This inspection took place on 3 and 5 September 2016 and was unannounced. During our last inspection on 16, 18 and 19 January 2015 we found the provider had not fully protected people against the risk of potential infection, had not fully protected people against staff who may not be suitable and had not established systems and processes that effectively ensured the service was adequately monitored. The provider had forwarded an action plan which told us how they would meet these breaches of regulation. The provider told us these would be met by 30 July 2015. At this inspection we found these areas of regulation had been met although further improvement was needed to ensure the appropriate processes under the Mental Capacity Act were completed at the appropriate times and auditing process was fully completed.

The care home is registered to provide care and accommodation to up to 22 people; predominantly older people. At the time of the inspection there were no vacancies. Each person had a private bedroom with toilet and washing facilities. There were additional bathing and toilet facilities with specialised equipment to help people. Two lounges and a dining room provided people with comfortable, domestic style areas to sit and socialise. The care home had very well maintained gardens which people told us they enjoyed when the weather was good. Work had started to secure these gardens so people who could get confused and disorientated could enjoy these independently. There was ample parking for visitors.

This is a family run business of which the registered manager is a member of the family.

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.

Prior to the inspection we had received information of concern telling us there were not enough staff to meet people’s needs. There were also concerns relating to the safety of one person who chose to take a walk outside of the care home and that people were being forced to get up from bed earlier than when they wanted to. We explored all of these concerns during the inspection. We found no evidence to suggest people were being forced to get up and where people were at risk staff had taken action to address this.

Risks to people’s health were identified and actions taken to address these. Senior staff fully understood the principles of the Mental Capacity Act 2005 (MCA) and had liaised with external professionals where they had concerns about a person’s mental capacity. In some people’s cases however, where it would have been appropriate to assess the person’s mental capacity and make applications under the Deprivation of Liberty Safeguards (DoLS), this had not been completed. Work to rectify this started at the time of the inspection. We made a recommendation that the provider seek further advice about when applications under the DoLS should be made.

This was an unannounced inspection which was carried out on 16, 18 and 19 January 2015.

The service had not been inspected since it had become a limited company in October 2013.

A registered manager was in position. 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.

Knightsbridge Lodge provides care to 22 older people. At the time of the inspection there were 19 people in the home. The accommodation was across two floors with a passenger lift for access to the first floor.

Improvements to the service were being made and the management team were working to an annual action plan which had been implemented in May 2014.

People were not fully protected against risks of infection because there were shortfalls in the service’s infection control policy and procedure and the staffs’ understanding of some of these arrangements. There was a potential risk that poor or inconsistent infection control practices may put people at risk of infection.

Robust staff recruitment practice had not been adhered to when the service had needed new staff urgently. This had put people at risk of being cared for by staff who may be unsuitable. Effective quality monitoring checks were not always in place leading to some shortfalls identified in this inspection having not been identified by the provider. Actions to rectify these shortfalls had therefore not been put into place. Risks to people were therefore not being sufficiently identified and addressed.

Care was centred around the people who live in Knightsbridge Lodge and the environment was comfortable and welcoming. One relative said, “I would highly recommend the home, it’s very good”. All the staff were involved in promoting the wellbeing of those that lived there. The staff told us they were happy and felt supported by the management team.

Opportunities for staff to have designated time to talk with managers about their training needs and performance had varied for each member of staff. The management team recognised they needed to allocate more time to organise and complete formal support sessions with staff. The registered manager and deputy manager worked together on a day to day basis and provided joint leadership to the staff. They communicated effectively with staff and their ultimate aim was for people to be respected, treated with dignity and to receive the care and support they needed in a caring environment.

Staff had been provided with basic training so as to care for people safely, or, they had received this in previous care jobs. Although staff lacked formal training in areas such as end of life care, dementia care, equality and diversity and infection control procedures this had not had a negative impact on the people living in the home. This was because there were staff with the appropriate knowledge to advise them and monitor care practice.

People’s risks were identified and managed. Risks such as poor dietary intake, falls, problems with swallowing and the development of pressure ulcers were all addressed. Care records were in place to give staff guidance on how to meet these risks. People had an opportunity to review their care plans each month or if they were unable to do this, their representative did so. One health care professional said, “This home actually implements the care they write in the care plans”. Staff worked alongside health and social care professionals to ensure people’s needs were met in the best possible way.

People’s preferences and wishes were known to the staff. This included their likes and dislikes with regard to their food, delivery of personal care and social activities. People told us they enjoyed the food and confirmed they were given the choices we saw advertised. When people were particularly poorly the cook provided food which the person “fancied” on the day. People’s preferences regarding social activities varied. For example, two people we spoke with were happy with what was being provided and one other felt they needed more stimulation. Staff were looking at how they could make activities more suited to the individual person. People told us they felt included and involved in decisions and changes made in the home.

Staff recognised the need to support and encourage people to make decisions and choices whenever possible. Where this was not possible, due to a lack of mental capacity, staff adhered to current legislation to ensure people were protected.

People told us they were treated with dignity and respect and a survey carried out by the management in December 2014 confirmed this was a majority view. End of life care was planned so as to ensure any discomfort or distress was managed effectively. This involved community health care professionals who provided support where needed. One relative talked to us about their relative’s recent death they said “she died with dignity, they really cared for her and the family.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The evidence was gathered prior to 1 April 2015 when the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were in force. You can see what we asked the provider to do about this at the end of the full version of the report.