About the service: Knoll House is registered to provide accommodation and personal care for up to 22 people. At the time of inspection, 14 people were using the service

People’s experience of using this service:

• People did not always receive safe care. Appropriate window restrictors were not in place on first floor windows. This was a potential risk to people.

• The service was clean, but some areas appeared tired and in need of replacement.

• Staff understood safeguarding procedures.

• Risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Medicines were stored and administered safely.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were trained to support people effectively.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people likes dislikes and preferences.

• People were able to take part in a range of activities.

• People and their family were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required

• Audits of the service were detailed and any issues found were addressed promptly.

• The service had a registered manager in place, and staff felt well supported by them.

Rating at last inspection: Good (report published September 2016)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Follow up: • We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced inspection was carried out on 26 July 2016.

Knoll House is registered to provide accommodation for people who require support with their personal care. They are registered for up to 22 older people, who may be living with dementia. At the time of our inspection there were 17 people living at the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People did not always have activities and entertainment to keep them stimulated or provide them with an opportunity to socialise. Staffing levels were such that people's care needs were met however; staff did not regularly have time to provide additional activities. When it was possible to provide people with activities, these were well attended and enjoyed by people and the registered manager had a plan to extend the range or activities and hobbies available to people.

Staff members worked to ensure that people were kept safe at the service. They were trained in safeguarding and were aware of the actions they should take to identify, record and report incidents of potential abuse. There were also risk assessments in place to identify hazards and provide staff with control measures to help minimise risks.

There were robust procedures in place to ensure that staff were recruited safely and were of good character and suitable to be working with people living at the service. Systems for medication administration were also in place to ensure that people received their medication correctly.

Training was available for staff to provide them with the skills and knowledge they needed to meet people's needs. New staff members received induction training and support and there were on-going training courses and supervisions for all staff to provide them with support and development opportunities. Staff members were knowledgeable about key legislation, including the Mental Capacity Act 2005. They made sure people were offered choices and sought their consent before providing them with care.

People enjoyed the food provided by the service and were supported to have a balanced and nutritious diet, which was sensitive to specific dietary or cultural needs. If necessary, the service supported people to access healthcare professionals, both within the local community and in the service.

Staff members treated people with kindness and compassion and worked hard to develop strong and meaningful relationships with them. People and their family members were involved in planning their care to ensure that their needs were known by the service and they were provided with the information they needed about the service. People were treated with dignity and respect and the service took measures to ensure that people's cultural needs were met.

Care was person-centred. People had specific care plans in place which detailed their individual needs and wishes, which staff used to inform their practice. These were reviewed on a regular basis and updated when people's needs changed. The service was also receptive to complaints or comments from people and acted on them to put things right and develop the service.

There was a positive and open culture at the service. People were happy to be living there and staff were motivated to work with people and try to meet their needs. The registered manager was approachable and supportive to people, their relatives and staff members. They carried out a range of different quality assurance processes to monitor the care at the service and identify areas for improvement.

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with three people and two relatives of people who lived at the home. People told us that they felt safe at the home. One person said, "People are very kind. The girls are all reliable, kind, courteous and helpful."

On the day of our inspection the home appeared to be clean and bright and was free of any bad odours. We looked in the communal bathrooms, wet rooms and toilets. All were clean and had liquid soap and paper hand towel dispensers for hand washing purposes. We spoke with two care workers who were able to demonstrate that they had a good understanding of infection control procedures, including the use of personal protective equipment and effective hand washing. We also saw that the environmental health service had awarded the home's kitchen a rating of 5, the highest available.

Is the service effective?

People told us that the care workers always knocked on their door before entering their room and asked for their consent before any care was delivered. One person told us, "They always ask for my consent. In the morning they say, "Is it alright if I get your glasses out of your bag?"

The two care workers we spoke with told us that if a person did not want the care to be provided they would be encouraged to receive it and the benefits would be explained to them. If the person continued to refuse the care then it would be offered again later. Both care workers told us that they were encouraged to undertake additional training and supported to gain additional qualifications.

Is the service caring?

People told us that they were very happy with the care that they or their relative received. One person said, "People are very kind. The girls are all reliable, kind, courteous and helpful." A relative described the care given as, "...pretty good to excellent." They went on to say, "I only hear kindness, even when they don't know there are visitors here."

Is the service responsive?

One person told us, "They are very caring. If you ring they come straight away. I wouldn't want to be anywhere else." People and their relatives commented that their views were listened to and acted upon. One comment was, "...very well....acted on immediately."

We looked at the care records of three people who lived at the home. We found that these were very personalised and detailed. We saw that people's needs were evaluated and reviewed by care workers on a monthly basis and reviewed with people and their relatives on a six monthly basis. Care plans were also reviewed following any change in need, such as those arising from an admission to hospital.

Is the service well-led?

People told us that they were happy with the quality of the care provided. One person told us, "I came to try it out and decided that I would not find anything better."

We saw that satisfaction surveys were undertaken on a rolling programme with survey forms given to two people who lived at the home a month. We noted that the responses to the questions asked in the survey were mostly positive. One person had commented, "I think it's super."

We saw records that showed that there were regular staff meetings at which the quality of care, care plans and infection control had been discussed. The records also showed that there had also been meetings with relatives and monthly meetings with people who lived at the home.

We saw that there were a number of quality audits undertaken on a regular basis.

When we visited Knoll House on 17 December 2013, we spoke with two people who used the service and two relatives. We also spoke to four staff members and the registered manager.

People said they were satisfied with the care they received from staff at Knoll House. A person who used the service said, “We are looked after 110%. If you can’t be home this is the nicest place to be.”

We observed positive interactions between people and staff and people looked relaxed in staff's company. A relative of a person who used the service said, "The care is very good. The staff are helpful, kind and cheerful.”

We found that people were provided with a choice of suitable and nutritious foods which met their diverse needs.

The systems in place to reduce the risk and spread of infection needed to be improved to ensure that people were protected against the risk of exposure to a health care associated infection.

We found that equipment used was adequately maintained, safe and fit for its purpose. This meant that people were not at risk of unsafe equipment.

The home had effective recruitment and selection processes in place to ensure that the appropriate checks were undertaken before staff commenced work.

We found that the home had systems in place to deal with people’s complaints. These were handled appropriately, without the fear that people would be discriminated against for making a complaint.

We spoke with seven out of the nineteen people currently living at the home and a visiting relative. People told us they were well looked after by staff, who were very helpful and kind.

We were told that people were happy with their rooms and were able to bring in their personal belongings to make their room feel more like home.

One person said, “I like my room. I keep all my personal things in there.”

People told us that they liked living in the home and felt happy to be there. They told us they were well looked after by staff who were always around to help them.

People told us that they were happy living in the home. One said, "I couldn't recommend it highly enough, it is the best place I could be". Another person told us that, whilst they would prefer to be in their own home, this was a close second. They said that the staff were lovely and very helpful. One person told us that they liked the fact that the staff encouraged them to maintain their independence and only helped them with the things they were not able to do for themself.

People told us that they rarely had to wait for call bells to be answered and that, if they stayed in their rooms, the staff regularly called in to see if they needed anything. People said that the staff spent time chatting to them, which they liked. Two people who spoke with us told us about the additional equipment that the staff had obtained for them to assist them with mobility and pressure care. They said that the staff would always contact the doctor for them if they were unwell.

We spoke with people about the activities available and they gave examples of the events, such as carol singers, that had taken place over the Christmas period. They said that weekly exercise sessions took place and that the hairdresser visited weekly. They also said that there were not many other organised activities on a daily basis but that sometimes staff asked them if they wanted to play games.

People told us that they were able to make their own decisions whilst living in the home. They said that they could get up and go to bed when they wanted to. One person told us that, "Its the same as when I was at home, I go to bed late and sometimes I have a lie in". People told us that the staff were polite and kind. They said that they staff knocked on their doors and respected their privacy.

We spoke with people living in the home about the situation regarding the lift being out of use for approximately two weeks whilst a new one was being fitted. One of the people who had to remain upstairs said that, although they were not happy about it, they understood the reasons for it and that the staff kept them informed.

People told us that they liked their rooms and that they had been able to bring in personal items with them to make their rooms more homely. One person told us that they were able to choose whether to have a bath or a shower. Another person told us that they were not happy about the bathroom as there was no heating in it and it was too cold. They said, "Its perishing in there".