This inspection took place on 25 September 2018 and was unannounced. This was the first inspection of Knowle Hill since the service moved to this address.

Knowle Hill is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Knowle Hill can accommodate up to 74 people who require accommodation and personal care. The home is purpose built over three floors and each floor has communal lounges and dining areas. At the time of our inspection there were 64 people living in the home.

There was a registered manager employed at Knowle Hill. A registered manager is a person who has registered with the 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 about how the service is run.

People told us they felt safe. Staff had received training in their responsibility to safeguard vulnerable adults. They all knew what action to take if they witnessed or suspected abuse.

People’s medicines were not always managed safely. Some aspects of the medicine system were well managed, however medicine administration records for topical medicines were not adequately completed. This posed a risk to people’s health.

People’s needs were assessed before they moved into the service. Suitable risk assessments were in place, such as moving and handling, use of equipment and risk of falls. People's care records were sufficiently detailed and person centred. They set out what care the staff needed to provide. People's care plans and risk assessments were kept under review.

People living at Knowle Hill were happy with the staffing levels in the home. However, staff felt the staffing levels were too low and this was affecting their ability to deliver person centred care. We have made a recommendation about staffing levels.

Staff were kind and caring. We observed staff treat people with dignity and respect. People we spoke with and their relatives were very positive about the staff at Knowle Hill and the care they received.

Staff received regular supervision, appraisals and appropriate training to support them to carry out their jobs effectively.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People had access to a range of activities at Knowle Hill, which were tailored to their personal preferences and abilities. They were also supported to access the local community.

The registered provider had an appropriate complaints procedure in place. People’s complaints were recorded, investigated and responded to appropriately.

The registered manager and team leaders completed various audits of the service to identify anything that could be improved. Audits were usually acted upon, however not all audits resulted in necessary improvements being implemented. We have made a recommendation about the audit system used by the registered provider.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report.