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, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 1 November 2016. We last inspected this service in October 2014 during which we found that the provider met all the regulations in force at that time. Since then there has been no incidents or concerns raised that needed investigation.

The Knells Country House provides care and accommodation for up to 22 older people some of who may live with dementia. It is situated in a rural setting not far from the centre of Carlisle. It is an older property, which has been adapted and extended with accommodation on two floors accessed by a passenger lift and stair lift.

At the time of our visit there was a registered manager in post. 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 and associated Regulations about how the service is run.

People who used this service were safe. The staff knew how to identify if a person was at risk of abuse and the action to take to protect people from harm. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. Staff had completed training in the protection of vulnerable people.

Staffing levels were good. The records we looked at showed that staffing levels were planned around the needs of people who lived in the home. We saw that staffing levels were increased at certain times during the day when the work load was at the highest level. People were recruited safely which ensured only suitable people were employed at The Knells.

We found that peoples' medicines were managed well through a computerised system and in line with their prescriptions. Healthcare needs were met through advice from the mental health team, peoples’ doctors and consultants where necessary. Dental, optical, chiropody and dietician services were accessed when required.

People were provided with sufficient food and drink in order to maintain good levels of nutrition and hydration. People told us “We have a choice of meals and if there is anything we don’t like we can choose something else” and “The food is excellent and all home cooked”. Dietary needs and nutrition were well managed.

People had their care and support needs assessed and kept under review. Staff responded quickly when people’s needs changed, which helped to ensure their individual needs were appropriately met.

We saw that people were treated with kindness and respect. They were included in planning and agreeing to the support they received. The care staff knew the people they were supporting well and respected the choices they made about their care. The staff knew how people communicated and gave them support to make and express choices about their lives. People were encouraged to follow activities of their choice both in the home and out in the wider community if they wished.

The registered manager set high standards and the focus of the service was on promoting people’s choices and rights. The registered manager and the staff team had a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, (DoLS). They understood how to protect the rights of people who needed support to make important decisions about their lives.

The provider had policies and procedures in place to deal with any concerns or complaints. There had been no complaints to record. There was an appropriate internal quality audit system in place to monitor the quality of the service provided.

The home was m

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, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 22 October 2014. During our previous inspection visit on the 28 November 2103 we found the service met all the national standards we looked at. Since then there has been no incidents or concerns raised that needed investigation.

The Knells Country House (The Knells) provides care and accommodation for up to 22 older people some of who may suffer from dementia. It is owned by The Knells Country House Limited and is situated in a rural setting not far from the centre of Carlisle. It is an older property, which has been adapted and extended with accommodation on two floors accessed by a passenger lift or stair lift.

At the time of our visit there was a registered manager in post. 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 and associated Regulations about how the service is run.

We spoke to people who lived in the home in the communal areas and in the privacy of their rooms. We were able to speak to people who were visiting relatives and a health care professional who had come to talk to the registered manager.

People told us they were happy living in The Knells and said, "I love it here and the staff are so kind. I am glad I moved in". Relatives told us they were pleased with the care their family members received. Comments included, "I am so pleased my relative moved here. It gives me peace of mind knowing they are so well cared for".

People were protected by staff who knew how to keep them safe and managed individual risks well. Staffing levels were appropriate which meant there were sufficient staff to meet people’s needs and support their independence. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

We saw, throughout our visit, staff treated people with respect and preserved their dignity. This did not mean staff did not have time for a laugh and joke with people and one person said, "I really enjoy having a good laugh with the lassies".

The registered manager provided details of the staff training plan that evidenced staff training was up to date. Staff confirmed they received training appropriate to their roles within the staff team.

People had access to external health care services which ensured their health care needs were met. Staff had completed training in safe handling of medicines and the medicines administration records were up to date. People were provided with sufficient food and drink in order to maintain good levels of nutrition and hydration. People told us "We have a choice of meals and if there is anything we don’t like we can choose something else" and "The food is excellent and all home cooked".

We saw evidence that staff recruitment and selection was robust and guaranteed only suitable people were employed to care for and support people using this service.

There was an appropriate internal quality audit system in place to monitor the quality of the service provided.

People and their relatives told us they were happy with the care and support provided by the staff in The Knells. They said,

“I love it here. I was so lonely at home on my own and I could not be happier”.

“I am very well looked after thank you. I go downstairs for my breakfast and lunch but have my tea in my room”.

Relatives said,

I am very happy with the care my relative receives. I chose this home because she was unable to do so at the time. I have never regretted it. She has really settled down well”.

We saw, throughout our visit, that people were treated with respect and their dignity was preserved. Staff were constantly chatting to people whilst they were providing support.

Each person had an up to date care plan which evidenced that every person was fully assessed prior to moving in to The Knells. This ensured that the service was able to provide an appropriate level of care and support.

Medicines were managed well and safely. All staff who administered medicines had been appropriately trained.

Risk assessments were in place and reviewed each month with the care plans.

The home had a full set of policies and procedures in place and records were up to date and securely stored in lockable facilities.

When we asked people living in The Knells about the care and support they received they all told us how happy they were. One gentleman said, "I made the best decision of my life when I decided to move into this house". Other people told us how kind the staff were, "Nothing is too much trouble" was one comment and another was "I like to do as much as I can for myself but I only have to use the call bell and someone comes".

We found that staff interacted well with the people living in the home and that there was a warm and friendly atmosphere throughout our visit.

Each person was fully assessed prior to moving in and care records were informative and up to date. The staff knew people well and were seen treating them with respect and as individuals. Some people had difficulty in communicating but the staff understood their needs and met them in an appropriate manner.

people using this service told us they were very pleased to live in the Knells and were happy with the care they received. Comments included:

'I love living here'

'The staff are so kind and are always around to help'

'I enjoy my meals and we have lovely home made cakes ans biscuits'.

Familiy members were also very positive about the care provided. they said' 'My uncle is very well cared for and he is very happy'.

'My mother is looked after very ell and I have no complaints at all'.