The Knights provides accommodation for up to 31 people, who require help with personal care. The home is situated close to the centre of St Annes on Sea and is within easy reach of public transport, the beach and local amenities. Accommodation within the home is situated on three floors. There is a passenger lift and stair case providing access to the upper floors. The service has two lounges and a dining room situated on the ground floor. A limited number of car parking spaces are available to the front of the building on a private forecourt, but on road parking is also permitted. At the time of our inspection visit there were 23 people who lived at the home.

At the last inspection carried out on 01 November 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

When we undertook our inspection visit the registered manager had recently left the service. 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. The service had appointed a new manager who had submitted an application to be registered with the Care Quality Commission (CQC). This was being dealt with by CQC’s registration team when the inspection visit took place.

People who lived at the home told us they were happy, felt safe and were treated with kindness at all times. Comments received included, “I get on with all the staff they are very caring and show a genuine interest in you.” And, “The staff do a really good job and I feel safe in their care.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at times they needed them.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place to live. We found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place. People who lived at the home told us they were happy with the standard of hygiene in place.

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’s care and support had been planned with them. They told us they had been consulted and listened to about how their care would be delivered.

Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People told us they were happy with the variety and choice of meals available to them. We saw

This inspection visit took place on 01 November 2016 and was unannounced.

At the last inspection on 06 April 2016 we asked the provider to take action to make improvements because we found multiple breaches of legal requirements. This was in relation to safeguarding people from unsafe care, poor management of medicines, abuse and improper treatment, risk assessment to people’s health and safety, person centred care, premises and equipment; infection control; consent and capacity and governance of the home. The provider sent us an action plan saying they would meet the legal requirements by 30 September 2016. During our inspection visit on 01 November 2016 we found these actions had been completed.

The Knights provides accommodation for up to 31 people, who require help with personal care needs. The home is situated close to the centre of St Annes on Sea and is within easy reach of public transport, the beach and local amenities. Accommodation within the home is situated on three floors. There is a passenger lift providing access to the upper floors. Communal areas, such as lounges and a dining room are available. A limited number of car parking spaces are available to the front of the building on a private forecourt, and on road parking is also permitted. At the time of our inspection visit there were 22 people who lived at the home.

There was a registered manager in place. 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.

People who lived at the home told us staff who supported them were kind, caring, polite and professional in their approach to their work. Comments received included, “You hear some bad things about care homes but this one is very good.” And, “I cannot find fault with anything. The staff do everything I ask.”

Staff knew people they supported and provided a personalised service. The service operated a keyworker system. This is where a member of care staff is allocated to each person and acts as a focal point and will try and ensure the person’s personal requirements are not overlooked. One person who lived at the home said, “Yes I know my keyworker they make sure I am looked after.”

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at the recruitment of two recently appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about the support needs of people in their care.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without being rushed. Comments received included, “The staff are so caring and responsive when I need help.” And, “I think there is enough staff around, I don’t have to wait long if I need them.”

We found the registered mana

This inspection took place on 06 April 2016 and was unannounced.

The service was last inspected 27 September 2013. At that inspection we found the service was meeting the legal requirements in force at the time. We made some recommendations for the provider to consider which included ensuring hand written medicine administration records were double signed to avoid transcription errors. We also recommended the provider to ensure they obtained two references before staff were appointed to work at the home. We checked to see if these recommendations had been taken on board and found the home had followed the recommendations.

The Knights provides accommodation for up to 31 people, who require help with personal care needs. The home is situated close to the centre of St Anne’s on Sea and is within easy reach of public transport, the beach and local amenities. Accommodation within the home is situated on three floors.

There is a passenger lift and stair case providing access to the upper floors. Comfortable communal areas, such as lounges and a dining room are available. A limited number of car parking spaces are available to the front of the building on a private forecourt, but on road parking is also permitted.

The registered manager was present throughout our inspection. 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.

At the time of this inspection there were 18 people who lived at The Knights.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that some staff had received training in safeguarding adults and demonstrated a good understanding about what abuse meant.

We found safeguarding incidents had been recorded. The provider had recorded accidents and incidents and documented the support people were getting after experiencing falls. We found evidence staff had sought advice from health professionals.

We found people’s medication was being managed safely however plans [protocols] for “as and when medication (PRN) were not robust”. Staff had received appropriate medication training.

We found there was a building fire risk assessment on the premises.

People had Personal emergency evacuation plans (PEEPS) which were meant to enable safe evacuation in case of emergency however we found these were not accurately completed and did not give accurate detail on whether people could walk independently, require assistance from staff and where people would be evacuated to.

Staff were suitably recruited and there were enough staff to ensure that people's needs were safely met. There was scope within the staffing levels to keep checks on people's welfare and, when necessary, to provide extra care and support.

We found evidence of staff disciplinary actions being recorded.

The staff showed awareness of Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. However we found the knowledge was not sufficiently turned into action when planning for care and supporting people on a daily basis. Staff were provided with effective support, induction, supervision, appraisal and training.

We found that people’s health care needs were not effectively assessed on admission to the service.

Consent was not always sought from people. The home did not consistently involve people in decisions made around the care they received. Care plans did not evidence people’s involvement. However the home had a key worker policy in place. The service did not regularly seek people’s opinions on the quality of care and service being provided. Evidence on surveys could not be relied on as dates had been altered on surveys before our inspection.

We found evidence of management

During our visit to The Knights we spoke with five people using the service, who all provided us with positive comments about what life was like at the home. People told us they were able to make choices about how they lived and what they wanted to do. They told us their needs were being met by a kind and caring staff team and that the food was of a good quality. We noted that those living at the home looked comfortable in the presence of staff members.

Comments received included:

“The girls (staff) are marvellous. The young fellows are too. The food is delicious and the surroundings are very comfortable. What more can you ask for?”

One person told us he often stayed at the home for respite care. He commented, “They (the staff) are very helpful. The ‘grub’ is always good. They cannot do enough for us. I have no complaints whatsoever. If I wasn’t happy with the service I wouldn’t keep coming back, would I?”

“This place is perfect. I cannot think of anything I would change.”

"The Knights is the best. It is really very well organised and friendly. I am comfortable here. It is warm and homely."

During our inspection we looked at standards relating to care and welfare and how the quality of service was assessed and monitored. We also checked the management of medications, meal provision and how staff were recruited and supported. We did not identify any concerns in any of the outcome areas we assessed.

We spoke with a range of people about the home. They included the registered manager, staff members, people who lived at the home and two family members visiting their relatives.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "You can’t beat this place.” And, “I can’t think of anything that isn’t right”.

We spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and dignity.

We had the opportunity to speak with a number of residents during our visit to the home. In general, we received some very positive feedback. People we spoke with were complimentary about the service provided and spoke highly of staff and managers.

People told us that they were satisfied with the standard of care they received and that they were confident carers understood their individual needs. Comments included;

‘’I’ve lived here for ten years and have no complaints at all.’’

‘’I take care of my own tablets but there is help if I want it.’’

‘’I have a special diet - there are a lot of things I can’t have but they always have something to suit me.’’

‘’I know while I am here I will be well looked after. We can all be sure of that.’’

People said that they were satisfied with the quality of meals provided and in particular, people were pleased with the choices available to them about what they ate. One resident said ‘’There are lots of choices on the menu but they will do you whatever you want. I had poached egg yesterday just because I fancied it!’’ ‘’You can have something different to what is on the menu – there are no questions they just sort it out for you’’ commented another resident.

We asked people about daily life at the home and if they felt there were enough activities available to them. The majority of people said that they were satisfied with the provision of activities. ‘’I go out maybe once a week, that is enough for me’’ said one resident. Another person told us ‘’We have nice tea parties, they are very good like that.’’

One person commented that there had been an activities coordinator employed but went on to say that she no longer worked at the home. However, we were also told that a new activities coordinator had been appointed and would be joining the home in the near future.

None of the people we spoke with expressed concerns about any aspects of their care, although two residents did say that they felt staffing levels at the home were variable. One person stated ‘’There are times when the carers are absolutely run off their feet’’ and another told us ‘’I think they have problems when people don’t turn in but they always do their best.’’