The Knowle is registered to provide personal care for up to 32 older people. Accommodation is provided on the ground and first floor and accessed by a passenger lift. There are two communal lounges, two dining rooms and a conservatory on the ground floor and ramped access to the garden. The home is close to Docklands Retail Park with good local transport links.

At the last inspection on 26 July 2017, 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.

During this inspection visit, people and their relatives told us they felt The Knowle was a safe home to live in and visit. One person said, “My [relative] doesn’t have to worry about me when I am here. The staff are very friendly and take good care of me.” The registered manager had robust systems to maintain a safe environment and reduce the risk of accidents and incidents. We saw evidence staff had relevant training and were knowledgeable about who to report safeguarding concerns to.

We discussed the management of medicines with people, who said this was safely administered at The Knowle. An excellent electronic medication recording system was used whereby information was accurately documented and failsafe processes prevented the risk of errors.

The provider followed the same safe recruitment procedures we found during our last inspection. We saw this contributed to good staffing levels and skill mixes at The Knowle and we observed a patient, unhurried workforce. A person who lived at the home stated, “I need help sometimes and the girls are always around to help.” A range of courses and regular supervision helped staff to strengthen their skills. A staff member told us, “There’s plenty of training available.”

Those who lived at The Knowle and their relatives consistently spoke about good nutritional support and meal options. A relative told us, “The food [my relative] is given is good and there is plenty of choice.”

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. Care records included written consent to care.

We observed interactions between staff and people who lived at The Knowle showed trust and empathy. The registered manager assessed and promoted people’s diverse needs to maintain their human rights. This included the right to be involved in decision-making and care planning. One person said, “I am cared for very well. My personal needs are met.”

The focus of support provision centred on people’s individualised needs and actions to help them retain their independence. Information found in care records included details to guide staff to understand the person and their preferences.

People, staff and relatives said the management team was supportive, approachable and led the home well. One staff member told us, “[The registered manager’s] approachable and gets everything we need to do our jobs.” The management team completed a variety of systems to check quality assurance and people’s experiences of living at The Knowle.

Further information is in the detailed findings below.

At the last inspection March 2015 the service was rated Good. At this inspection we found the service remained Good.

The Knowle is registered to provide personal care for up to 32 older people. The home offers short and long term care. Accommodation is provided on the ground and first floor, which is accessed by a passenger lift. There are fifteen single and four double bedrooms, five of which have en-suite facilities. There are two communal lounges, a dining room and a conservatory on the ground floor and ramped access to the garden.

People who lived at The Knowle Care Home told us they felt safe and supported by staff and the management team. Assessments took place to ensure people’s needs could be met by the service. Care records included detailed risk assessments, which provided staff with guidance on how risks to people were minimised.

Systems were in place to reduce people being at risk of harm and potential abuse. Staff had received up-to-date safeguarding training and understood the provider's safeguarding adult’s procedures. People told us there were enough staff on duty and the staff came quickly to any requests for support.

People were protected by suitable procedures for the recruitment of staff. We saw records which showed the provider had undertaken checks. These checks ensured staff had the required knowledge and skills, and were of good character before they were employed at the service.

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 support this practice.

People received care which was relevant to their needs and effective because they were supported by an established staff team. They had received appropriate training such as moving and handling and had a good understanding of people’s needs.

We found the service was pro-active in supporting people to have sufficient nutrition and hydration. Peoples comments about the quality of food varied. One person said, “The food is good, sometimes the vegetables are watery.” We raised this with the registered manager who agreed to address this and speak to people about the quality of the food to ensure consistency.

Care plans showed where appropriate staff had made referrals to health care professionals such as the community nursing team and doctors.

We received consistent positive feedback about the care provided at The Knowle Care Home from people who lived at the home and their relatives. We saw, from care records, staff had discussed people's preferences for end of life care. We found assessments were undertaken by the registered manager and staff prior to any person being accepted into the home.

The registered manager and staff told us they fully involved people and their families in their care planning. People we saw were well presented and staff sought to maintain people's dignity throughout the day.

People were encouraged to raise any concerns or complaints. The service had a complaints procedure. People we spoke with said they felt comfortable raising concerns if they were unhappy about any aspect of their care.

The Knowle Care Home had procedures to monitor the quality of the service provided. Regular audits had been completed. These checks helped to drive up improvements in the service. This helped to ensure people were living in a safe environment.

The registered manager kept up to date with current good practice guidelines. We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

We visited the home on the 19th November 2013 and looked at outcomes relating to consent to care and treatment, care and welfare, safety and suitability of equipment as well as staff recruitment and quality assurance. We found the provider was compliant with these outcomes.

People told us that they were able to determine their care and support and we observed that care and support was offered to people when staff anticipated they needed it, or when it was requested.

People told us that there care was met with the support from staff. We saw one person continually approached staff asking them to see a district nurse. Staff were patient to explain they would do this and arranged for the district nurse to visit.

Staff were recruited appropriately and supported to develop their knowledge and skills.

The safety systems and equipment in the home was regularly maintained and serviced as part of the quality and safety monitoring systems in place.

People said they were involved in making decisions about their care, treatment and

support they received.

People said staff encouraged their independence. A person said, "I'm in my 90's and they ask me to help myself. That way I won't become lazy".

People were supported to maintain links with their local community. A person said, "My

daughter visits every week and we go out shopping and for a meal".

People said that they had access to a local general practitioner and NHS services. A

person said, "I don't need to see my doctor that often, but the staff give me some medicine the doctor prescribed when I need it". Another person told us, "I see a specialist as I have arthritis and see nurses twice a day to give me injections".

Family members of people living at the home said that their relatives received prompt

treatment from health care professionals when staff recognised their physical and mental health was deteriorating.

Family members of people living at the home said that their relatives were involved in a variety of social activities and there were staff available to accompany them into the local community.

People said staff were very protective when supporting them. A person said, "They ask me if I need someone to go out with me. I'm old not daft. They're only doing their job". Another said, "I get annoyed when they ask me were I'm going and when I'll be back. I'm safe they don't need to fuss".

People said they received their medicines safely with staff support. People said that staff were kind and helpful.

People we spoke with told us that medicines were given at about the same times every day. One person told us that staff were kind and that they were happy to take their medicines. A second person told us they could have their ‘when required’ medicine when they needed it.

One person we spoke with told us “They (care workers) are very good, if I ask what the tablets are for they say.” But, we were also told that they had “run out” of one of their medicines for a few days. A second person told us that care workers helped them to use their creams. People wishing to self-administer medication were able to do so but, we found a lack of written information about how safe self-administration was supported.

The Knowle is registered to provide personal care for up to 23 older people. The home offers short and long term care. Accommodation is provided on the ground and first floor, which is accessed by a passenger lift. There are fifteen single and four double bedrooms, five of which have en-suite facilities. There are two communal lounges, a dining room and a conservatory on the ground floor and ramped access to the garden. The home is close to Docklands Retail Park with good local transport links.

The last inspection of the service took place on 19th November 2013, during which the provider was found to be complying with regulations in all the areas assessed. This inspection took place on 31st March 2015 and was unannounced.

The registered manager of the home assisted us throughout the 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 2008 and associated Regulations about how the service is run.

We found people who used the service were provided with safe and effective care. Care workers had a good understanding of people’s needs and any risks to their safety or wellbeing were assessed and well managed.

People were supported to access health care support when they needed it and care staff worked effectively with external professionals to ensure people’s needs were met safely.

People felt they were treated with kindness and respect and that their privacy and dignity was promoted. People were able to make decisions about their care and were encouraged to express their views.

People’s rights were respected. Where concerns were identified about the capacity of a person who used the service to consent to any aspect of their care, the key requirements of the Mental Capacity Act 2005 were put into practice to ensure people’s best interests were protected.

People who used the service received their care from well trained, well supported staff. The registered manager ensured that staff at the service had the skills and knowledge to carry out their roles and received regular supervision.

Managers of the service were supportive and approachable. People felt able to raise concerns and were confident any concerns they did raise would be dealt with properly.

There were processes in place to ensure that all aspects of the service were regularly checked and monitored, both by the registered manager and the provider of the service. This meant that any areas for development could be identified and addressed.