The inspection took place on 19 June 2017 and was unannounced.

The Knoll is a residential care home located in Urmston, Trafford and is registered with the Care Quality Commission to provide personal care for up to 10 older people.

There was a registered manager in place at the home. 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.

Staffing levels were sufficient to meet the needs of the people who currently used the service. The service used a dependency tool and staffing levels were flexible to ensure extra staff could be deployed when the need arose. There was evidence of a robust recruitment procedure to help ensure staff were suitable to work with vulnerable people.

Safeguarding policy and procedures were in place and staff we spoke with demonstrated an understanding of safeguarding issues and were confident to report any concerns. Accidents and incidents were logged appropriately and analysed for patterns and trends.

Health and safety information was in place and up to date. Medicines were managed safely at the service and staff were trained appropriately.

Staff induction was thorough and training was on-going with reminders in place to help ensure no staff training was out of date.

Nutritional and hydration records were complete and up to date and appropriate referrals were made to other professionals and agencies when required. The mealtime experience was pleasant and choices were offered with regard to food and drink.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We observed care throughout the day and saw that interactions between staff members and people who used the service were friendly and respectful. People’s dignity was respected and care was offered and given discreetly and sensitively.

Residents meetings and families meetings took place on a regular basis and minutes were available for those who were unable to attend. Information was given to prospective users of the service and their families in the form of an information pack.

The service had an End of Life policy in place and training was undertaken by staff. Advanced care plans, where the person’s wishes had been expressed, were included within the care files.

Care files we looked at evidenced that care was person-centred. There was a range of health and personal information and people’s preferences, likes and dislikes were recorded.

There were a variety of group activities on offer as well as one to one engagement. Questionnaires were sent out regularly to obtain people’s views of the care delivery.

There was an appropriate, up to date complaints policy and complaints were followed up in a timely way. Compliments had been received in the form of thank you cards and letters.

The registered manager had an ‘open door’ policy and was available to staff, visitors and people who used the service regularly. Staff members told us they were well supported by the registered manager and the providers.

We saw evidence of regular staff supervisions and appraisals. We saw minutes of staff meetings, which were undertaken approximately two monthly.

There were a significant number of audits undertaken by the service. Audits for issues such as accidents and incidents were analysed to look at how continual improvements could be implemented.

We carried out this unannounced 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.

The inspection was unannounced and took place 15th October 2014. The inspection was carried out by a lead inspector, an expert by experience and a specialist advisor. Experts by Experience are people who have personal experience of using or caring for someone who use this type of care service. Specialist advisors have up-to date knowledge and experience in their specialist area.

The Knoll provides personal care and accommodation to 10 older people in single and shared accommodation over two floors. Upstairs accommodation can be accessed by stairways or a stair lift. The Knoll is situated close to public transport links into the city of Manchester and surrounding areas. At the time of our inspection there were nine people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and had legal responsibility for meeting the requirements of the law; as does the provider.

We spoke with people who lived at the home and their relatives who told us they were happy living at The Knoll. Comments included: “I am very happy here, they [staff] are very helpful.” “I can’t fault it here.”

We spoke with health and social care professionals who visited the home on a regular basis. They told us: “I have no concerns about the care people receive.” “The staff contact us if they have any concerns about [people who live at the home] they are good at identifying if [a person] needs our support.”

We spent time observing the interactions between staff and the people they cared for. We saw staff approached people with respect and worked in a way that maintained people’s dignity. We observed that staff were caring and compassionate and treated people with kindness. We found that staff knew people well and were able to tell us about peoples care needs. 

People knew how to make a complaint. The people we spoke with told us if they had any complaints they would speak with the manager and they were confident their concerns would be taken seriously.

We spoke with people who lived at the home about the meals provided at the home. People told us: “It is good plain cooking.” “I have no complaints about the food it is always nice; I clear my plate.”

There were menus in place and the people we spoke with confirmed they were offered a choice of meals. Care plans contained a nutritional assessment and identified people’s preferences in relation to meals and drinks.

We found there were enough staff on duty in the home to meet peoples care needs. Where people asked for help this was provided in a timely manner and people did not have to wait long for help.

We spoke with staff about how they were appointed to their role. Staff told us: “I have been here 10 years so it is different now but we had to have CRB checks and give references.” “We have all been here for years.”

We looked at a sample of staff recruitment files and saw there was a robust recruitment process in place that included obtaining a Disclosure and Barring Scheme (DBS) check and written references from previous employers. This was to make sure the staff employed at The Knoll were safe to work with vulnerable people.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and staff followed the Mental Capacity Act 2005 for people who lacked capacity to make their own decisions.

As part of our inspection we spoke with three people who used the service, three members of staff, a visiting relative and the registered manager. We also spent time looking at care plans, staff personnel files and policies and procedures.

Overall, we found people were happy living at the home and felt well cared for. Comments from people who used the service included; “Everything is fine. I like it here the care is good” and “The staff help me with everything whether it be getting me up, giving me my medication or helping me to the toilet” and “It’s like home from home” and “I’m quite satisfied here”. A visiting relative said to us;"The care is brilliant. 'X' has gained weight and is alot more settled living here".

We looked at the measures in place to safeguard people from abuse and we found there were appropriate systems to enable this. One person said to us; “I feel safe here. I trust the staff”.

We spoke to three members of staff to ensure they received the support required to carry out their job role effectively. We found there was an induction programme in place and staff had received relevant mandatory training which was regularly updated.

We found there were effective systems in place to monitor the quality of service provision. This was done with the use of audits, surveys and the monitoring of accidents and incidents.

We did not speak with any people using the service as they were unable to communicate with us.

During our visit we asked five people about their experiences of living in the home. We were told that the staff were kind and caring and that they provided safe care and support according to each person's specific needs.

Staff provided the right level of support and encouragement for people to make their own choices and decisions about how their care should be provided.

People told us that they enjoyed the activities and found them interesting and stimulating. These included regular trips out, arts and crafts and visits from local schoolchildren. One person added, "I really enjoy the trips we have. We have a great time."

The five people told us that they were happy living in the home, they felt safe and they were satisfied that their care and support needs were being met. One person told us, "The Knoll is a well run home. It is very family orientated and we are looked after well by the girls."