The inspection took place on 25 and 26 April 2018, it was unannounced and carried out by one inspector.

The Knoll is a ‘care home without nursing’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide care and accommodation for up to seven people who may be living with a learning disability, mental health condition and/or physical disability. There were seven people living in the service on both days of the inspection. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice and promotion of independence. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection, the service was rated good and at this inspection, we found the service remains good.

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 2008 and associated Regulations about how the service is run.

People received safe care and support. Staff knew how to support people and protect them from the risk of harm. The service had a safe, robust recruitment system and employed sufficient numbers of staff to meet people’s assessed, and changing needs. There was a good medication system in place and the records were of a good standard. Staff had been trained and had their competency to administer medication assessed. People received their medication safely as prescribed. Infection control measures were in place and staff were trained and demonstrated a good knowledge of infection control procedures. The environment was well maintained, clean and hygienic.

People’s needs had been fully assessed and their support plans updated when their needs changed. Staff were well trained and received formal and informal supervision and knew how to care for people effectively. People had a choice of sufficient food and drinks, which they had helped to shop for and people chose what they wanted to eat and drink on a daily basis. Staff ensured people’s healthcare needs were met. They worked well in partnership with other professionals to ensure that people received the healthcare they needed.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. Appropriate assessments had been carried out in line with legislation. Where people were deprived of their liberty, the service had made appropriate requests for authorisation. People’s independence was encouraged and supported while minimising risks to help keep them safe.

Staff were kind and caring and listened to what people had to say. They treated people with dignity and respect and ensured they had the privacy they needed. People and their families were kept fully involved in decision-making. Advocacy services were available if needed. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People received personalised support that was responsive to their needs. They had good community links and enjoyed a range of indoor and outdoor activities. The support plans and daily notes were detailed and informative. There was a good pictorial system in place for dealing with complaints and people had confidence that their complaints would be dealt with appropriately.

People and their families knew the registered manager well and had confidence in them. Staff felt well supported by

The inspection took place on the 20 October 2015.

The service provides accommodation and support for up to seven people with learning disability and mental health issues. There were five people living at the service at the time of our inspection.

The service had 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 2008 and associated Regulations about how the service is run.

People were cared for by staff that had been recruited and employed after appropriate checks were completed. There were enough staff available to support people.

Records were regularly updated and staff were provided with the information they needed to meet people’s needs. People's care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff and the manager were able to explain to us what they would do to keep people safe and how they would protect their rights. Staff had been provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People were relaxed in the company of staff. Staff were able to demonstrate they knew people well and treated people with dignity and respect.

People who used the service were provided with the opportunity to participate in activities which interested them; these activities were diverse to meet people’s social needs.

The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance was sought from health care professionals, including people’s G.Ps and district nurses and mental health teams.

People knew how to raise a concern or make a complaint; any complaints were resolved efficiently and quickly.

The manager had a number of ways of gathering views on the service including using questionnaires and by holding meetings with people, staff and talking with relatives.

The manager carried out a number of quality monitoring audits to ensure the service was running effectively. These included audits on care files, medication management and the environment.

During our inspection, we considered if staff were caring and we talked with four people using the service. They told us that the care was good and staff gave them support. We observed positive interactions between staff and people using the service. A relative told us that the care was, “Excellent.”

We spoke with three staff and a visiting professional. We found that there were systems in place for supporting people with any nutrition and hydration needs. We saw that staff cooperated with other providers. We found that there were systems to keep people records safe. We found that improvements had been made to infection control systems. We found that not all maintenance systems were consistently being followed and felt this could pose a risk to people.

We spoke with three people using the service. One person told us, “I like it here, there are nice people.” People told us that staff gave them support.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We looked at three care plan files and found that people’s individual needs had been considered and plans detailed the support required.

We found that some systems were not in place to reduce the risk and spread of infection.

We spoke with three staff who told us that the service had enough staff available.

We found that people were made aware of the complaints system. This was provided in a format that met their needs.

People living in The Knoll seemed relaxed and very comfortable in their home. People told us that they felt safe and happy living at The Knoll. They liked the fact that the staff team and manager had worked at the home for a long time and were familiar to them. People said that they could talk to any of the staff and the manager about anything.

People said that they made their own choices and decisions about what they did and where they went. People told us that the food was good.