Knaresborough Two Group

Updated 20 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Knaresborough Two Group is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Knaresborough Two Group is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 26 July 2023 and ended on 11 August 2023. We visited the service on 26 July 2023 and 1 August 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with 3 people who used the service, 1 advocate and 2 relatives about their experience of the care provided. We spoke with 8 members of staff including the registered manager, the deputy head of residential services, the deputy manager, and support workers. We spoke with a further 3 professionals who work with the service.

We reviewed a range of records. This included 5 people’s care records and medication records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including training data and quality assurance records were reviewed.

Updated 20 September 2023

About the service

Knaresborough Two Group is a residential care home, set across 2 separate properties, providing personal care to up to 10 people. The service provides support to people with a learning disability and autistic people. The service also supports people with sensory impairments and physical disabilities. At the time of our inspection there were 7 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection there were 6 people using the service who received personal care.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Appropriate fire safety measures were not always in place to minimise potential risks to people who used the service. There was not always clear and robust guidance in place for staff around some people’s health conditions. People were not always supported to develop new skills and gain greater confidence and independence. Staffing levels and deployment of staff had improved. We made a recommendation around the continuous review of staffing levels. Staff supported people safely with their medicines. People were supported by staff who had been recruited safely. People were supported to make their own decisions wherever possible, including around their end-of-life choices.

People were generally supported to have maximum choice and control of their lives, although further work was required around supporting people’s independence, goals and aspirations. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Assessments of people’s needs were not always fully comprehensive and did not always consider each person as a whole, and the wide range of their needs. There was not always evidence that people were involved in reviews of their support plans. Staff treated people with dignity and respect. People told us they were happy and liked the staff. Staff had received suitable training to meet people’s needs. People were able to personalise their own rooms and the houses were homely. The management of laundry was not in line with best practice guidance and we have made a recommendation about this.

Right Culture: Quality assurance processes were not always effective. The provider involved people through house meetings, but we made a recommendation about ensuring engagement was as meaningful as possible. Documents were available in an easy read format for people but there were only limited aids available for people with a visual impairment. We made a recommendation about this. There was an open-door policy and people and staff told us the registered manager was approachable and knowledgeable. There was generally a positive culture within the service although some areas of support needed to be more person-centred. Staff managed incidents affecting people’s safety well and there was evidence of learning from incidents. Staff worked well with professionals and lines of communication were good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 June 2022) and there were 5 breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider had made some improvements but remained in breach of 3 regulations.

At our last inspection we recommended the provider reviews its approach to providing accessible information. At this inspection we found the provider had made some improvements, but we have made a further recommendation in this area.

At our last inspection we recommended the provider enhances its information sharing with staff to share lessons learned. At this inspection we found the provider had made improvements and shared lessons learned with staff.

At our last inspection we recommended the provider reviews end-of-life care planning and staff training in this area. At this inspection we found the provider had made improvements and had created an easy read document which facilitated discussions with people around their end-of-life wishes, and staff had received appropriate training.

The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The provider has been responsive and taken action following our feedback.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Knaresborough Two Group on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to supporting the independence of people using the service, the management of risk, and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations about reviewing staffing levels, the safe management of laundry, engaging people fully in the service, and further improving the use of sensory impairment aids.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.