We carried out a review of the data available to us about Knaresborough House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Knaresborough House, you can give feedback on this service.
Knaresborough House is a domiciliary care agency providing care and support to younger and older people in their own homes. Some people who receive support may be living with dementia or have physical disabilities. The service supported 40 people at the time of the inspection. 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.
People’s experience of using this service and what we found
Overall people shared positive feedback with us about their experience of Knaresborough House. They felt the staff enabled them to keep safe. However, relatives did share mixed feedback regarding communication, and this was passed onto the registered manager who took action to address this.
Accidents and incidents were managed and recorded effectively. Recruitment was carried out effectively with the right safety checks and records in place.
Staff training was up to date and staff also received regular supervision and appraisals to ensure their development and practice was meeting people’s needs.
Risk assessments and relevant care plans were improved to ensure all the details needed to manage risk and support people safely was current. Care plans were person-centred and ensured people’s preferences were clear to guide staff on how to meet people’s individual needs.
Complaints records were improved and managed, people knew how to raise a complaint and told us they would do so. Audits in place were improved and were addressing concerns to manage risk and improve the quality of care provided.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Rating at last inspection and update
The last rating for this service was requires improvement (published 17 January 2022). 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 improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider review their recruitment and complaints procedures. At this inspection we found the provider had acted on our recommendations and made improvements.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Knaresborough House is a domiciliary care agency providing care and support to younger and older people in their own homes. Some people who receive support may be living with dementia or have physical disabilities. The service supported 34 people at the time of the inspection. 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.
People’s experience of using this service and what we found
Medicines were not always recorded and monitored in line with the providers own policy. Medicine errors had not always been thoroughly investigated and managed to prevent them happening again. Guidance for staff for “as and when” medicines were not in place. These shortfalls put people at risk of harm.
Accidents and incidents were not recorded or managed as per the providers own policy and there was a lack of action taken or lessons learnt when things went wrong.
COVID-19 risk assessments for staff and guidance around how to best support people through the COVID-19 pandemic were not robust enough and this put people at risk of harm.
People, their families and professionals shared concerns about communication and language barriers with staff. The provider did not have effective measures in place to assess staff’s communication skills as part of the recruitment process. We made a recommendation relating to the providers recruitment process in this report.
Staff did not receive regular supervision and appraisals in line with the providers own policy. We recommended the provider reviewed their supervision practices to ensure they are following their own policy.
Risk assessments and relevant care plans were not always in place. They did not always provide detail on how to manage risk or how to meet people’s needs holistically. Care plans were not always person-centred and people told us they did not have access and involvement in these. There was not always information about people’s life history or preferences to guide staff on how to meet people’s individual needs.
Information recorded about the care provided was not detailed enough and did not evidence actions taken when there were concerns.
Complaints were inconsistently managed, and people didn’t always find it easy to raise concerns to the provider. We recommended the provider reviewed their processes around complaints.
The governance system and audits in place were not effective in identifying and addressing concerns to manage risk and improve the quality of care provided.
Staff had received a good level of training and felt supported by their colleagues and manager. Most people told us they were happy with the care they received and liked that carers were regular and consistent. Staff treated people with kindness and respect and tried to encourage independence. One person told us, “We are 100% safe with them. The carers are good and they ask us ‘Can I do anything else for you’ and ‘shall I help you’. They never rush and there is no pressure at all”
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Rating at last inspection
This service was registered with us on 23 January 2020 and this is the first inspection.
Why we inspected
This was a planned inspection as the service has not been inspected since registering with CQC.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.