Knaresborough Two Group

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.

Knaresborough Two Group is a residential care home providing accommodation and personal care to seven people at the time of the inspection. The service can support up to nine people.

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

People did not benefit from robust and comprehensive risk assessments to minimise the risk of injury or harm.

People said there were not enough staff to provide meaningful in-house activities and to guarantee privacy at medical appointments.

People did not give written consent and there was an inconsistent approach to applying the Mental Capacity Act.

People’s care plans and risk assessments were not robustly updated and reviewed.

Not all staff had essential training to provide safe care and treatment.

Not all staff spoke to people, and about people, using language which was dignified or respectful.

People were not encouraged to live as independently as possible with a consideration of setting goals and achievements.

People’s end of life decisions were not recorded or evidenced that these had taken place.

Audits and governance systems did not identify the poor practices found by the inspection team.

People’s views, opinions and contributions were not reliably sought to inform the development and improvement of the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not provided support which consistently maximised choice, control and Independence. People did not reliably receive person-centred approaches and staff did not consistently promote people’s dignity, privacy and human rights. Development was required in regards to the ethos, values, attitudes and behaviours of all staff and care staff ensure people using services lead confident, inclusive and empowered lives

People said they liked living at the service and staff felt they had the skills and support to provide safe care.

People were supported to have a balanced and nutritious diet.

People had access to health and social care professionals.

Infection prevention and control measures were in place and were robust.

Medicines were managed safely. The provider reviewed accidents and incidents to learn when things have gone wrong. Staff were recruited safely.

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

Rating at last inspection

The last rating for this service was good (9 March 2020).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. We also undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Enforcement and Recommendations

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 have identified breaches in relation to the dignity and respect people receive, obtaining consent, assessing risk, having a robust management oversight and enough staff to meet people’s needs 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Knaresborough Two Group is a residential care service. It supports adults who are living with learning disabilities. The service comprises of a house and a bungalow approximately two miles apart. It is registered to provide accommodation for up to ten people. At the time of the inspection seven people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People told us they felt safe and well cared for. Staff knew how to protect people from the risk of abuse. Risks to people were identified and reduced. Checks were made of the two buildings to ensure their safety.

We have made a recommendation about the assessment of risk around fire.

Recruitment checks and processes reduced the risk of unsuitable staff being employed. Staff were suitable trained and qualified to carry out their roles effectively. They felt supported and had regular supervision meetings and an annual appraisal.

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. We identified some records relating to decision making in one person’s best interest could be improved.

People and relatives said staff were kind and caring. Positive relationships had been formed between people and staff. Each person’s care and support reflected their individual preferences and choices. A complaints procedure was in place however no complaints had been received. People followed their own hobbies and interests.

At the last inspection of the service we had not been notified of authorised applications to deprive people of their liberty. We also identified that the provider had not ensured that the rating, awarded following our last inspection of the service was displayed on their public website. At this inspection we found these issues had been addressed.

The provider and registered manager carried out checks to monitor and improve the quality of the service. Feedback was gathered and acted upon to develop and improve the service. Staff worked closely with a range of other agencies to meet people’s needs fully.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was good (published 30 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected this service on 28 June 2017. The inspection was announced. The provider was given 24 hours’ notice of our visit because this is a small service and we needed to be sure someone would be in when we visited.

At our last inspection we rated the service ‘requires improvement’ and identified breaches of regulation relating to safe care and treatment and around the governance of the service. During this inspection, we identified that improvements had been made and the provider was compliant with these regulations

At the time of our inspection, the service had a registered manager. They had been the registered manager since January 2017. 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 have referred to the registered manager as ‘the manager’ throughout this report.

We had not been notified of authorised applications to deprive people of their liberty. We are required to be notified of these so we can monitor the service provided. We also identified that the provider had not ensured that the rating, awarded following our last inspection of the service, was displayed on their public website. The failure to meet these key requirements demonstrated that the service had not been consistently well-led. We have further addressed these concerns outside of the inspection process.

Despite this, people gave us positive feedback about the manager and the service provided. We found there was a positive, open and inclusive culture at the service and the manager was clearly committed to providing a person-centred service for the benefit of the people that lived there. We noted the manager did not receive formal documented supervision and have made a recommendation about this in the body of our report.

People who used the service told us they felt safe. Staff completed appropriate training to enable them to provide safe and effective care and support. Staff understood their responsibility to identify and report any safeguarding concerns. There were effective recruitment systems in place to ensure only people considered suitable were employed. We found that sufficient staff were deployed to ensure people’s needs were met. People were supported to take their prescribed medicines.

Care plans and risk assessments were in place providing detailed guidance for staff on how to safely meet people’s needs. We observed that staff understood people’s needs and care and support was provided in-line with the guidance set out in their care plans. Staff sought people’s permission before providing care and support. Consent to care was recorded in people’s care plans and appropriate applications had been authorised or submitted where people were deprived of their liberty. We noted some inconsistencies in records kept with regards to people’s capacity and best interest decisions and have made a recommendation about this in the body of our report.

Staff received regular supervision and support to enable them to provide effective care and support. People were supported to ensure they ate and drank enough and to access healthcare services where necessary. Professionals told us they had effective working relationships with staff and the manager.

People told us staff were kind and caring. We observed that staff had established meaningful relationships with the people they supported. Staff supported people in a way which maximised their choice and independence. People were supported to maintain their privacy and dignity.

The care and support provided was person-centred. People’s needs were regularly assessed and person-centred care plans were in place to provide detailed guidance to staff on how best to meet people’s needs. Staff were attentive and responsive to people’s needs. People were supported to engage in a wide range of meaningful activities and to pursue their hobbies and interests.

The Knaresborough Two Group is registered to provide residential, personal and social care for seven people with learning disabilities and an associated sensory impairment. The service is comprised of two separate homes located at 17 Park Way and 21 Fairfield Avenue. The two homes are both on residential housing estates, close to Knaresborough town centre and have good access to local services and amenities. The registered provider is Homes Together Ltd.

The location is required to have 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.’ At the time of our visit there was not a registered manager in post.

We found that window restrictors were not in place in all areas of the home in order to meet the requirements of the Health and Safety legislation and to protect people from the risk of harm.

Not all of the records required to ensure the provider had followed the correct procedures in relation to consent were available. This included recruitment and accident and incident records. We have made recommendations about these and about staff consultation.

Risk assessments were individual and personalised to assist people to live their lives safely; however there was a lack of environmental risk assessments.

There was a recruitment system in place to help ensure only people suitable to work with vulnerable people were employed. However improvements in respect of record keeping were needed.

Additionally we found improvements were required in the quality assurance systems used within the homes and that not all required records were available. These are breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives told us they felt safe living in their home. Staff were aware of how to handle any concerns and we found there were enough staff available in each home to meet people’s needs.

Staff completed a variety of training and felt well supported in their role. People told us they liked the food provided and that their health and medication needs were met in the home.

Staff were kind, caring and polite. They knew people and their preferences on how their care was provided. People were supported through a care planning process which supported them to be involved or represented in decisions about their care.

One person told us how they were supported to maintain their independence and people were supported to attend a variety of leisure activities.

Staff told us there was a good culture in the home and people were consulted through the use of questionnaires.

You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

All the people we spoke with told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. All the relatives we spoke with told us they felt their relatives were well cared for and had no concerns about their safety.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the home's responsibilities under the Mental Capacity Act 2005 and DoLS. We saw two applications had been submitted to the local authority and had been recorded according to the provider's policy and procedures. They told us they had received training in making an application and showed us the policy and procedures they followed.

Is the service effective?

We saw people were involved in their care and treatment. One person we spoke with told us, 'The staff have been very good to me here. I am ready for a change in some areas. The staff have helped me and I now have an advocate.' Care staff told us they worked closely with people. One staff member told us, 'We always try to respond to people in the service and gain an understanding of what they want. We also work closely with people's families.' All the relatives we spoke with told us they were very satisfied with the care and support provided. One relative told us, 'I am very happy with the level of care. My relative is fine and the staff are good.'

People who used the service had a keyworker who supported them with their care and welfare needs. Staff told us how they supported people with any appointments with their doctor, dentist or consultant. They told us they needed to be flexible and responsive as people's care and support needs can change on a daily basis.

Each member of staff we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals. One person told us, 'We work as a staff team and we know the people's care and support needs.' They told us that they felt supported by the manager and could approach them at any time for support or to raise any issues or concerns.

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. People were not rushed when care was delivered and we saw staff interactions with people were caring.

We saw staff treated people with respect and dignity. All the people we spoke with - and the three relatives - told us they were very happy with the care they received.

Is the service responsive?

We saw staff respond to any requests for support. One relative we spoke with told us, 'The staff are great. My relative has complex needs and they have really supported them well. I am very happy with the service and confident with the care my relative receives.' A second relative told us, 'They are very good with my relative. They know her very well. They know she requires certain routines. I am very happy with the care she receives from the staff.'

People's care needs had been reviewed at least every month. We saw when people's requirements had changed the provider had responded appropriately and reviewed the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The service had a registered manager in post who showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people, relatives and staff had been taken into account.

We saw the home had systems in place which ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place.

We saw from people's care plans that people were supported to live as independently as possible. Assessments of the needs of each person had been kept under review, to enable appropriate care and support to be given. However,these had not been regularly reviewed at Park Way.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with had received training in safeguarding adults, but refresher training was needed for some staff.

We looked at the environment of both houses and found some attention was needed at Park Way but not at Farfield Avenue.

We reviewed the level of staffing for the home. Records showed there was always enough staff to support people with their care needs.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems. Although at Park Way some improvements were needed in this area.

We did not speak to people about managing their medication, although we did speak to them about how they would make a complaint. Both said that they would speak to the manager and staff at the home or their care manager.

People living at 21 Farfield Avenue were unable to tell us their views about the outcome areas we looked at because they had complex needs and verbal communication difficulties, which meant they were not able to tell us their experiences. Instead we spent sometime observing people whilst they were at home. We observed good interaction between people living at the home and staff.

We spoke with the area manager during our visit to the home, who had visited to carry out an audit on behalf of the organisation.

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.