CQC report explained · a residential care home
What the CQC found at Knaresborough Two Group
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Fire evacuation arrangements and guidance about some health conditions were not always safe or clear. Medicines, safeguarding, recruitment and learning from incidents were managed well.
- Effective?
- Requires improvement
- Assessments did not always cover people's full needs, and people were not always involved in reviewing their support plans. Staff training, decision-making support, food and healthcare support were positive.
- Caring?
- Requires improvement
- People were treated with dignity and respect, and staff knew them well. However, people were not always supported to develop skills, confidence, independence or meaningful long-term goals.
- Responsive?
- Requires improvement
- People attended activities and clubs and had some choice about what they did. Support plans were not always fully personalised, and accessible aids for people with visual impairments were limited.
- Well-led?
- Requires improvement
- The manager was seen as approachable and staff morale was good. However, quality audits did not identify all problems, and actions taken after audits had not always solved the issues.
What inspectors found, September 2023
Knaresborough Two Group rated Requires Improvement; inspectors found kind staff and some progress, but safety, independence and management still need significant improvement.
This was an unannounced follow-up inspection. Inspectors visited on 26 July and 1 August 2023, spoke with people, relatives, staff and professionals, and reviewed care, medicines, recruitment and management records.
The home had made some improvements since the previous inspection. Medicines were managed safely, staff recruitment and training were suitable, people were treated with dignity, and staff worked well with health professionals. People also had access to activities and community groups.
However, inspectors found important gaps. Fire safety plans and guidance about some health conditions were not always robust. People were not always helped to build independence or set meaningful goals. Care assessments and quality checks were not thorough enough. The overall rating and all five question ratings remain Requires Improvement.
Kind and respectful staff
People said they were happy and liked the staff. Inspectors saw staff treating people with dignity and respect.
“People told us they were happy and liked the staff.” from the report
Medicines managed safely
The home had systems for storing, giving and checking medicines. Staff also recorded why and whether medicines given when needed had worked.
“Medicines were managed safely. Systems were in place for safe storage, administration and auditing of medicines.” from the report
Support with decisions
Staff followed the Mental Capacity Act principles. They recorded decisions and involved relatives and professionals in best-interest decisions where needed.
“People were supported to make their own decisions wherever possible. This was recorded.” from the report
Activities and community links
People attended regular activities and clubs, and a weekly activity day had been introduced at one property.
“People regularly attended formal activities and clubs with local organisations, colleges, and charities.” from the report
Learning from incidents
Incidents were reviewed and lessons were shared with staff through meetings and supervision.
“There was evidence of learning from incidents. Incidents were reviewed to find out what had happened and what could be done better.” from the report
Fire and health risks
seriousMost staff had not practised a fire evacuation. One person's evacuation plan could have put them at risk, and guidance about some health conditions was not always clear.
“A fire evacuation plan for one person who used the service put them at risk of harm, and other options had not been robustly or thoroughly considered.” from the report
Independence and goals
seriousPeople were not always encouraged to build skills, help with everyday tasks or work towards meaningful, personal goals. Reviews did not usually show that people had been involved.
“People were not always supported to develop new skills and gain greater confidence and independence.” from the report
Incomplete care assessments
needs fixingAssessments did not always consider the whole person or the full range of their needs. Support plans were also not always fully person-centred.
“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.” from the report
Weak quality checks
seriousAudits missed some problems, and actions taken after issues were found did not always work. This meant managers did not have a reliable enough picture of care quality and safety.
“Quality assurance processes were not always effective. Regular audits were carried out and the provider had commissioned an external audit.” from the report
Laundry and visual aids
needs fixingLaundry arrangements did not follow best practice guidance. The home also had only limited aids for people with visual impairments.
“The management of laundry was not in line with best practice guidance.” from the report
- 01What has been changed in the fire evacuation plans, and how have all staff practised evacuations?
- 02How will you make sure staff have clear guidance about each person's health conditions and signs of deterioration?
- 03How will each person be involved in setting and reviewing meaningful goals for independence?
- 04How will you check that care assessments cover the person's full range of needs?
- 05What changes have been made to quality audits so they identify problems and confirm that actions have worked?
This was an unannounced follow-up inspection that rated all five key questions; CQC inspected the premises and care, including personal care for six people, and also considered infection prevention and control. This explanation was written from the published report of 20 September 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Knaresborough Two Group was rated Requires Improvement; inspectors found important risks around staffing, consent, dignity, care records and management oversight.
The inspection was unannounced and took place on 8 April, 12 April and 3 May 2022. One inspector and a CQC medicines specialist spoke with five people and 10 staff. They reviewed care records, medicines records, staff files, rotas, audits and other documents, and spoke with two visiting professionals.
Inspectors found several serious weaknesses. Risk assessments and care plans were incomplete or out of date. There were not enough staff for activities and some medical appointments. Consent was not recorded consistently, some staff used undignified language, and people were not always supported to build independence. Some staff also lacked essential training.
There were positive findings too. Medicines were managed safely, infection control was robust, staff were recruited safely, and people could access health professionals. However, all five inspection areas were rated Requires Improvement. This was a fall from Good at the previous inspection on 9 March 2020. The provider began making some changes during the inspection, but CQC said it would monitor progress.
Medicines
Inspectors found that medicines were given at the right time, recorded and stored safely. Medicines were regularly reviewed.
“People received the correct medicines at the right time.” from the report
Infection control
The home had robust arrangements for preventing and managing infection, including safe use of protective equipment and testing.
“We were assured that the provider was using PPE effectively and safely.” from the report
Health support
Staff worked with health and social care professionals and acted promptly when people's health needs changed.
“Staff worked closely with visiting professionals such as GPs, nurses, social care staff and learning disability teams.” from the report
Safe recruitment
The recruitment checks reviewed by inspectors had been completed safely.
“Staff were recruited safely, and all mandatory checks were completed.” from the report
Incomplete risk assessments
seriousRisk assessments did not cover all relevant risks or clearly guide staff. One person who needed supervision when eating was not always supervised.
“Risks and safety systems were not robustly assessed to minimise the risk of harm.” from the report
Not enough staff
seriousStaffing levels did not reliably support meaningful activities or privacy at medical appointments. The provider had not completed a systematic review of staffing needs.
“There were not enough staff to meet their needs.” from the report
Consent and decision-making
seriousMental capacity assessments and best interest decisions were missing from the care plans reviewed. Written consent was not consistently obtained.
“People who were able to consent to care and treatment did not give written consent.” from the report
Dignity and independence
seriousSome staff used disrespectful language. People were not consistently supported to do tasks they could manage themselves or to set goals.
“Some staff described, or talked to people, using undignified and disrespectful language.” from the report
Out-of-date care records
needs fixingSome care plans were several years old and had not been meaningfully reviewed since 2020. They did not always reflect people's current needs, choices or goals.
“We found some care plans were several years old and had not been meaningfully reviewed since 2020.” from the report
Weak management checks
needs fixingAudits did not identify the problems found by inspectors, and people were not regularly asked for feedback about the service.
“Quality checks were not robust.” from the report
- 01What changes have been made to ensure every person's risks, including eating, oxygen, visual impairment and financial affairs, are clearly assessed and reviewed?
- 02How many staff are now on duty, and how do you make sure there are enough staff for activities and private medical appointments?
- 03Which staff training gaps have been completed, and how are staff competencies checked before lone working?
- 04How do you now record written consent, mental capacity assessments and best interest decisions?
- 05How are residents involved in care plan reviews, setting personal goals and deciding activities and menus?
This was an unannounced inspection covering all five CQC questions, carried out partly to assess the Right support, right care, right culture principles; the previous Good ratings changed to Requires Improvement in every area. This explanation was written from the published report of 9 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Knaresborough Two Group
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- September 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 11 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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