About the 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 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.