Knaresborough Two Group is a residential care service. It specialises in supporting younger adults who have a learning disability, visual impairment and/or autistic spectrum disorder. The service is registered to provide accommodation for up to seven people. The service is comprised of a house and a bungalow which are approximately two miles apart. The two homes are both on residential housing estates, close to Knaresborough town centre and have good access to local services and amenities.

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

The inspection took place on 12 March 2016 and was unannounced. At the time of the inspection there were seven people being supported by the service. The last inspection of the service was 31 July 2014 when it was found to be compliant with the regulations assessed.

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.

At the time of the inspection there were seven people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service. We observed their experiences to support our inspection. We spoke with the registered manager, three care staff, the area manager and three relative we contacted by phone.

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 spoke with three people living at Park Way. Everyone we spoke with told us they liked living at the home. People living at Farfield Avenue were unable to tell us their views about the outcome areas we looked at. This was because they had complex needs and verbal communication difficulties, which meant they were not able to tell us their experiences.We telephoned and spoke with relatives of people living at Farfield Avenue.

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 spoke with two people at 17 Park Way during our visit. People told us they were well looked after and happy with the care they received. One person said, “It is brilliant living here I love it.” Another person said “I like living here, the staff look after me well.” Both people we spoke with confirmed that they were always involved in planning their care and had signed their care plans.

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.

We talked to three people in the first house we visited about the care they received and what it was like living at the home. People told us that they were well looked after and that they were happy with the care they received. One person commented ‘Yes, it’s allright living here, we do have a good banter here. We are well looked after you can’t fault it. Weekends we go out to Knaresborough, concerts or go to the pub.’ Another person told us ‘I think it’s all right here. We chill out at weekends. Staff are very nice here you have a good time.’ And another person said, ‘It’s all right I like it here, staff are very good’

We were unable to speak to people in the second house as people living there were unable to communicate verbally. However throughout the morning we observed good interaction between people living at the home and staff. People were seen being assisted in making themselves drinks and participate in activities.