Knappe Cross Care Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection in December 2022, we identified a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found not enough improvement had been made at this assessment. The provider’s systems had failed to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of people. This was a continued breach of Regulation 17. We have issued a Warning Notice in relation to these concerns.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider had systems in place to quality monitor the service, however, many of these had not been completed correctly. It was not clear that the required action was taken when shortfalls were identified or that any changes or improvements implemented were effective and embedded within the service. This meant, people were placed at risk due to poor quality monitoring and oversight of the service provided.

There was a lack of robust oversight from the provider and checks of the quality of the service were not being consistently completed.

The provider and the management team were working with stakeholders to identify and address areas for improvement. The need for improvement was acknowledged by the senior management team.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

It had been a difficult time for the service, due to lack of leadership and clear direction. Staff now spoke confidently about the changes that had been put into place and the support they had received. They spoke about an open, transparent, inclusive culture which met the needs of people. One staff member told us, “Can't say we are always perfect, always something you can do better.” Another said, “Atmosphere in team is good, no problem across cultures, people work well together.”

The new manager was working alongside staff providing support and supervision to identify concerns and to help shape the new culture of the service. They were ensuring staff had a good understanding of the provider’s vision for the service to provide positive outcomes for people in a person-centred way.

The management team and staff told us about changes in the management team at the home in 2024. We were told that the deputy manager and clinical lead had left. Although a new deputy had been appointed this had not been successful. The provider’s operations manager had been managing a new home in the group, so had not regularly visited Knappe Cross. Therefore, the registered manager did not have the support of these roles.

A new manager had started at the service in October 2024 and had worked alongside the previous registered manager before they left their role. The registered manager deregistered with CQC on the 26 November 2024.

The new manager was knowledgeable about the issues and priorities at the home. They were working alongside the new clinical lead and the provider’s operations manager to implement the changes needed and to work with partner agencies.

People were positive about the new manager. One person commented, “I find [new manager] very nice. He is direct and if you ask him something you will find out the answer very soon.” Another said, “Approachable. I find him very pleasant. He is under a great deal of pressure.”

Staff were very positive about the new manager. Comments included, [Manger] seems so genuine. You can go to him for anything”, “He's always busy, seems ok” and “Is very calm. Knows what he is doing.” They also praised the operations manager and said they were both approachable and responsive.

There was no current registered manager. The manager had applied to CQC to become the registered manager.

The management team were aware of their roles and responsibilities and the lines of accountability. The manager, operations manager and staff were working together to promote people's wellbeing, safety, and security and we observed a supportive staff culture. We observed staff and the managers were respectful and kind towards people and each other.

The management team told us they had been working with staff, to have the confidence to speak up if they had a concern. Staff confirmed they would raise concerns with the management team and were confident they would take action as required.

Staff said they supported each other as a team and spoke positively about the team. Comments included, “Team is quite diverse. We are ok working together” and “Team gets on, took a while to form. Quite a stable team.”

The provider had systems and processes in place to enable staff, people living at Knappe Cross Care Centre and their relatives to speak up. There was a whistle blowing policy in place which provided guidance to staff about how to raise concerns. There was also a complaints policy. Staff meetings and handover meetings were held to provide staff the opportunity to speak up.

The provider had asked staff to complete a staff survey in February 2024. They had received 7 responses. When asked, ‘do you know what to do if you have any worries about the way a colleague does their work’, 2 responded no. One staff member was spoken with but no other actions were taken to help ensure all staff were informed about what action they needed to take.

The manager told us there were staff from a range of different cultural backgrounds, genders and races. They told us they were working with staff to be inclusive and work as a team.

Processes were in place to promote equality and diversity and a fair culture. The provider’s service improvement plan, dated November 24, showed the management team were working with staff to change the culture at the home and improve communication.

Staff told us it had been a difficult time at the home. They confirmed things had improved and they felt supported by the management team and felt confident to approach them with issues.

At our previous inspection in December 2022, we found a breach of Regulation 17. We found similar concerns at this assessment. There was still no effective system in place to monitor and mitigate risks to people.

The provider had been very responsive to the concerns raised by the Police and local authority. However, they had not identified the shortfalls and the extent of these concerns themselves through their own audits and checks. The provider had a quality assurance program, but this had not been effectively carried out in the last 8 months. For example, care records had not been consistently reviewed to ensure they accurately reflected people’s needs. Concerns identified in audits had not been actioned and clear accurate documentation had not been maintained.

Information we requested was not easily accessible. Some information could not be located such as the DoLS folder, some audits and records of falls.

The staff training record did not accurately reflect up to date training information and had been inconsistently completed regarding actual date of training or when training needed to be completed again. The operations manager took action to have this updated.

The provider had undertaken a resident’s survey in January 2024. This demonstrated good engagement, but the analysed information and response was not shared with the individuals who provided feedback.

Staff told us they had good partnership working with the local authority and NHS teams who visited.

A visiting GP told us they felt that people at the home were safe and that the staff were contacting them appropriately and were being proactive, particularly regarding people’s weight management.

During the whole service safeguarding process, the local authority had found the quality monitoring processes in use at the home were not effectively identifying the concerns they had identified.

The provider had put in place a service improvement plan to address these concerns and were working with the local authority to address the concerns they found during the whole service safeguarding process.

Staff were mostly positive about access to training and learning facilitated by the provider.

Staff received additional training appropriate and relevant to their role, including care for people with Parkinson’s disease, stoma care, end of life care, catheterisation and venepuncture.

To maintain staff standards in manual handling and dealing with challenging behaviours, designated staff had completed ‘train the trainer’ training to deliver training and work alongside staff.

The provider was working with partner agencies as part of the local authority whole service safeguarding process. Any concerns found were actioned by the management team and there was partnership working. The provider had completed a service improvement plan setting out the actions they were taking in response to the concerns identified by partner agencies. Although there was learning at the home, we found where one improvement had been put into place this was still not actioned correctly at the time of our site visits.

The management team fully understood their duty of candour, to be open and honest when things went wrong and were committed to improving the service.