Scorton Care Village

We found the following examples of good practice.

• Staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed. All visitors were asked a set of screening questions to ascertain any risks posed and for track and trace. People chose to use applications such as video calls to maintain contact with their families. The provider was working with the local authority to understand how safe visiting could occur in the future.

• The provider was fully aware of all current best practice guidance. This had been communicated to people, their families and staff as and when updates occurred. Personal Protective Equipment (PPE) was safely stored in designated stations throughout the service. This reduced staff time putting on and taking off PPE and reduced the risk of transmission. Some of these stations were portable to accommodate safety if an outbreak occurred.

• Cleaning schedules were thorough. The schedules through the day were continued at night to ensure all areas were regularly cleaned to reduce the risk of transmission.

• Staff had been trained to use a tool to recognise early signs that a person’s health was deteriorating. Staff were able to seek quick healthcare support when people needed this.

• Where people living with dementia found the use of PPE strange, staff had worked to understand their needs and show them why it was essential at this time.

• An outbreak happened early in the pandemic and an exercise had been carried out to understand what lessons could be learnt to reduce the risk of a future outbreak.

• The provider and registered manager had recognised the challenges staff had overcome during the pandemic and had introduced specific support sessions staff could use to de-brief and offload their feelings. This supported staff resilience.

Further information is in the findings below.

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

Since the last inspection the provider and registered managers had worked to implement new systems and recruit new staff. Improvements were seen at this inspection to the safety and quality of the service. People experienced better care and outcomes because of this. A plan was in place to keep improving the service in areas such as fire safety, care plans and medicines management. The provider was committed to using feedback from people and occurrences to develop the service further.

The provider had recently worked in partnership with the local authority and clinical commission group to open a new unit when a local care home had closed. This transition had been completed successfully in a person-centred way with minimal impact of the people supported. The skills and experience of the staff team who transferred with people will further develop the support for people who display distressed behaviour at Scorton Care Village.

The staff team had been inducted, supported and trained which had brought stability to the service. Staff understood their roles clearly and they knew what was expected of them. People were treated with respect and dignity, they were also supported to maintain their independence.

People’s needs and preferences were known by the staff and this had led to people receiving person centred, responsive care. Staff had worked to improve or maintain people’s quality of life. Feedback from people and their relatives was positive. Staff had developed positive relationships with people which led to people feeling safe and happy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The environment had been improved and people were happy with the changes. People enjoyed access to a garden and were supported to access the community to take part in local activities. People were offered a wide variety of activities to take part in if they chose this.

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

Rating at last inspection and update

The rating for this service at their last comprehensive inspection was requires improvement (published 5 October 2018) and there was one breach of regulations. We carried out a focused inspection where the rating of requires improvement continued (published 5 February 2019) and one breach continued. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence 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.

People’s experience of using this service: The provider did not have sufficient oversight of the service to ensure people received a safe, high quality service. Where they introduced new medication systems, they did not ensure appropriate training, coaching and monitoring occurred to check they were implemented safely. This had led to people being at risk of not receiving their medicines as prescribed.

Although staff knew people and their preferences very well, the records to guide staff on how to support people safely and monitor their progress were not always up to date or in place.

Where accidents or incidents occurred the management team did not ensure they investigated and understood where lessons could be learned to prevent future occurrences.

Staff and the management team demonstrated they were committed to people’s wellbeing and understood that their records are used to evidence how they keep people safe and deliver high quality care. A new registered manager had been in post since December 2018 and had already started to implement changes to improve safety and quality.

The provider reflected on the concerns raised prior to the inspection and our findings. They advised us after our inspection that they had implemented a series of changes to their systems and approach to governance. They told us this would achieve improvements.

We observed people were supported well, with kindness and compassion by all staff. There was enough staff on duty to provide timely support to people when they needed it.

Improvements had been made to the environment as part of a refurbishment programme which was ongoing at the time of our inspection.

A full description of our findings can be found in the sections below.

Why we inspected: We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Scorton Care Village on our website at www.cqc.org.uk.

Rating at last inspection: Requires improvement (Published 5 October 2018). The service remains rated requires improvement. This is the second consecutive time the rating has been requires improvement.

Enforcement: The provider continued to be in breach of a regulation because the governance of the service had not improved. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group to monitor progress. If any concerning information is received we may inspect sooner.

Scorton Care Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Scorton Care Village is registered to provide both nursing and residential care across two buildings for a maximum of 114 people some of whom maybe living with dementia. Elizabeth Swale House provided residential care for up to 54 people. 29 people lived there when we inspected. Archery Bower House provided nursing care for up to 60 people. 30 people lived there when we inspected.

Each ‘House’ had their own 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.

When the provider had taken over the management of the service they had immediately initiated an improvement programme to recruit more permanent employees and reduce the reliance on agency workers. This had been successful and a positive impact on people’s experience of care were reported. All recruitment of staff had been completed in a safe way.

Archery Bower House had increased the number of people supported by more than double since December 2017. Resources for activities, Housekeeping and care workers had not increased at the same pace. This meant people were at risk of not receiving support in a timely way. The provider immediately made plans to change the staffing resources following inspection.

A refurbishment plan was in place and this included better resources to make the garden areas more welcoming, replace flooring and to make the environment more dementia friendly when it was decorated based on good practice.

Records reflected that health and safety checks were carried out on the equipment and environment. However, day, day-to-day hazards were not always recognised such as cleanliness and trip hazards. Plans were put in place following the inspection to prevent the likelihood of those happening again.

A new system to manage medicines was in place and this had improved medicines safety. Better care plans were needed to ensure staff worked in a consistent way where people displayed anxiety or distress. We have issued a recommendation in relation to this.

Where accidents or incidents occurred, we saw records did not always reflect the work completed to reduce the likelihood of future occurrences. Care plans were not always reviewed following an incident. We recommended that the provider review the document format to include all the requirements to robustly report and manage incidents.

Staff were very knowledgeable about people’s care needs and the interventions they needed to keep people safe. However, care plans were not always reviewed to ensure they reflected people’s current needs or record the interventions they made, such as wound management. This meant people were at risk of receiving poor care.

The checks undertaken by the registered managers and provider had not picked up on all the areas we highlighted for improvement during the inspection. This meant the systems were not effective enough to ensure quality and safety. The provider told us they were committed to ensuring further development would happen following the inspection. They sent us examples of the improvements they had made following our visit and this gave us confidence they understood the work required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

People and their relatives were happy with the support they received. They told us staff were kind and caring. We observed positive relationships between people and staff which meant people were listened to and respected.

People, staff and their relatives all felt the leadership of the service was positive. They all told us they felt involved in the running of the service and where they had concerns they were listened to and dealt with appropriately.

A breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found during this inspection. You can see what action we told the provider to take at the end of this report.