York House

About the service

York House is a purpose-built care home providing personal care to 35 people at the time of the inspection. The service can support up to 36 older people, some of whom are living with dementia. The home stands in its own grounds with an enclosed garden and car parking.

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

We found one breach of the regulations in relation to medicine management. Medicines were not always safely managed.

People and their relatives were positive about the service and the care provided. The recruitment of staff was safe and staff received induction and undertook mandatory training.

Staff were kind, caring and compassionate. The home was welcoming and friendly. It was clear people and staff had formed good relationships. People and relatives were involved in decision making. Staff respected people’s privacy and dignity.

People told us they thought the food was good. People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. There were suitable and sufficient numbers of qualified staff to support people in line with their assessed needs.

Staff were responsive to people's needs and wishes and knew people well. People were offered choices and encouraged to remain independent. People's views were sought and action taken to improve the service from these.

The registered manager was proactive and visual within the home. They operated an open-door policy. People, relatives and staff knew them well.

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. The provider was working within the principles of the Mental Capacity Act.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 October 2018). The service remains rated requires improvement. This is the second time the service has been rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had not been made and the provider was still in breach of regulations.

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 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.

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection. You can see what action we have asked the provider to take at the end of this full report.

York House 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.

A new manager had recently been appointed but they were yet to apply to be registered with the CQC. 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. It is a condition of the registered providers registration for there to be a registered manager in post.

Staff we spoke with were knowledgeable about safeguarding people and could explain the procedures to follow should an allegation of abuse be made. Assessments identified some risks to people although associated management plans were not always in place to reduce the risks and ensure people’s safety. We found some issues in relation to the identification of suitable equipment in people’s care plans and how equipment was checked.

There were insufficient staff to ensure people’s needs were met at a time of their choosing. There were periods during the day when staff were unavailable in the communal lounge, however the provider’s dependency tool showed there were sufficient staff for the number of people at the home. Staff were observed to be spending time away from the caring role on ancillary tasks.

During our inspection we observed medicines were administered safely, but there were issues with recording as the actual count and records did not tally. In addition, a record of the administration of creams was not always completed.

The manager understood their responsibilities under the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and authorisations had been requested. However, recorded evidence was often missing in relation to the assessment of mental capacity and best interest decisions, where people lacked the capacity to consent to certain aspects of their care and treatment. The provider was still in the process of ensuring each person had a record in place and they had identified the requirement for this.

There had been an issue with weight loss at the home which had been recognised by the regional manager in their audit and people’s weights were regularly monitored. Some improvements in records relating to people’s food and fluid intake was required and there was a lack of consistent recording in relation to what people had eaten. The information held in the kitchen and in people’s care plans did not always tally.

The quality of the record keeping varied and some care records we looked at were not personalised, were inconsistent and in many instances incomplete. The provider had recognised care plans needed to improve to be person-centred and reflective of people’s care needs.

The home had not been well-led and there had been a lack of robust monitoring to drive improvements. Detailed audits had been carried out by the regional manager, which had identified the issues and there were plans in place to improve the home within a set time-frame to ensure they improved the quality of their care provision and were fully compliant with the regulations.

The registered provider was open and honest with people, their relatives and with staff about the issues they had found at the home. They held regular meetings to update people and share their plans for improvements.

This is the first time the service has been rated Requires Improvement. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, safe care and treatment, and good governance. You can see what action we told the provider to take at the back of the full version of the report.