Archived: York House

York House provides accommodation and personal care for up to ten people who have a learning disability.

The home had a registered manager but they were not present for the inspection. The provider had made arrangements for a registered manager from another service within their organisation to run the home in the absence of the home’s registered manager. Reference to the registered manager in this report relates to this person. 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.

People were not always supported to take their medicines and they did not always receive their prescribed treatment. People were not always protected from poor care practices because staff did not act on this to protect them. The provider had taken action to provide additional staffing so people would receive a better service. People were protected from the risk of accidents because knew how to reduce the risk of this happening.

The provider had taken action to provide staff with one to one [supervision] sessions to assist them in providing a better service for people. The provider had also taken measures to ensure new staff were supported in their role. People were cared for by staff who had access to routine training to ensure they had the skills to care and support them.

Staff had a good understanding of the Mental Capacity Act 2005, but their knowledge was not always put into practice to ensure decisions made on people's behalf was in their best interest. People had a choice of meals and had access to drinks at all times. People were supported to access healthcare services when needed to promote their health.

Staff demonstrated a good understanding of how to promote people’s right to privacy and dignity but this was not always put into practice. People’s support and care needs may not be met because not all the staff were aware of their needs.

Practices did not support people to be involved in their assessment of their needs, so people may not receive a service specific to their needs. People had limited access to their local community and they were not always supported to do the things they enjoyed.

People were unable to tell staff if they were unhappy but staff knew by their body language and facial expression. Systems were in place to manage complaints and to show what action had been taken to resolve them.

The home was managed by a registered manager and two compliance managers. Prior to our inspection the provider had taken action to improve the service provided to people. The culture of the home was not inclusive to support people to have a say in how the home was run. The provider’s governance was not effective to ensure people received a good service. However, the provider was confident their governance was effective if implemented properly and managers were in place to ensure this.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People who were able to told us they felt safe living at York House. Other people appeared relaxed and comfortable in the company of the staff and the other people they shared their home with. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Risks to people had been identified, assessed and kept under review.

The service was safe, clean and hygienic. Records showed that equipment such as hoists were appropriately maintained and serviced regularly. This ensured people were not placed at unnecessary risk. Arrangements were in place to upgrade the fire system and the registered manager was nearing completion of meeting the requirements made by the food standard agency.

Records were maintained to a satisfactory standard in most areas and had improved since our last inspection. The registered manager acknowledged this was very much work in progress with the implementation of new paperwork being introduced.

Is the service effective?

People's health and care needs were assessed and people and their representatives were involved in reviewing their care and support. Specialist mobility and equipment needs had been identified in support plans where required.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Staff told us they received effective support from their managers and said they were approachable and operated an 'open door' policy.

Is the service caring?

People were supported by staff who demonstrated a clear understanding of their needs. We saw that care workers showed patience and gave encouragement when supporting people. People told us, 'I like living here. The staff are OK, they look after me well'.

Managers told us people were supported by a very dedicated staff team who were good at listening and responding to people's needs. They said, 'We've got exceptional people here'. Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people with great sensitivity and empathy.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We saw people took part in a range of social activities in and outside the home regularly. One person told us they helped out at the local church. They said they liked giving out leaflets, turning off the lights and keeping the church tidy. They also told us about the holidays they had enjoyed. Another person told us they made a card to give their Mum to celebrate Mother's Day.

People were treated with respect and dignity by the staff on duty. Staff shared examples of how they promoted people's privacy and dignity in their everyday practice.

Is the service responsive?

We saw the home had been responsive to people's changing needs. The home worked well with other agencies and services to make sure people received their care in a joined up way. We saw the home had requested a person to be reassessed due to their changing needs. Appropriate equipment to meet the person's needs had also been sought.

Staff had developed close and positive working relationships with health and social care professionals such as the district nurse and GP. This ensured they worked in people's best interests and were able to continue to meet people's changing needs.

People who were able to told us they enjoyed their activities. We saw these reflected people's personal choices and needs.

Is the service well-led?

The service had a quality assurance system. People had access to an advocacy service if they needed it. We saw people had been supported by an independent advocate to complete satisfaction questionnaires. This meant that people's views about the service they received were represented.

Staff were clear about their roles and responsibilities. They told us the management team operated an open door policy and always welcomed their suggestions for improvement. They considered the service was well-led. They said they received regular opportunities to meet on an individual and group basis and felt supported in their work.

Managers told us they required more time to undertake quality checks. They said, 'We do our best given the workload has doubled and the growth in the service'. We were informed a drive to recruit additional staff was underway.

We saw that care plans had been reproduced in an easy to read format to help people understand and be involved with their care planning. However, some information was duplicated in different folders. It was not always clear which records were the most up to date. We also found that some key information was missing from one care plan.

We found that people were involved in the planning of their care and support as far as they were able. Where appropriate, the staff consulted people's relatives to help them make decisions. We saw records of when best interest meetings had been held to make decisions on people's behalf.

We found that the provider was protecting people from the risk of abuse, by taking reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff we spoke with understood the provider's safeguarding procedures. There were robust measures in place to protect people's finances.

We were satisfied that the provider made all the appropriate checks on staff before their full employment started.

We found that the provider regularly monitored quality and performance and followed up action points from previous audits.