Archived: Yarborough House Care Home

Yarborough House Care Home is a care home providing accommodation and personal care for up to 25 older people, some of whom may live with dementia. At the time of our inspection 20 people lived at the service.

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

Improvements had not been made and sustained since the last inspection in relation to safe care. Standards of cleanliness and hygiene around the service were poor as we found furniture, flooring, bedding and equipment was dirty. Damaged flooring, furniture and fittings meant these areas could not be cleaned effectively. Staff were not following infection control guidance consistently. Although the number of hours allocated to cleaning the home had increased, the senior staff were not monitoring the standards of cleaning adequately.

Aspects of COVID-19 guidance were now being followed in relation to staff wearing PPE, testing and temperature monitoring of visitors and staff.

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 last rating for this service was requires improvement (published 23 September 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection sustained improvement had not been made and the provider was still in breach of this regulation.

Why we inspected

We undertook this targeted inspection to check the Requirement Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The inspection was also prompted in part due to concerns received about standards of hygiene and infection prevention and control practices at the service. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last focused inspection, by selecting the ‘all reports’ link for Yarborough House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to infection prevention and control. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

Yarborough House Care Home is a care home providing accommodation and personal care for up to 25 older people, some of whom may live with dementia. At the time of our inspection 23 people lived at the service.

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

There were not enough staff to give people timely care, provide the reassurance and support people required when they were distressed and keep the home clean. Standards of cleanliness were poor and expected infection control guidance and procedures were not followed.

Risks to people were not always identified and managed. Accidents and incidents were not effectively monitored to consider lessons learnt and reduce the risk to people. There were several incidents that should have been notified to Care Quality Commission (CQC), but this had not been done.

Areas of the service needed redecoration, refurbishment and maintenance. We contacted the local environmental health agency to request a visit to the service and support the provider with the disposal of items left in the grounds.

Staff morale was mixed and staff turnover was high. Some staff did not feel listened to. Staff did not have training in some key areas and some staff had not received formal supervision. One area of the recruitment process required improvement to ensure safe and robust recruitment of new staff.

Quality assurance systems were not operated effectively and failed to ensure compliance with regulations. Where issues had been identified the provider did not act in a timely manner to address these.

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. Medicines were managed safely, and people’s nutritional and health needs were met. People were safeguarded against the risk of abuse.

The service worked with local agencies and had developed close community links. People told us they liked the staff and were happy and settled in the service.

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 last rating for this service was good (published 21 March 2018).

Why we inspected

The inspection was prompted due to concerns received about infection prevention and control, the environment, staffing levels and the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. Following the inspection, we requested an action plan from the provider which detailed the improvements they needed to make.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yarborough House Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to infection prevention and control, the management of risk, staffing, staff training and support, the environment, notification of serious incidents and safeguarding matters to CQC and failure to operate effective monitoring systems to improve the quality and safety of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People gave us positive feedback about the management team. There were a range of audit systems in place to monitor the quality of the service. We found some shortfalls in the re-decoration and renewal programmes, which were addressed following the inspection.

People who used the service were supported by caring staff. People were treated with dignity and respect by staff who knew their needs and understood their preferences. Staff showed a genuine interest and affection for the people they cared for.

We observed a positive and inclusive atmosphere within the home with people and staff getting on well. People's views were sought during care reviews, resident meetings and surveys. The provider had systems in place to respond to complaints about the service.

People were involved in planning their care and support. Care plans contained person-centred information about people’s needs and guidance for staff on how best to support them. Staff explored people’s wishes about how they wanted to be cared for at the end of their life.

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 were provided with the opportunity to participate in meaningful activities which interested them and were encouraged to maintain links with the local community.

People told us they felt safe. There was sufficient staff deployed to ensure safe care and treatment.

Systems in place minimised the risk of harm to people. These included effective risk assessment of people’s needs, safeguarding matters, management of medicines, safe recruitment and effective management of accidents and incidents. The provider ensured safety checks and servicing of equipment was completed regularly.

Staff received regular training; supervisions, observations and appraisals were used to monitor their performance and support their continued professional development. There were staff meetings which enabled them to receive information and express their views. Staff told us they felt supported by management.

The registered manager was very experienced and had managed this service for many years. People and relatives spoke positively about the service and said it provided good quality care in a personalised and friendly way.

Further information is in the detailed findings below

The registered manager told us, 'We changed our supplying pharmacy not long ago so asked them to come and audit us, a couple of minor changes were recommended.' We saw that the one concern highlighted by the pharmacy had been implemented.

The chef explained, 'I get all the information about people provided but you build up knowledge over time, people's likes and dislikes, portion sizes that sort of thing, we have a couple of people who are diabetic but its tablet controlled so they can still eat certain desserts' and went on to say, 'We have a picture book to show people what options they have.'

Fridge and room temperatures were recorded on a daily basis to ensure that medicines were stored as directed by the manufacturer. However there was no guidance for staff in relation to maximum and minimum temperature ranges.

A staff member told us, 'The staff meetings are good, we can all talk about any issues or changes and share how we support people if there are any changes.'

We saw evidence that personal and sensitive information was retained for the appropriate period of time. The home had specific arrangements to ensure specific information was securely destroyed.