Archived: Yatton Hall Care Home

Yatton Hall Care Home provides accommodation with nursing and personal care for up to 48 people. When we visited, 37 people lived there.

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

During this inspection we found that people’s needs were not always met due to inadequate staffing levels. People, their relatives and staff said care needs were not always met and we made observations to support this. People’s medicines were not always managed safely, and this placed people at risk.

People’s risks were assessed and identified, and risk management plans were in place to reduce known risk. However, during a review of some people’s care records the service could not evidence care had been delivered in line with people’s assessed needs. We observed the service was clean, however observations of staff infection control practice place people at risk.

We reviewed the service practice in relation to the Mental Capacity Act 2005 (MCA). People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. This was not in line with the principles of the MCA. The registered manager did not have robust system to monitor Deprivation of Liberty Safeguards (DoLS) applications and authorisations meaning some people at the service may have been unlawfully deprived of their liberty. Legal conditions on DoLS authorisations had not been identified or met.

Staff were not always fully supported in their roles, and in addition to being below the providers training completion compliance level, staff had not received regular supervision and appraisal. We spoke with staff who confirmed they had not been receiving their supervision and staff new to care had not been appropriately supported in the early stages of their employment. People’s feedback was mixed in relation to the current standard of food at the service. We saw records relating to nutritional support were not always accurate.

People spoke positively of the staff and many commented on how they tried their best to provide the best possible care in challenging circumstances. However, during the inspection we made observations and received comments from people evidencing how their dignity had been compromised.

We found the service was not always fully responsive to people’s care needs. Whilst we found care was planned, people did not consistently receive care in line with their assessed needs. We found that people’s records were inconsistent and information about people preferences, past history, important relationships and religious and cultural beliefs were not always documented. Whilst this had not impacted anybody, it did not demonstrate a consistent person-centred approach.

There was an inconsistent approach to end of life care planning throughout the service. There was a system to investigate complaints, however it was not evident it had been consistently used and records were incomplete. The service had an activities provision. However, this had been impacted since the passenger lift became defective and people gave us information about how they had become socially isolated.

It was evident that the governance systems in operation at the service at both internal and provider level were currently ineffective. Internal auditing systems had not identified the breaches of regulation we found during the inspection. Provider level governance and auditing in August 2019 had not identified concerns affecting the health, safety and welfare of people at the service. The provider had failed to send a DoLS notification to the Care Quality Commission (CQC) as required by law.

Staff felt unsupported and some commented on not feeling appreciated or valued. People using the service gave mixed feedback about their involvement through continual engagement and meetings. Staff told us meetings were held and we saw supporting minutes.

Whilst it was evident people’s needs were not always met through inadequate staffing and management oversight, people and their relatives spoke positively about staff. There was awareness of staff effort in the face of adversity and people felt that staff were doing their best to support them. Staff we spoke with told us they worked well as a team together despite staffing issues.

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

Rating at last inspection:

The last rating for this service was Good (published September 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

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 and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement:

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this focused inspection to ensure that people living in the service were safe, and that there were sufficient staffing arrangements in place to make sure people’s care needs were being met. We reviewed the medicines management in the service, and spoke with staff to establish their knowledge in relation to identifying and reporting safeguarding concerns. We looked at the training staff received in relation to moving and handling people and what systems were in place to review falls or incidents. This report only covers our findings in relation to these areas.

When we last inspected Yatton Hall Care Home in November 2016, we found no breaches of the legal requirements and the service was rated ‘Good’ overall. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Yatton Hall Care Home on our website at www.cqc.org

Following this inspection, the current overall rating for the service remains at ‘Good.’

Yatton Hall Care Home is registered to provide accommodation for up to 48 people. At the time of our visit, 38 people were living at the service.

A registered manager was in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People were not fully protected against the risks associated with medicines. Records had not been accurately maintained by nursing staff. This placed people at risk as staff were unable to confirm if a person had received their prescribed medicine the day prior to our inspection.

We found that some records were not clear when detailing how to meet people’s care needs in relation to reducing their risk of developing a pressure ulcer. This was due to no record detailing the support people received during daytime hours. We found some air mattresses were also incorrectly set. Improvements were required in the risk management of epilepsy management. Improvements were also required when people were identified as losing weight and the recording of all referrals made when nutritional risks were identified.

People at the service were very positive when speaking about their care experiences and the staff that supported them. All said they felt very safe in the service. People told us there were sufficient staff to support them and staff told us there were sufficient staff to meet people’s needs, but expressed frustration at frequent short notice sickness from colleagues.

Staff understood their obligations around safeguarding adults and felt confident matters would be addressed by the service management. Staff were knowledgeable about external agencies they could contact to raise safeguarding concerns with should the need be required. Staff received moving and handling training to ensure safe practice and their competency was assessed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There is a 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.

There were good arrangements for the administration of "as required" medicines, storage and management of medicines. Action had been taken to ensure one person's health was not at risk because of their inability to swallow medicines safely.

There were varied views from people about the staffing arrangements in the home. Some were satisfied with how staff responded to requests for assistance whilst others thought it could be improved. Comments from people included: "It’s poor trust me” – when referring to staffing levels. Another person commented, "Serious staffing problems here, agency staff are variable with knowing needs” and "They could do with an extra one in the mornings." This was also commented on by staff. However, other people spoke positively about the staffing arrangements. One person told us "I feel safe with staff, they will come when needed” and another said "Staff always seem to be there when we need them."

We observed staff responded in a timely manner however, there were delays on some occasions specifically in the morning with people wanting to get up but having to wait. The registered manager provided their staffing assessment based on people's dependency and the numbers of staff on duty fitted the recommendation from this assessment. In discussion with the registered manager they recognised staffing arrangements would benefit from being looked at.

People told us they felt safe in the home. One person said, "Best bit, in short, is that I’m safe”. Another person said, "I am safe because I can trust the staff they know what they are doing. A relative told us "Girls are amazing, mum has been in the home since May and has found it to be excellent and safe." Staff had a good understanding of their responsibilities in protecting people from abuse. They spoke of reporting any concerns and being confident they would be listened to and action taken to address their concerns.

Improvements had been made in ensuring people's rights were protected especially when consent was required for the use of equipment such as bed rails and sensors which detected people moving in their rooms. There were systems in place to make decisions on behalf of people who lacked mental capacity and ensure they were taken in people's best interests.

People told us they felt staff were competent to provide the care they needed. One person commented, "Staff skills are very good." another said, "Staff all seem well trained." Staff were all very positive about the training provided by the provider.

There were good arrangements to ensure people's nutritional needs were met with liaison with specialists where this was needed to provide advice and guidance about supporting people. However, comments from people reflected differing views about the quality of meals and food. One person said, "Food is patchy here" and another "Food is alright sometimes but it has deteriorated. The quality has dropped overall”. Whilst others told us how they enjoyed the meals: "I always enjoy the food" and "There is always good choice."

Staff were described by people and relatives as caring, friendly and kind. Staff were observed interacting in a warm and caring way with people. There was respect for people's dignity and right to privacy. People told us they made decisions and choices for themselves and were able to be as independent as they wished with the support of care staff.

People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.

There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home and their relatives were kept informed about the service and people could give feedback about the quality of care provided in the home.

There were a range of quality assurance audits which had identified areas for improvement.

People and staff spoke of a registered manager who was approachable and made themselves available to people on a daily basis through walking around the home. This was commented on by people we spoke with: "She is very good, is often around the home coming to say hello and ask how we are." and "She would be here if I wanted her, she is very friendly."

The inspection team consisted of two inspectors, a pharmacist and an expert by experience.

At the time of our inspection there were 41 people living permanently in the home. We observed the care being provided to people in the communal areas of the home and examined the care documentation and supporting records. We spoke with eight people that used the service, one relative and we spoke with nine members of staff to gain their understanding of how they met the needs of people living in the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is it safe?

Staffing was maintained at safe levels. During our inspection people's needs were responded to in a timely manner. People we spoke with told us they felt safe living in the home and knew who to tell if they didn't. One person told us 'they know me very well and what I need'.

Appropriate arrangements were in place for managing medicines. People's medicines were available for them and given in a safe way. People told us their medicines were given at the correct times. Comments included "they are meticulous about medicines" and "generally staff are very good".

People's personal records were not always completed fully. Therefore it was not clear from the information whether the person had received care in line with their identified need.

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff had a good understanding of who they needed to contact should they have any concerns around people's welfare. Staff received training in safeguarding adults.

People who used the service were cared for by staff who knew how to protect them from the risk of abuse. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The registered manager confirmed no one currently living in the home was subject to such an application. However relevant staff had been trained to understand when an application may be required. This meant that people were safeguarded from abuse.

Not all areas of the home were clean and there was a risk of cross infection as appropriate standards of cleanliness had not been maintained.

Is it caring?

People were supported by sensitive and attentive staff. Comments we received from people living in the home were positive. Comments included "staff ask if a want a shower. and always knock before coming into my room", 'we are very well looked after' and 'staff are very nice and listen to us'.

We saw that care staff showed patience and gave encouragement when supporting people. We spent time in the communal lounge observing interactions between staff and people that used the service. People were treated with care and respect while using handling equipment such as a hoist. People were encouraged to be as independent as could reasonably be expected, while staff were ready and willing to offer assistance sensitively when it was needed.

Is it effective?

We found people's health and care needs were assessed and reviewed regularly. Care plans provided guidance for staff to follow to ensure people's individual specific needs were met. Care plans were reflective of people's current level of need. Specialist dietary, mobility and equipment needs had been identified in care plans where required and staff were observed using equipment to support people competently.

Most care documentation that we viewed was reflective of people's current level of need. However some recording charts for the administration of people's creams and moisturisers, food and drink, and repositioning were not completed fully. This meant there was a risk people were not being given the support required in line with their care plan.

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

Is it responsive?

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example people's files held information and advice sought from the district nurse team in relation to their wound management care.

People's needs had been assessed before they moved into the service. Documentation that we viewed evidenced that people were involved with the planning of their care. One person told us 'they came to visit me before I came here and checked what I needed".

Is it well led?

A stable management team was in place. People told us the registered manager was available to talk to them if they had any concerns. One person told us "oh yes, I would speak to the manager if I wasn't happy with what went on". Staff we spoke with felt supported by the management team. One member of staff told us "the best thing about this work is the residents and the staff. I love working here".

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. Comments we viewed were positive from people.

All the people we spoke with told us they liked the home and were happy with the care and support they received. One person told us 'I enjoy living here, this place has given me a new lease of life'.

We saw that the home assessed people's needs and care plans were developed to meet these needs.

During our inspection we observed that call bells were answered quickly and efficiently and people's needs met appropriately by care staff. Although one person we spoke with was not able to reach their call bell.

People told us they felt safe living at the home and felt confident that staff would take any concerns seriously.

Staff demonstrated to us that they were aware of the providers safeguarding procedures and knew how to respond to allegations of abuse appropriately.

We found that staffing levels were appropriate to the needs of people living at the home.

The provider had systems in place to monitor the quality of the service. Where checks identified shortfalls, these were addressed and action plans put in place to ensure these areas were addressed.

We found care plans reflected the needs of people living in the home and the provider had taken appropriate steps to address risks associated with people's health and welfare needs. We found that care plans did not reflect a person centred approach to the providing of care.

We found that staff had a good understanding of safeguarding vulnerable adults and their responsibilities in relation to reporting any concerns about possible abuse.

We found that the provider had experienced difficulties around maintaining staffing levels but had made efforts to address the shortfall specifically in relation to staff sickness and need for recruitment. However there was not a robust system in place to help make a judgement about the level of staffing required in the home.

We found the provider did not have an effective system to assess and monitor the quality of the service that people receive.