Youell Court

Youell Court provides accommodation and personal care for up to 40 older people. At the time of our visit 35 people lived at the home. Accommodation is provided in a purpose-built home across three floors. One floor provides specialist care to people who live with dementia.

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

People felt safe and received their care and support from staff who understood their responsibilities to protect people from the risk of harm. The management of medicines and risks associated with people’s care and the environment had improved. This demonstrated lessons had been learnt. Staff were recruited safely and there were sufficient staff available at the times people needed them. The prevention and control of infections were managed in line with government guidance and the provider procedures.

Improved management oversight ensured checks of the quality and safety of the service were effective. People and relatives were very satisfied with the service provided and the way the home was managed.

The provider and registered manager understood their regulatory responsibilities. Staff felt supported by the registered manager who had developed an open and inclusive culture within the home and led by example. Partnerships working and feedback from people, relatives and staff was used to further enhance people’s experiences of the service provided.

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 10 May 2019).

Why we inspected

This was a planned inspection based on the previous rating. We looked at the key questions of safe and well led. Ratings from our previous comprehensive inspection for those key questions we did not look at were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Youell Court on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information 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:

•Individual and environmental risk was not consistently managed and management oversight did not always ensure the effectiveness of quality monitoring systems. Action was being taken to address this.

•People and their relatives were very positive about the service and the care provided.

•People felt safe living at the home and with the staff that supported them with care.

•Staff were recruited safely and received the training they needed to be effective in their roles.

•Staff knew how to protect people from potential abuse and avoidable harm to keep them safe.

•Overall medicines were managed and administered safely.

•People had access to healthcare professionals as needed and their nutritional needs were met.

•The management and staff team worked in partnership with other professionals and followed recommendations made to improve outcomes for people and maintain their health and wellbeing.

•People received information in a way they could understand and were supported to make choices about how to live their lives in the least restrictive way possible.

•The home’s design met people’s needs, the atmosphere was relaxed and the environment clean.

•Staff respected people’s rights to privacy and dignity and promoted their independence.

•People and relatives said staff were caring and friendly and provided timely personalised care.

•People’s needs were assessed to ensure they could be met by the service.

•End of life care was provided sensitively and in line with people’s beliefs and wishes.

•People and relatives were involved in planning and agreeing their care.

•Care plans were detailed to ensure people received the care and support they had agreed.

•Staff felt valued and supported by the management team and provider.

•Feedback from people, relatives and staff was used to drive continuous improvement.

•Complaints were managed in line with the provider’s policy and procedure. Lessons were learnt when things had gone wrong.

•People were supported to fulfil their dreams and aspirations and engage in meaningful activities.

•Staff knew people well, so they could provide them with care and support in ways they preferred.

Rating at last inspection: Requires Improvement (report published April 2018)

This is the third consecutive time the service has been rated 'Requires Improvemen'.

Why we inspected: This was a scheduled 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 any concerning information is received, we may inspect sooner.

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

Youell Court accommodates a maximum of 40 people in one adapted building across three floors. One floor provides specialist care to people who live with dementia. At the time of our inspection visit 28 people lived at the home and one person was staying at Youell Court on respite care. Of the 28 people, three were in hospital during our inspection visit.

This inspection took place on 31 January and 8 February 2018, and the first inspection visit was unannounced. The service was rated as 'requires improvement at our last inspection but there were no breaches of the Regulations. During this inspection visit we found two breaches of the regulations.

The home has a registered manager. 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.

The registered manager informed us they had not moved the home forward with improvements as much as they hoped they would. Since our last visit they had managed a number of staff performance issues which had led to an increase in staff vacancies. They had not had a stable and experienced management team in the home to support them. The provider had recently supported the registered manager by providing extra management cover to help them with their responsibilities. Some decisions taken by a member of the senior team at the home were not based on assessed need.

People who lived at the home felt well cared for and safe. But records related to their care did not always provide up to date and accurate information about their health and social care needs, or provide information to explain why some care practices had changed or been implemented. Staff were compassionate with people at the end of their life, but the home did not provide staff with training or procedures to help staff more fully understand how to support people's end of life care. We recommended the home seek further professional advice for this area of care.

There were enough staff on duty to meet people’s needs, but deployment of staff was not always effective in making sure people’s care needs were always met in a timely way. Communication between care staff and their seniors did not always ensure staff were aware of people’s changing needs. The use of agency staff had reduced from 88 percent at our last visit, to 43 percent at this visit. The provider ‘block booked’ agency staff to support continuity of care.

People enjoyed their meals and changes to meal times had improved people’s well-being. Some people were provided with specific diets, but records did not explain why they had been placed on these diets and staff did not know. The registered manager had recently contacted the appropriate healthcare professionals to ask them to assess whether people needed to be on these diets.

Medicines were managed safely and staff recruitment procedures meant staff could not start work until all checks on their suitability had been carried out. Staff understood how to safeguard people from harm.

The premises and the equipment used to support people’s needs were safe and well maintained. There had been further improvements in the décor of the units which housed the ‘butterfly project’ to support the needs of people who lived with dementia. The home was clean and staff knew their responsibilities to maintain cleanliness and reduce the risks of infection.

Staff had received training to help them keep people safe, and to help them work effectively with people who lived with dementia. Staff felt supported by the manager to carry out their roles and responsibilities.

People were treated with dignity and respect. Staff recognised the importance of maintaining people’s independence and did their best to do so. People were asked their consent prior to any care task being delivered.

People’s lives were enhanced by a range of activities. These included group activities and ones which linked more with people’s individual interests and past lives. Relatives and people who used the service were provided with opportunities to share their views of the service, and complaints were managed in line with the provider’s policy and procedure.

Youell Court is a residential home which provides care for a maximum of 40 older people, and people who live with dementia. The home has three floors. The ground floor is primarily used to support people on respite; the first floor supports people who live with dementia; and the second floor supports people who are more independent. At the time of our visit there were 30 people who lived at the home.

At our previous inspection on 16, 22 and 30 August 2016, the provider was rated as ‘Inadequate’ overall, and placed in ‘special measures’. We identified three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to improve staff numbers, staff training and support; improve staff understanding of the risks related to people's care so they could minimise these; improve the administration of medicines and the implementation of the Mental Capacity Act; improve management responsiveness to concerns and complaints raised; and improve management checks and audits to support the home becoming a better place for people to live.

The provider responded immediately to the concerns raised at our previous inspection. They sent us an action plan detailing the improvements they were going to make and were in regular contact with the CQC informing us of how they were progressing.

During this inspection we checked if improvements had been made. We found sufficient action had been taken in response to the breaches in regulations and the home was no longer in ‘special measures’. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

At our last inspection the home had a registered manager but they had been unwell for much of the time they had been employed at the home. 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.

Since our visit the registered manager had left the service and the provider had put interim management measures in place to support staff. The most recent interim manager secured the permanent manager position the day after our inspection visit.

There were enough staff on duty to keep people safe. There continued to be a high level of agency staff employed at the home however the provider tried to ensure they were staff familiar with the needs of people who lived at Youell Court.

Risks to people's health and well-being were now known by staff, and written risk assessments and care plans mostly had up to date information to support staff in their knowledge of people. Medicines were mostly managed safely.

Staff had received training to support people with their health and social care needs, and specialised dementia care training meant people who lived with dementia received much more responsive and effective care than previously.

Staff now understood the principles of the Mental Capacity Act, supported people to make informed choices, and where necessary acted in people's best interest when it had been assessed the person was unable to make their own decision.

People and relatives now felt their concerns or complaints were listened to and addressed. Complaints were managed in accordance with the provider's complaints policy and procedures.

People received choices of meals, and food which met their specific dietary requirements. Most people enjoyed the meals provided.

Staff had time to provide care which met people's physical, social and emotional needs. They supported people's dignity and privacy and treated people with respect.

People were much more engaged in individual activities, group activities, and activities that supported and maintained levels of independence. Visitors were made welcome in the home.

Previously the morale of most staff, people and relatives was low. This time, staff told us they were happy in their work, there was a relaxed and calm atmosphere in the home, and people and relatives reported there had been big improvements to the quality of people's lives.

The home had continued to have a lack of continuity in management. The most recent interim manager had been in post for two months and had secured the confidence of people, staff, and relatives. Whilst they had made big improvements during their time working at the home, these had not been tested over a longer period of time to ensure they could be sustained.

Youell Court is a residential care home which provides care for up to 40 older people, and people who live with dementia. The home has three floors. The ground floor is primarily used to support people on respite; the first floor supports people who live with dementia; and the second floor supports people who are more independent. On the first day of our visit, there were 37 people who lived at the home.

The service had a registered manager. 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. The registered manager had been registered with us since March 2016. Since then, they have had periods of absence from the home and due to ill-health. They had only recently returned when we visited.

Since our last inspection, the provider had undergone changes in the management team at the home. There had been periods of time when there was either no registered manager in post, or when both the previous registered manager, and the current registered manager were absent. There have also been changes to the head of care, and periods where no head of care has been available to support staff.

People were not always safe. There were not enough staff to meet people’s needs. The provider was trying to fill the gaps in the rota with agency and bank staff. The use of agency and bank staff to cover staff vacancies meant people were not provided with continuity of care by people who knew them well. The ‘staffing tool’ (the system which determined how many staff were needed to meet the needs of people who lived at the home) used by the provider did not provide sufficient staff to meet the needs of people or take account of the size and layout of the building.

Risks to people’s health and well-being were not always known by staff, and written risk assessments and care plans did not have up to date information to support staff in their knowledge of people. Senior staff had not had the time to update the care records, and care staff told us they did not have time to read them. During our visit we saw one person’s safety was compromised as a result of staff not knowing what their risks were. Medicines were not always managed safely.

Not all staff had received training the provider had deemed as necessary to meet people’s specific individual needs or ensure their safety. Until very recently staff had not received sufficient supervision or support from the management team to help them work effectively.

Staff knew the importance of seeking consent when providing care to people, but did not have knowledge of the principles of the Mental Capacity Act, and had not received training to help them understand them. Where people had been diagnosed as having a condition which impacted on their capacity to understand, there were insufficient assessments to determine what decisions the person could make, and what needed to be made in their best interest. Deprivation of Liberty safeguards were in place for people whose reduced capacity had meant their liberty had been restricted.

Formal complaints had been addressed appropriately through the provider’s complaints policy and procedure. However informal verbal complaints had not always been addressed to the satisfaction of relatives; and these had not been recorded to determine whether there were any trends or learning points from the concerns raised.

People enjoyed the meals provided, but we could not be assured that people who required support to eat and drink were getting sufficient support to maintain their health and well-being. People were provided with activities but these were mostly group activities, and individuals who either could not, or did not want to attend the organised activities, had limited opportunities to engage in other interests.

Individual staff members were kind and attentive to people. However, due to insufficient numbers of staff available, staff interaction with people was mostly when supporting people with care tasks. Friends and relatives could visit the home at any time during the day and evening.

The provider had not supported the management and staff team to ensure the home provided safe, and good quality care to people. Staff felt the new management team at the home were open and supportive to them. However, not all felt the provider’s senior management team were as supportive, and felt they had not listened to their concerns about the service when they had been raised.

The provider was in the process of improving its responsiveness to people who lived with dementia. They had arranged for a nationally respected organisation to support staff in improving the care provided to people with dementia.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During this inspection we found the service to be in breach of several 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.

When we inspected the home there were 33 people living there. The home was laid out over three floors. Some people were unable to communicate with us verbally. During our inspection we spent time in the communal areas of the home observing people to see how they spent their time, and how staff interacted with them.

We spoke with four people who lived at Youell Court about their experiences of the service. We also spoke with four relatives of people about their family member's experience. We observed the care that was given to people during our inspection. We looked at care records at the home.

We spoke with a range of staff including members of staff who provided personal care to people at Youell Court, the registered manager (referred to as the manager in this report) and the care manager.

We visited the service to check on a number of concerns that had been raised at the previous inspection in December 2013 to see whether improvements had been made. Before our inspection concerns had also been raised with us by three relatives of people who used the service. We found further improvements were still required in some areas.

During our inspection we looked to see whether we could answer five key questions: Is the service safe, effective, caring, responsive and well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that care records did not contain enough detail to meet the needs of people who used the service. For example, where people had physical health needs there were not always guidelines in place for staff to follow to meet those needs. This put people at risk of being given inappropriate care.

We observed staffing levels during our visit. There were times in the early evening when there was no visible staffing presence to assist people if they needed help. Some of the people we spoke with expressed concern over staffing numbers, especially in the early evening and particularly on the top floor of Youell Court.

The manager told us the home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). Relevant staff were trained to understand when an application should be made and how to submit one. The manager was aware of the latest guidance and information on DoLs and was liaising with the local authority to ascertain whether any changes were required to their policy.

People were not protected against the risks associated with medicines because the provider had not made appropriate arrangements to manage medicines safely.

Is the service effective?

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively. We found that these assessments did not always adequately identify people's support needs which placed people at risk.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate.

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

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived there.

People and relatives we spoke with told us staff were kind and caring. We saw one person who was asleep woke up and was very pleased to see a member of staff. One person became upset and the member of staff held them and reassured them. We saw people were cared for in a compassionate way.

Is the service responsive?

We saw people were able to access help and support from other health and social care professionals when necessary.

We saw people were able to make choices about their day to day lives. For example, people were able to participate in a range of activities both in the home and in the local community.

We asked relatives and people at the home whether relatives could visit at any time, they told us they could. One person we spoke with told us, "I come here every few days. I'd like to be here if I needed to be anywhere."

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. We saw that there were recent audits in a number of areas including medication. Records seen by us showed that identified improvements were addressed promptly. As a result the quality of the service was continuously improving.

We saw staff being supportive and kind to people living at Youell Court. They were aware of the importance of preserving people's dignity and respect and their actions demonstrated this. People we spoke with said staff treated them with dignity and respect. One person told us they kept their door closed to their room when they wanted privacy. Another person told us, 'They keep me covered when they wash me'.

Care records showed that before people were admitted to the home they received an assessment to identify if the home could meet their needs. This assessment included the identification of people's; communication, physical health, mental health, mobility and social needs. Care records showed that people, their relatives and health and social care professionals were involved in the assessment process.

Care records showed that staff were responsive to changes in people's needs. We saw that health and social care professionals were consulted, and staff worked with other providers to ensure that people received the right care at the right time.

We asked people if staff talked to them about their care or treatment. People told us they did. One person said, 'Oh yes, the home is very good, you get good treatment. We don't have anything to complain about'.

During our visit we saw people being given their medication. This raised some concerns. We therefore extended our inspection to look in detail at the management of medicines in the home. We found that medicines were not always being accurately recorded or monitored. We found that records did not provide staff with sufficient information about medication that needed to be administered on an 'as required' basis.

We observed staffing levels during our visit. There were times when there was no visible staffing presence to assist people if they needed help. Some of the people we spoke to also expressed concern over staffing numbers on the top floor of Youell Court. We have made the provider aware of our concerns about staffing levels and expect them to confirm the action they take as part of their formal response to this report.

The service had taken account of good practice guidance available from dementia specialists about making the environment safer and more accessible to people with dementia. Staff received training in dementia which enabled them to provide safe and professional care.

Effective systems were in place to enable the quality of care to be assessed, monitored and improved. Care and treatment was planned and delivered in a way that was intended to ensure people with dementia were offered good quality care in a safe environment.

The report from the provider showed that appropriate action had been taken to ensure people's personal records were accurate, fit for purpose, held securely and remained confidential.