Archived: York House Care Home

York House Care Home is a residential care home providing personal care to people aged 65 and over. The service can support up to 34 people in one adapted building. At the time of the inspection, there were 27 people living there or having a respite break.

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

People, visitors and staff had confidence in the management team. The registered manager addressed any issues robustly. However, the service’s quality assurance system had not flagged up matters we found. These included not notifying CQC of a serious injury and the last inspection rating not displayed correctly on the provider’s website. Issues were promptly rectified once drawn to the registered manager’s attention. We have made a recommendation about management oversight and quality assurance processes.

People and visitors gave positive feedback about their or their loved one’s life at the service. People’s needs were assessed before they arrived at the service to be sure it was suitable for them. Meals were appetising, and dietary needs and preferences were met. Staff were prompt to contact health professionals when there were concerns about people’s health. There were adaptations for people with mobility difficulties. Staff were supported through training and supervision to perform their roles effectively.

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. We have made recommendations regarding recording of mental capacity assessments and best interests decisions, and the system for monitoring the expiry dates and conditions on Deprivation of Liberty Safeguards authorisations.

People had care from staff who knew about and respected their individual needs and preferences. Care plans reflected people’s individual needs and were up to date. Staff were aware of people’s communication needs and provided the support they needed with these. There were organised activities for people who wanted these. Staff liaised with health professionals to ensure people were in comfort as the end of their life approached. People and visitors said they would feel able to raise a complaint with the management team. We have made a recommendation in relation to the complaints policy.

People told us staff were kind and helpful. Staff were respectful towards people and upheld their dignity and independence. People and, where appropriate, relatives felt involved in decisions about their or their loved one’s care. People said they could have visitors whenever it suited them.

People told us they felt safe and comfortable with the staff who supported them. There were enough staff on duty to provide the care people needed. Staff only started work for the service once recruitment checks were completed. They had training in safeguarding adults and knew how to report suspected abuse. Risks for people were assessed and managed, in consultation with them. The management team reviewed accident and incident forms to ensure all necessary action had been taken for people’s safety and wellbeing. Learning from accidents and incidents was shared through team meetings or staff supervision meetings, as appropriate. Medicines were stored securely and managed safely. The premises were kept clean and tidy.

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 14 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had 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.

We spent time with people seeing how they spent their day and observing the care and support being provided. Most people were able to talk to us and reported that they were happy with the care and support they received. We saw people were treated with care and respect by the staff team who they approached for support without hesitation. People told us, “It’s not like your own home, but staff are lovely and kind” and “Some carers are better than others, but on the whole they are very supportive.” While people’s relatives said, “The carers are, I think excellent” and “I think [my relative] is very happy and well looked after.”

Staff knew people well and provided compassionate care and support throughout our inspection. People requested support from staff without hesitation and staff responded promptly to people request for support. We saw numerous examples of people and staff laughing and joking together and staff said, “We all have a good laugh.”

The service was short staffed during the morning of our inspection as a member of care staff had become ill and had been sent home and staff were noticeably busy. Staff told us it was unusual for the service to be short staffed and commented, “It’s normally four carers in the morning and four in the afternoon”, “It’s busy today” and “Today there are only three of us on, the fourth person does make a huge difference. Tomorrow there are five staff.” We reviewed the services staff rota and found that the service was normally staffed by four or five care staff during the day and confirmed that the reduced staffing level on the day of our inspection was unusual.

The service did not employ staff with specific responsibility for organising activities. During the morning of our inspection there was a noticeable lack of meaningful activities for people to engage with. In addition in the early afternoon we observed that staff were unable to support people to go outside when they wished. These issues may have been a result of unexpected staff shortages. However, people told us activities within the service were limited and staff told, “It is frustrating when you can’t respond immediately” and “In the afternoon between three and five they [staff] have more time to do things.” We have made a recommendation about the provision of meaningful activities.

Staff understood their role in safeguarding people from abuse and had completed appropriate training to ensure they were sufficiently skilled to meet people’s care and support needs. Staff told us, “We are all up to date with our training”. Staff recruitment processes were robust and designed to help ensure all new staff were suitable for work in the care sector. Once recruited staff received formal training and shadowed experienced staff before being permitted to provide care independently. In addition, staff new to the care sector completed six weeks of shadowing during which they were supported to complete the care certificate training designed to provide new staff with a good understanding of current best practice.

Records demonstrated staff had received regular supervision during which their performance was discussed and any additional training needs were identified. Staff told us, “I do feel supported” and “I’ve had supervisions, I raised some issues and they were dealt with straight away.” Staff handover meetings were held at each change of shift to ensure staff were aware of any changes to people’s needs. In addition larger staff team meetings were held regularly to enable information about the services performance to be discussed and allow staff to share information and any concerns they may have. Staff told us, “We do have staff meetings. We had a list of concerns at the last meeting and it was all addressed.”

Assessments of risks had been completed and people’s care plans included guidance for staff on the action they must take to protect people from identified risks. Where accidents or incidents had occurred these had been documented and fully investigated.

People’s care plans had been developed from information gathered during the assessment process and regularly updated to ensure they reflected people’s current care and support needs. These documents provided staff with clear direction and guidance and included information about the person’s background, life history and interests. People received regular support from external health care professionals and any guidance provided, had been incorporated into people’s individual care plans. Professionals told us, “The management and staff are open to ideas and suggestions” and “They are very good at following advice.”

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and we noted that staff consistently offered choice and respected people’s decisions. Appropriate deprivation of liberty applications had previously been made where the service had recognised that the care plan of a person who lacked capacity may have been restrictive.

People and their relatives provided mixed feedback on dining experiences in the service. Relatives told us, “I have been to worse restaurants.” However, some people said, “My only gripe is that, when I sit down for lunch or tea, I have to wait a long time” and “We do not get a choice and the food is not always nice or enough.” We observed the support provide at lunch time. Staff offered choices and the three course meals provided were appetising and freshly cooked. People told us their meal time experiences would be improved if the pace of service between courses was reduced. We observed staff removing plates immediately once people had finished eating which was not consistent with a relaxed dining experience. We discussed these observations with the registered manager who agreed to review the manner in which support was provided at meal times.

The service was well led by the registered manager supported by an effective system of three duty managers. Duty managers normally worked two consecutive day shifts and slept in the service on the night between their shifts in order to help ensure staff had immediate access to support if required. Staff took pride in their role and told us they felt well supported. Staff comments included, “Our first point of call is the [duty manager]”, “[The registered manager] is good, very knowledgeable” and, “I know I can go to [the registered manager] with anything”.

The service had effective quality assurance system in place designed to ensure both compliance with the regulation and to drive continuous improvements to the quality of care the service provided.