Ebor Court

The home had been inspected four times between November 2015 and July 2017 and on each occasion was rated Requires Improvement. At our last inspection in July 2017 there were breaches of Regulation 12, 17 and 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because of concerns in relation to the management of medicines and because robust recruitment procedures had not been followed. We issued a warning notice in respect of Regulation 17, Good Governance, because the quality assurance systems in place were not being used effectively to assess, monitor and improve the quality and safety of the service provided. The systems had been ineffective in driving sufficient improvement to demonstrate sustained progress and achieve a rating of Good. At this inspection we found improvements had been made and the home was now meeting all legal requirements.

Ebor Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ebor Court does not provide nursing care.

The service is registered to provide support for up to 64 older people and people living with dementia. The home is spread across three floors. The Guy Fawkes area is on the ground floor, the Dame Judy area on the first floor and the George Hudson area on the second floor. At the time of our inspection 54 people were using the service.

The registered provider is required to have a registered manager and there was a registered manager in post, who had been working at the service for about five months. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Improvements had been made in relation to the management of medicines. Medicines were now safely stored, administered and recorded and the provider was working with their pharmacy suppliers to maximise the effectiveness of the systems in place.

Recruitment records showed that staff only commenced working with people on their own once all appropriate safety checks had been made. This included previous employment references and a check with the disclosure and barring service (DBS).

At our last inspection in July 2017 the provider had failed to ensure that Deprivation of Liberty Safeguards authorisation applications had been submitted for all people who needed one. At this inspection we found that action had been taken to address this and the provider had submitted appropriate applications for all those who required them. Staff worked within the principles of the Mental Capacity Act 2005.

Staff knew how to identify and respond to any signs of abuse, to protect people using the service from harm. There were mixed views about staffing levels at the service, but the majority of people and relatives we spoke with felt there were sufficient staff to meet people’s needs. We found that the provider had recruited new staff, and agency staff were used where required, in order to maintain staffing levels.

There were systems in place to identify and minimise risks to people's safety. The provider was taking action to try and reduce the number of falls at the service and staff had worked with the local clinical commissioning group to access pressure ulcer prevention training. People received appropriate support with their nutrition and hydration needs.

People told us that staff were caring and we observed staff treated people with respect. People’s privacy and dignity was upheld. People’s diverse needs were catered for.

Staff had access to end of life care training and we received positive feedback from a visiting healthcare professional in relation to the support people received at this stage of their lives.

Care plans were in place to guide staff on how to meet people’s needs and preferences. The provider had recently introduced a new electronic care monitoring system. The system enabled the registered manager to monitor the care that was delivered. We noted some errors recorded on the new computer system in relation to people’s care requirements, but the provider addressed this by the second day of our inspection to ensure that staff had the information they needed.

Activities were available to people who used the service and the provider had recently appointed a new activity coordinator to develop the opportunities on offer.

There was a system in place to investigate and respond to complaints. Resident and relatives' meetings were held, and surveys conducted, to give people opportunity to comment on the quality of service provided.

Staff received induction, training and support. There was a plan in place to ensure all staff supervisions were up to date.

Infection control measures were in place, but greater vigilance was required to ensure bathrooms were maintained in a clean and hygienic state at all times.

Quality assurance systems were in place. The provider had made sufficient improvement to achieve an overall rating of Good at this inspection. However, some of the improvements made were still relatively recent and further time was required to fully imbed these systems and demonstrate consistent, sustained progress. There were also a number of minor issues that the registered manager was continuing to address, such as ensuring all supervisions were up to date, consistency of record keeping and improvements to cleaning and laundry arrangements.

The service was previously inspected in December 2015, when it was found to be in breach of regulation with regard to safe care and treatment (managing risk), meeting nutritional and hydration needs and good governance (quality assurance). The service was re-inspected during May and June 2016 to check that improvements had been made. We found that improvements had been made to managing risk and meeting nutritional and hydration needs. However, improvements had not been made in relation to good governance (quality assurance and record keeping). We issued the registered provider with a warning notice due to this continued breach in regulation. We also found a new breach in regulation in relation to safe care and treatment (medicines management). The service was then inspected on the 5 and 13 December 2016. At this stage we found that improvements had been made in relation to record keeping, quality assurance and medicines management and the provider was no longer in breach of regulation. Some further improvement was still required however in order to demonstrate consistent and sustained progress.

This inspection took place on the 17, 18 and 20 July 2017 and was unannounced.

At this inspection we saw that improvements were needed to quality audits to show that any areas requiring improvement had been actioned. The quality audits that had been carried out had not always identified the shortfalls we identified during our inspection. The oversight by senior managers had not resulted in sustained improvements to the service. This had been an area of concern at previous inspections and had reoccurred. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at the systems in place to ensure people received their medicines safely. We saw that medicines were stored safely, administered on time and disposed of appropriately. However, we noted some minor concerns in recording and that medicines had not always been obtained in a timely way so that people did not run out of them. This had been an area of concern at previous inspections and had reoccurred. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked the recruitment records for four members of staff and these showed that some staff had commenced work prior to all safety checks being in place. The risk of new staff working during the night had not been thoroughly assessed. There was no record that the information in one person’s reference had been fully explored. This meant there was a lack of evidence that only people considered suitable to work with people who may be vulnerable had been employed. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff worked within the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) although some applications to deprive a person of their liberty had not been submitted to the local authority. We have made a recommendation about this in the report.

The registered provider is required to have a registered manager as a condition of registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 was no registered manager in post on the day of our inspection and, as such, the registered provider was not meeting their conditions of registration. The provider had recruited a permanent manager, who was due to start work in September 2017. In the meantime they had appointed a temporary manager to cover the post until the permanent manager took up their position.

The feedback we received indicated that, although there had been continued issues with recruiting and retaining new staff, this had recently improved. People told us that staff responded quickly to call bells and they did not have to wait for support, and that there had started to be some consistency in respect of the staff on duty.

There were systems in place to help staff identify and respond to any signs of abuse, to protect people using the service from harm. There were systems in place to identify and minimise risks to people’s safety, but some improvement was required to the consistency of recording in risk assessments.

Staff received induction training and on-going refresher training on the topics considered essential by the provider. Staff also had supervision meetings with a manager when they were able to discuss any concerns they might have and their training and development needs.

People received appropriate support with their nutritional needs and any concerns identified in respect of dehydration or malnutrition were monitored. People were able to access healthcare professionals where required.

People we spoke with told us that staff were caring, and respected their privacy and dignity. We observed staff interacting with people throughout our inspection, and found that these interactions were friendly, supportive and respectful. When people wished to observe their religious beliefs, they were supported to do so.

People spoke positively about the activities they took part in and people’s family and friends were made welcome at the home.

Care plans were in place which contained sufficient information to assist staff in providing person-centred care. These had been reviewed regularly since our last inspection although there were some minor anomalies in the information held. At our last inspection we found that care plans in relation to diabetes required further improvement. At this inspection we had no concerns about this aspect of care planning and noted that staff had received appropriate training on this topic.

The registered provider had a complaints and compliments policy in place, and records showed that concerns had been investigated and responded to. People and relatives we spoke with said they would feel comfortable raising complaints.

The service was previously inspected in December 2015, when it was found to be in breach of regulation with regard to safe care and treatment (managing risk), meeting nutritional and hydration needs and good governance (quality assurance). The service was re-inspected during May and June 2016 to check that improvements had been made. We found that improvement had not been made in relation to good governance (quality assurance and record keeping), so we issued the registered provider with a warning notice, due to the continued breach in regulation. We also found a new breach in regulation in relation to safe care and treatment (medicines management).

This inspection took place on the 5 and 13 December 2016 and was unannounced. During this inspection we checked to see if improvements had been made in relation to the two outstanding breaches of legal requirements.

At this inspection we found that the registered provider had made improvements to the effectiveness of, and adherence to, their quality assurance system. The registered provider used a comprehensive set of monthly audits to monitor the quality of care provided, and since our last inspection these audits had been completed regularly. Most issues we identified during our inspection had already been identified in the registered provider’s audits. We saw evidence of action taken in response to these shortfalls and where further action was still required this was detailed in an overall action plan for the home. We found that record keeping overall had improved, and although there were still some areas of further improvement required in order to demonstrate consistent and sustained progress, the registered provider had made sufficient progress to show that they were now meeting legal requirements in relation to quality assurance and record keeping.

We looked at the systems in place to ensure people received their medicines safely. We found some improvements had been made, and the registered provider was now meeting legal requirements. Further improvement was still needed to ensure consistency of practice in relation to the recording of variable dose medicines and ensuring timely supplies of medicine stocks.

The registered provider is required to have a registered manager as a condition of registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 was no registered manager in post on the day of our inspection and, as such, the registered provider was not meeting their conditions of registration. An acting manager was managing the home until a permanent manager was appointed, but they were not registered with CQC.

There were mixed views from people and relatives about staffing levels at the home, but most people we spoke with felt there were enough staff to meet their needs. The registered provider had recruited new staff since our last inspection and had reviewed rotas to provide an additional staff member during the evenings.

There were systems in place to help staff identify and respond to any signs of abuse, to protect people using the service from harm. The registered provider followed safe recruitment practices to ensure the suitability of workers employed.

Staff received an induction in order to carry out their roles but not all staff had received regular formal supervision in the last six months. Some staff were overdue their annual refresher training. Action was being taken to ensure all staff received a supervision meeting, and training had been booked for staff that required it. However, improvement was still required to ensure the consistency of staff supervision and the timeliness of refresher training.

People received appropriate support with their nutritional needs and were able to access healthcare professionals where required. Staff worked within the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People we spoke with told us that staff were caring, and respected their privacy and dignity. We observed staff interacting with people throughout our inspection, and found that these interactions were friendly, supportive and respectful. We observed staff chatting and laughing with people on several occasions and people appeared comfortable in the presence of staff. People were supported to observe their religious beliefs, where they wished to.

People had opportunity to participate in activities at the home and we observed some activities taking place during our visits, including craft sessions and a quiz.

Care plans were in place which contained some person centred information and preferences. These had been reviewed regularly since our last inspection and the information was much clearer to follow. However, at our last inspection we made a recommendation to the registered provider to seek guidance on best practice in diabetes care, and at this inspection we found that limited improvement had been made in this area. Care plans in relation to diabetes required further improvement. However, we did not find evidence that people’s care had been directly impacted by this, and people received an appropriate diet.

Monitoring records, such as repositioning charts, were not always completed in a timely manner. This increased the risk of recording errors and people potentially not receiving care in line with their assessed needs.

The registered provider had a complaints and compliments policy in place, and records showed that concerns had been investigated and responded to. People and relatives we spoke with said they would feel comfortable raising complaints.

Overall most people and relatives we spoke with were happy with the care provided.

Ebor Court is a purpose built care home, which is registered to provide personal care and support for up to 64 people. At the time of our inspection the home had one vacancy. The home is spread across three floors. The Guy Fawkes Unit is on the ground floor, the Dame Judy Unit on the first floor and the George Hudson Unit on the second floor. The George Hudson Unit provided personal care, whilst the other two units specialised in providing dementia care.

The service was last inspected in December 2015, and was rated ‘requires improvement’ in four of the five key questions we ask: Is the service safe? Is the service effective? Is the service responsive? Is the service well-led? The service was rated ‘good’ in the question: Is the service caring?

At the December 2015 inspection we found that risks were not always identified or appropriate action taken in response to concerns. This was a breach of Regulation 12 (2)(a)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we checked to see if improvements had been made in this area. We found that risk identification measures were in place, but record keeping in relation to the registered provider’s response to identified risk was not consistent; we have reported on this under Regulation 17.

At the December 2015 inspection we found that people’s food and fluid intake was not always effectively monitored increasing the risk of dehydration, malnutrition and associated health complications. This was a breach of Regulation 14 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked to see if improvements had been made in this area and found that people had access to a range of food, snacks and drinks. However, record keeping in relation to food and fluid intake was poor and we have reported on this under Regulation 17.

In our last inspection we found that quality assurance processes were not robust enough in identifying concerns with the quality and support provided and in driving improvements. This was a breach of Regulation 17 (2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked to see if improvements had been made in this area and found that the registered provider’s quality assurance audits had not been completed consistently since our last inspection and that, as a consequence, these processes were less robust than at our last visit. We also found that records were poorly kept. This was a continued breach of Regulation 17 (2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 17 (2)(b)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found there were systems in place to ensure people received their medication safely, however these systems were not always effective in promptly identifying when medication was out of stock, and as a consequence some people had not received their topical cream medication as prescribed. The opening date had not always been recorded on medication with a limited shelf life once opened. This increased the risk of people receiving medication that was no longer effective. This was a breach of Regulation 12 (2)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take in respect of these breaches at the back of the full version of this report.

The registered provider is required to have a registered manager as a condition of registration. The previous registered manager had left the service since our December 2015 inspection and there was no registered manager in post at the time of our inspection; as such, the registered provider was not meeting their conditions of registration. The home was being managed by an acting manager, until a new registered manager was recruited. The registered provider acknowledged that the recent changes at the home had been unsettling for staff and had also meant that they had not made as much progress on implementing the requirements from our last inspection as they had planned.

At our inspection in December 2015 we made a recommendation that the registered manager reviewed staffing levels and staff deployment over a 24 hour period to ensure they continued to meet the needs of people using the service. Before this inspection we also received further information of concern about staffing levels. When we inspected this time, we found that the registered provider had increased the staffing levels at the service and had recruited a number of new staff recently. However, there were also more people using the service, so the staffing ratios were broadly comparable. The acting manager was actively recruiting for additional staff to increase the staffing levels at the service on an evening. There was mixed feedback from staff and visitors about whether there was sufficient staff to meet people’s needs, and this feedback showed us that whilst action had been taken to improve staffing, there were still outstanding concerns in this area that had not been fully resolved.

At our inspection in December 2015 we made a recommendation about recording consent to provide care and support in line with relevant guidance and legislation. We found that there was information in care files to clarify where people had a Lasting Power of Attorney (LPA) for care and welfare, and that the home sought consent to provide care in line with legislation and guidance.

There were systems in place to help staff identify and respond to any signs of abuse, to protect people using the service from harm.

We checked the recruitment records for three members of staff and found that recruitment practices were robust and appropriate checks were completed before staff started work. This meant that the registered provider was taking appropriate steps to ensure the suitability of workers.

Staff received an induction in order to carry out their roles effectively but not all staff had received regular supervision in the last six months. We found that the majority of staff were up to date with all training considered essential by the registered provider.

People using the service told us that staff were kind and caring. We observed positive and friendly interactions between staff and people using the service. People using the service told us they were treated with dignity, and staff were able describe to us how they promoted people’s dignity and independence.

The registered provider completed care plans, and these contained some person centred information and preferences. However, files were difficult to follow and some information in relation to people’s care was held in different places and had not always been consistently cross referenced into the care plans. Some care plans also contained contradictory information, which meant that staff did not always have clear guidance in order to provide person centred care. The registered provider did not provide diabetes training and did not have a diabetes care policy and we have made a recommendation about this in our report.

People had opportunity to participate in activities at the home and we observed some activities taking place during our visits. Some people told us they would like more activities to be available.

People using the service were aware of how they could raise a complaint if they had one, and said they would feel comfortable doing so if needed. Relatives we spoke with said they would know how to raise a complaint, and one told us that they had recently noticed an improvement in the home’s handling of concerns.