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Reports


Inspection carried out on 7 February 2018

During a routine inspection

This inspection took place on 7 and 15 February 2018 and was unannounced.

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 ca

Inspection carried out on 17 July 2017

During a routine inspection

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 60 people lived at the home. 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 support for people living with dementia.

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

Inspection carried out on 5 December 2016

During a routine inspection

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 58 people lived at the home. 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 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 th

Inspection carried out on 17 May 2016

During a routine inspection

This inspection took place on 17, 18 May and 7 June 2016 and was unannounced.

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 recr

Inspection carried out on 18 November and 2 December 2015

During a routine inspection

Ebor Court is a purpose built care home which provides residential and dementia care for up to 64 older people. 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 residential care, whilst the Guy Fawkes and Dame Judy Unit specialised in providing dementia care.

The service was last inspected in December 2014 at which time it was rated 'good' in each of the five key questions and 'good' overall.

We inspected this service on 18 November and 2 December 2015. This inspection was unannounced. One of our visits was carried out between 6am and 1pm so we could speak with night staff. At the time of our inspection there were 51 people using the service.

Prior to our visit, concerns were raised about a number of issues including staffing levels within the home and infection prevention and control practices. We have recorded our findings in relation to these concerns in the body of this report.

During this inspection we found that the service was not always safe as 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.

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 received generally positive feedback telling us that the home was well-led. We observed that the manager was knowledgeable about relevant legislation and guidance on best practice. However, we noted that quality assurance processes were at times tokenistic and not robust enough in identifying concerns with the quality of care 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.

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 in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

Although the service sought consent to provide care and support, it was not always clear, when relatives or carers signed on people's behalf, whether this was with the person's agreement or in their best interests. We have made a recommendation about recording consent in line with relevant guidance and legislation in the body of this report.

People’s needs were assessed and care plans put in place detailing how these needs would be met. People told us they were not always involved in reviews of their care plans, however, we could see that there were systems to review and update care plans as people needs changed. We identified that care and support was not always person centred and have recommended that the registered manager reviews practices in-line with relevant guidance.

We received inconsistent feedback regarding staffing levels within the home and have recommended that the registered manager reviews staffing levels and staff deployment across a 24 hour period to ensure they continue to meet the needs of people using the service.

We found that staff understood the types of abuse they might see and how to respond appropriately to safeguarding concerns to keep people using the service safe.

We observed that the service had effective infection prevention and control policies and practices in place and the home was observed to be clean and tidy during our inspection.

There was a safe recruitment process and an effective induction to equip new staff with the skills and knowledge needed to carry out their roles. The registered provider ensured staff received on-going training and supervision to support them in their roles.

People we spoke with were generally positive about the kind and caring nature of staff. Staff supported people using the service to have choice and control and to maintain their privacy and dignity.

We received mixed feedback about the level activities within the home and support provided to enable people to pursue their own interests.

There was a system in place to manage and respond to complaints and feedback about the service.