York House

York House is a residential care home providing personal to up to 16 people. The service also provides personal care to people living in their own homes. The service provides support to older people, some of whom may be living with dementia. It also provides support to people with physical disabilities or sensory impairment.

At the time of our inspection there were 10 people living at the home and a further five people who received support in their own homes. Not everyone who received support in their own homes received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

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.

Risks to people living in the care home had been assessed, however, more work was needed to fully identify the risks to people receiving care in their own home. We have recommended the provider review the information in the care plans for people who receive care in their own homes.

Audits were in place to assess the quality of care provided and had identified most actions needed to drive improvements in care.

There were enough staff to meet people’s needs. Staff had received the training needed to provide safe care. Staff were confident to raise concerns where they felt people may have been at risk of harm.

The registered manager worked collaboratively with the local authority to ensure action was taken to keep people safe from abuse. Incidents were identified, analysed and action was taken to keep people safe.

Medicines were safely managed and people received their medicines as prescribed. The home was clean and staff followed infection control processes.

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 inadequate (published 8 June 2022) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 8 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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.

We carried out an unannounced comprehensive inspection of this service on 13 January 2022. Breaches of legal requirements were found. We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

York House is a residential care home and domiciliary homecare service providing accommodation and personal care primarily for older aged adults including those living with dementia. The service provides accommodation for up to 16 people across two floors. The service also provides homecare for people in Lincolnshire. This inspection focussed only on the residential care home service being provided. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of our inspection there were 16 people using the service for accommodation.

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

People were not always protected from the risk of abuse. Risks associated with people’s care and support were not always planned for. Medicines were not stored or managed safely. People did not always receive medicines as prescribed. People were at risk of harm due to widespread poor infection control practices.

People were at risk due to staffing levels and staff competence. Arrangements for staff recruitment, training and deployment did not support people’s safety. Most staff were not evidenced to have received training and staff did not always have complete recruitment information. Despite these concerns, people and relatives were mostly positive about the safety of the service.

York House was not well led. Governance systems were not effective in adequately supporting people. Audits failed to identify and act upon issues and to ensure person-centred care. Care plans and risk assessments were not always put in place in a timely manner. The service did not create a comfortable environment for staff to raise concerns and put people at risk of harm.

The service worked in partnership with other organisations.

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 2 August 2018).

Why we inspected

We undertook a targeted infection prevention and control inspection (IPC) to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting practices going against government guidelines during the COVID-19 pandemic. A decision was made for us to inspect and examine those risks.

We inspected and found there were other concerns, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at IPC 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. This included checking the provider was meeting COVID-19 vaccination requirements

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for York House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, infection control, staffing, management and leadership at this inspection.

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.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

York house 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. York House accommodates up to 16 people who need care due to old age, dementia, physical disabilities or sensory impairment in one adapted building. There were 14 people living at the home on the day we visited.

The provider also provides a domiciliary care agency which it promotes under the name LJ Home Care. It provides personal care to people living in their own houses and flats in the community. It provides a service to people who need care due to old age, dementia, physical disabilities or sensory impairment. Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were 17 people using the homecare service on the day we visited.

There was a registered manager for the service. 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.’

At the last inspection the service was rated as requires improvement at this inspection we saw that the provider has made improvements and the service was now rated as good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Checks were completed before staff started to work at the service to ensure they were safe to work with vulnerable people. There were enough staff to meet people’s needs and people who received care in their own homes were provided with a consistent group of staff who knew their needs to support them. Staff received training and support which supported them to provide safe effective care. There were good relationships between staff and other healthcare professionals and we received positive feedback about the care from healthcare professionals.

Risks to people were identified and care was planned to keep people safe while receiving care or in an emergency. Medicines were safely managed and available to people when needed. Infection control processes kept people safe from the risk of infection. However, we recommend that the provider follow the national guidelines on the use of different coloured cleaning cloths in each area.

People were offered a choice of food and staff monitored people to ensure they could eat safely and had enough to maintain a healthy weight. People told us that the staff were excellent. They told us that they were kind, caring and put the needs of the people at the centre of everything they did. People had been involved in developing their own care plans and we saw that care plans contained the information needed to provide safe care tailored to people’s individual needs. People and their relatives received compassionate care at the end of their lives which ensured they were comfortable and had people around them.

The registered manager was open and inclusive and people, relatives and staff felt comfortable raising issues with them. Audits monitored the quality of care provided and external expert audits were also used to drive improvements. If any issues were identified action was taken quickly to resolve the concern.

York House is situated in the village of Billinghay in Lincolnshire. It is registered to provide accommodation and personal care for 16 people who need care due to old age, dementia, physical disabilities or sensory impairment. There were 16 people living at the home when we inspected. The home is also registered to provide personal care to people in their own home. It does this under the name LJ Homecare. There were 25 people using the domiciliary care service when we inspected.

There was a registered manager for the service. 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 ran the care home and there were two managers who ran the domiciliary care service with regular oversight from the registered manager.

Care plans for both the care home and the domiciliary care service had not identified all the risks to people while receiving care. However, where risks had been identified care had been planned to keep people safe. In addition, the registered manager and the domiciliary care managers reviewed accidents and incidents and where necessary made changes to people’s care to reduce the risk of further accidents in the future. People’s support needs relating to their medicines were clearly recorded. However, there was a lack of recording around topical medicines such as creams. People’s dietary needs were identified and recorded in their care plans. People were supported to make choices about their meals and to maintain a healthy weight.

People were involved with planning their care and were able to make decisions about the way their care was tailored to meet their individual needs. This level of detail was reflected in the care plans. There were systems in place to ensure any information about people’s changing needs were made available to care workers.

There were some activities for people living at the care home to engage with and people were supported to access the local community. In addition, the provider had developed links with community groups so that they could visit the home. However, people felt that more activities would enhance their experience of living at the home.

There were systems in place to ensure that there were enough care workers available to meet the needs of people who lived at the care home and people who received care in their own homes. However, at busy times in the care home communal areas were not fully monitored. The domiciliary care service had systems in place to ensure care workers were available to provide care to people at the correct times. However, staff application forms for the domiciliary care service did not contain enough information for the domiciliary care managers to assess if people had appropriate skills and experience.

Care workers were kind and caring and had good relationships with people. In addition, care workers were supported to get to know people’s needs, abilities and communication skills and so could identify when people deteriorated or were unwell. Staff working for the provider were supported with appropriate training and supervision. Care workers had received training in the Mental Capacity Act and supported people to make decisions about the care they received. Where people were unable to consent to living at the home and were under constant supervision appropriate Deprivation of Liberty Safeguard applications had been submitted.

People had received information on how to complain from the provider and people told us they knew how to make a complaint. However, no recent complaints had been received. People living at the home and care workers told us the registered manager was approachable and would listen to concerns. In addition, people using the domiciliary care service told us that the domiciliary care managers were reliable, approachable and available to them if needed.

The provider has systems in place to gather the views of people who used the services they provided. While the provider had systems in place to monitor the quality of care people received we saw that they had not been fully effective and failed to identify some of the concerns we identified.

As part of our inspection visit we spoke with three people who lived at the home and a community nurse who visited the home. We also spoke with the manager and four staff members.

People told us they felt safe and staff were caring and responsive to their changing needs. One person said, 'I moved here a few weeks ago and I have to say it is great. Staff met me at the door when I arrived and the welcome has continued.' Another person commented, 'The staff are friendly, I feel safe here and comfortable in my room. The place is homely.'

Staff told us they received the training, supervision and leadership they needed from senior staff and the manager to enable them to meet people's needs effectively.

We found the service was well led and the home owners and manager monitored the quality of the service provided.

We noted people's care plans contained a 'consent to care' form which provided people with a description of their rights as well as a promise from the provider they would be treated with respect, dignity and compassion.

We looked at the menus and saw they offered a wide range of hot and cold meals. We asked people what they thought about the food. One person said, 'The food is really good, it's always good.'

We asked people about cleanliness in the home. We were told they had no concerns about the overall standard of cleanliness in the home. One person commented, 'The cleanliness is excellent, it always is.'

The people we spoke with said they found the home comfortable and that it met their needs. One person said, 'This has a real homely feel to it, we're surrounded by things we like and I think it's kept well.'

We observed staff provided support and engaged with people who lived at the home positively. People appeared relaxed and comfortable in the presence of their support staff. In discussion, it was evident staff understood the needs of people they supported.