Archived: Sowerby House

Sowerby House is a residential care home providing personal care for younger adults and older people who may be living with a physical disability or dementia. The service is registered to support up to 51 people in one adapted building. Thirty people were using the service when we inspected.

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

People were at increased risk of harm because infection prevention and control practices were not always safe and effective. Good practice guidance had not been followed to help minimise risks relating to COVID-19. The provider’s audits had not identified and addressed the issues and concerns we found.

Management were approachable and responsive to feedback. They acted in response to our concerns to make improvements to help keep people safe. We will check and make sure improvements continue and are sustained at our next inspection.

Staff were safely recruited, and enough staff were on duty to meet people’s needs. People provided positive feedback about the service and the kind and caring staff. The registered manager was approachable and responsive to feedback addressing any issues or concerns people had.

People had a choice of meals and felt staff provided good support to help make sure they ate and drank enough. However, records relating to people’s food and fluid intake did not always provide a clear picture of the support provided and we spoke with the provider about reviewing these.

Medicines were managed and administered safely.

Staff understood how to identify and report safeguarding concerns. Risk assessments were in place to guide staff on how to safely meet people’s needs. The registered manager reviewed all accidents and incidents to identify any actions that could be taken to prevent a similar thing happening again.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was Good (published 1 August 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of people’s medicines, support with meals and drinks, staffing and infection prevention and control practices. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection prevention and control practices, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control practices and governance. You can see what action we have taken at the end of this full report.

Follow up

We requested an action plan from the provider to understand what they would do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sowerby House provides residential care for younger adults and older people who may be living with a physical disability or dementia. The service is registered to support up to 51 people in one adapted building. Twenty-nine people were using the service when we inspected.

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

People felt safe and cared for. However, there were some inconsistencies in staff’s approach which increased the risk of harm occurring. Regular and thorough checks had not always been completed and there were some gaps in records relating to the support provided. We made a recommendation about reviewing the approach to monitoring and checking people’s needs were met.

People’s needs were assessed. Staff understood the support required and risk assessments were in place to guide them on how to safely support people. Enough staff were deployed to make sure people’s needs were met.

People were supported by staff who had been trained to identify and respond to any safeguarding concerns. Staff completed a range of other training to help make sure they knew how to safely look after people. Staff provided positive feedback about the culture, leadership and training provided.

Staff were kind and caring. Systems were in place to help support people to maintain their privacy and dignity. We spoke with the registered manager about securely storing all confidential information and they acted to address this.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (report published 2 August 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the quality and safety of the service. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Sowerby House is a ‘care home’ in the village of Sowerby on the outskirts of Thirsk. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides residential care for up to 51 older people and younger adults and specialises in supporting people with a physical disability or who may be living with dementia. Accommodation is provided in one adapted building with bedrooms spread across two floors. There is a passenger lift to access the first floor.

The service had a registered manager. They had been the registered manager since March 2018, but had worked as the deputy manager before taking this role. A registered manager is a person who has registered with the 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. The registered manager was supported by a regional area manager and deputy managers in the management of the service.

The service had previously been rated Inadequate in October 2016. At the last inspection in April 2017, significant improvements had been made, but we rated the service ‘Requires improvement’ overall. This was because we needed to see evidence of consistent good practice and that the improvements made could be sustained over time. At this inspection, we found the improvements had been sustained and the service was ‘Good’ overall.

Improvements were needed to ensure medicines were managed safely. Medicine stock levels were not always accurate. This meant we could not be certain people had taken their prescribed medicines. Protocols were not always in place to support staff on when to administer medicines prescribed to be taken only when needed. We made a recommendation about managing medicines. Although the registered manager responded to our concerns and acted to make improvements, the improvements need to be embedded and sustained to evidence medicines are managed safely.

At the time of our inspection work was in progress to replace ceilings, to improve fire safety, and to redecorate and update the home environment. This work caused some disruption, with contractors in the building and areas of the service closed for renovation, but the work had been managed in a sensitive way. Appropriate risk assessments and management plans were in place and the provider and registered manager had taken proactive steps to minimise the disruption and ensure people’s needs continued to be met.

People who used the service told us they felt safe. Staff were safely recruited and enough staff were deployed to meet people’s needs. Staff completed training to help them identify and respond to safeguarding concerns. Risk assessments helped staff to provide safe support to meet people’s needs.

The environment was clean and well-maintained. Maintenance checks ensured the home and equipment used were safe.

Staff completed training and received regular supervision and an annual appraisal of their performance to support them to provide effective care. The registered manager used competency checks to make sure staff were providing effective care and following best practice guidance.

We received generally positive feedback about the food and staff provided effective care to ensure people ate and drank enough.

Staff supported people to make decisions. People’s rights were protected in line with the Mental Capacity Act 2005 and best practice guidance. Applications had been made when necessary to deprive people of their liberty.

Staff worked closely with healthcare professionals. They sought advice and guidance when needed to help people maintain people’s health and wellbeing.

Work was ongoing to develop a more dementia friendly environment. The provider had ordered additional signage to help people find their way around the home.

People told us staff were caring, kind and friendly. The registered manager investigated and responded to feedback, issues or concerns regarding the care and support provided to ensure people’s needs were met in a caring and dignified way. People told us staff maintained their privacy and dignity.

People’s care plans included person-centred information about their needs and how those needs should be met. Staff listened to people and were responsive to their needs.

The registered manager ensured regular activities were on offer. There were systems in place to gather feedback about the service and to respond to complaints.

We received generally positive feedback about Sowerby House and the new registered manager. People told us they were ‘hands on’, approachable and had continued to improve the organisation and management of the service.

The registered manager encouraged people to give feedback and acted to improve the service. They completed regular audits to continually monitor the quality and safety of the service. A ‘development plan’ showed an ongoing commitment to continually improve the service.

At the last inspection in October 2016, we identified breaches of regulation around safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, the need for consent, staffing and the governance of the service. Due to the significant and wide spread concerns we had about the quality and safety of the service, we rated Sowerby House inadequate, placed it in 'Special Measures' and told the registered provider to take immediate action to make improvements.

Services that are in Special Measures are kept under review and are inspected again within six months. We expect services to make significant improvements within this timeframe. This unannounced inspection took place on 25 April 2017. During the inspection, the registered provider demonstrated that improvements have been made. For this reason, the service is no longer rated as inadequate overall or in any of the key questions and is no longer in Special Measures.

During the inspection we found that action had been taken to improve safety. People’s needs were assessed and risk assessments put in place to support staff to provide safe care and support. Risk assessments were generally detailed and comprehensive; however, we identified some examples where more information was required. Accidents and incidents were reported, recorded and analysed to identify any patterns or trends.

People were protected from the risk of abuse by staff who were trained to recognise and respond to safeguarding concerns. Sufficient staff were deployed to meet people’s needs in a timely manner. Medicines were managed safely.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received an induction, on-going training, supervision and appraisal to support continued professional development. Training courses had been scheduled to address gaps in staff’s training.

We received positive feedback about the food provided at Sowerby House. We observed that people were supported to ensure they ate and drank enough. People’s weight was being appropriately monitored and advice and guidance was sought, where necessary, from external healthcare professionals.

Staff were described as kind, caring and attentive to people’s needs. We observed that staff were respectful and supported people in a way which maintained their privacy and dignity. People had choice and control over their care and support.

The registered provider is required to have a registered manager as a condition of registration for this 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 time of our inspection, the service did not have a registered manager. However, there was a new manager in post and they had applied to become the service’s registered manager.

We received positive feedback about the new manager and the improvements they had made. The registered provider had ensured a range of quality assurance checks and audits were completed to monitor the care and support provided and to drive improvements.

Whilst improvements had been made, we have not rated this service as 'Good', because to do so requires evidence of consistent good practice over time and the improvements made need to be sustained to demonstrate this.

Sowerby House Nursing Home is registered to provide residential and nursing care for up to 51 older people some of whom are living with a dementia. At the time of this inspection, 27 people were living at the service 11 people were receiving nursing care and 16 people were receiving residential care. We were told that one person, receiving residential care, was in hospital.

The service did not have 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 inspection was prompted in part by the notification of two separate concerns following the deaths of two people living at the service. The Coroner had asked North Yorkshire Police to conduct a review of the deaths. These incidents are currently being assessed by the police to determine any levels of criminality. As a result this inspection did not examine the circumstances of these incidents.

However the information shared with CQC about the incidents indicated potential concerns about the management of people’s nutrition and hydration and general standards of care. This inspection examined these issues.

At this inspection we found that there were breaches of six of the Fundamental Standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, nutritional and hydration needs, consent, safeguarding, staffing and the overall oversight and governance of the service.

Also, there was a failure to meet the requirements of the Care Quality Commission (Registration) Regulations 2009 regulation 18 - notification of other incidents and a breach of the provider’s conditions of their registration – the requirement to have a registered manager.

The registered provider had failed to ensure all of the people who used the service had received safe and effective care and treatment. We found they had not taken reasonable and practicable steps to mitigate the risks posed to people who used the service.

Because of our concerns about people’s care and treatment during the inspection, we made 12 individual safeguarding referrals to North Yorkshire County Council. We will monitor the outcome of these investigations.

The service did not have sufficient numbers of skilled and competent staff to meet people’s needs. There was a lack of nursing oversight and the service was reliant on agency nurses which meant people’s clinical care needs were not sufficiently met.

Medicines were not being safely administered in line with prescribing instructions.

People’s nutritional and hydration needs were not being met and there was a lack of oversight or monitoring to ensure people received the support they needed.

The service was not following the principles of the Mental Capacity Act 2005. We did not see consent recorded within people’s care plans and when people were unable to give consent best interest decisions had not taken place. People were being deprived of their liberty without the required safeguards in place.

Care plans were difficult to follow; reviews were not up to date and did not consistently reflect people’s current needs. They did not provide staff with sufficient detail to deliver person centred care. People’s changing needs were not always responded to effectively.

The registered provider did not have effective systems in place to monitor the care being delivered to people. We found record keeping was poor and management oversight at the service was not effective in ensuring people were provided with safe care.

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 enforcement action, 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 and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with seven people using the service, 13 relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People's needs were assessed but not always delivered in line with their individual care plan. This meant that in some instances individual needs were not being addressed correctly.

We found that people were not always cared for in a clean, hygienic environment. We completed a tour of the home with the manager and saw that some areas were not clean or well maintained. We saw some areas of the home were not on the schedule for cleaning. Records showed on some of the days there had been no domestic on duty.

We found records did not provide staff with sufficient information about medication that needed to be administered on an 'as required' basis. We saw two people were administered medication for anxiety on an 'as required' basis. There was no information available to inform staff when and in what circumstances this medicine should be given.

Is the service effective?

We spoke with thirteen relatives. Some relatives raised concerns about the care provided at the home. One relative said, 'There has been a lot of changes to staff which worries me as the new staff don't seem to know how to provide care that people needed.' The relative went on to tell us that their relative looked untidy, wearing clothes that were dirty and had remains of the meal.

We saw meals provided were nutritious and appealing. However, we found people were seated in the dining room a long time before the meal arrived. Breakfast was served to people in their bedrooms on the first floor. Staff prepared and served the meal from an area on the landing that was unsuitable. This meant people were put at risk of cross infection as the area was dirty and had unpleasant odours.

Is the service caring?

People wishes were not always respected. We observed staff taking one person into the dining room to join in a coffee morning. They clearly told staff they did not want to attend but staff ignored their wishes.

People's dignity was not always respected as we saw examples where staff passed by a person who required assistance.

Is the service responsive?

We found that the service was not responsive to the needs of some people. A number of people who used the service and their relatives raised concerns with us that calls for assistance were not always answered in a timely manner.

Relative we spoke with said they were concerned about staffing levels and about the amount of new staff employed at the home. One relative said, 'There has been a lot of good staff who have left. New staff don't know the residents very well.'

Is the service well-led?

We spoke to relatives about the quality of care provided at the home. Some relatives raised concerns that they often visited and found no staff were available to speak to. One relative said, 'I keep bringing in new clothing but they seem to disappear. My relative was wearing another person's nightwear and this upset me.' They went on to say, 'We don't seem to see the manager here very much when we visit to discuss our concerns.'

The assurance system of assessing and monitoring the quality of service provision at Sowerby House was inadequate. Whilst the audits and checks had identified areas in which improvements were required, Sowerby House failed to take account of this information to make improvements to protect people and this put them at risk of harm.

We had also received anonymous concerns that there may be insufficient staff on duty to meet people's needs and that senior staff may not be helping to care for people. Other issues raised were that people may be being left in wet beds. Also that the washing machines were not working and laundry gas dryers were not being observed when in use. We looked at all of these issues and found that there was no evidence of none compliance.

We undertook this unannounced visit with a representative of North Yorkshire County Council. We used a number of different methods to help us understand the experiences of people using the service, including talking to people and observing the care being provided. We also looked at some records and staff rotas.

People we spoke with said 'The staff are here to help to get things for me. The staff are very good. It is very good here at the moment.' Another person said 'Some people are so demanding. The staff are so kind. People may not be patient. I never wait long. We have comfortable rooms. There have been problems with the laundry. I understand they are trying their best.'

We saw breakfast and lunch being served. People had a choice of what they wanted to eat and people told us that the food was "Nice and hot and tasty."

We looked at the administration, recording, storing and arrangements made by the home to ensure that people's medication is administered properly and safely and found this to be in good order.

We looked around the home and found that some areas such as the communal bathrooms and corridors were shabby and in need of redecoration and modernisation. We have asked the provider to improve in this area also.

People told us that the staff were "Brilliant" and "A great bunch of people". People also commented that they thought that they were "Good at their jobs". Staff told us that things were improving regarding support and said the acting manager listened and was very approachable.

We spoke with five relatives of people who use services. Some positive feedback was received, including: 'the staff have been supportive and they do keep you involved' and '90% of the time its lovely here'.

Care plans for residents have improved and now show that the home has carried out an assessment of people's needs to ensure the planning and delivery of appropriate care.