Yarnton Residential and Nursing Home

Yarnton is purpose-built care home registered to accommodate up to 60 people that was providing personal and nursing care.

We found the following examples of good practice:

The provider had sufficient stock of appropriate personal protective equipment (PPE) which complied with the quality standards.

Staff participated in various training sessions around infection control and using PPE. Staff's competency around infection control and PPE was checked regularly to prevent staff complacency. There were several designated areas for donning and doffing PPE. There was signage all around the service on donning and doffing PPE and handwashing. We observed staff putting on and taking off PPE as per guidelines.

Several visitation adjustments had been introduced including a visiting pod which had been created to safely facilitate relatives' visits on a pre-booking basis.

The registered manager had maximised on the essential care giver role. Families and friends had been encouraged to be essential care givers earlier on during the pandemic. This allowed them continued visitation despite the restrictions. Out of the 54 people in the home, 41 had families with essential care giver status.

On arrival to the service, infection control procedures were explained to visitors and a declaration form needed to be completed which included their temperatures taken at the time. We saw visitors were provided and required to wear the appropriate PPE in line with government guidelines. Healthcare professionals and tradesmen were asked to evidence their vaccination status before entry.

The provider had robust systems to ensure safe admissions, including only allowing new admissions after a confirmed negative result of the Covid-19 test. The provider had also assessed the environment, with consideration given where to allocate people should they need to isolate.

An additional cleaning schedule had been introduced to ensure robust measures to reduce infection risks, including additional tasks such as cleaning of any regular touchpoint surfaces.

The provider participated in the Covid-19 regular testing programme for both people and staff.

Impact assessments to ensure appropriate support for staff had been carried out, these included individual health conditions and personal circumstances. Staff had access to dedicated counselling and advice if they been affected directly or indirectly by Covid-19.

Additional, regular communication took place. This included updates for people and their relatives to share the current 'Covid-19 status' of the service and any changes to the visiting policy.

Yarnton is care home that was providing personal and nursing care to 52 people at the time of the inspection.

At the last inspection on 24 April 2018, we asked the provider to take action to make improvements in fire evacuation measures as well as pressure risk and risk management, and this action has been completed.

People’s experience of using this service:

People living at Yarnton received safe care from skilled and knowledgeable staff. People told us they felt safe receiving care from the service. Staff understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. The home used the same agency staff to ensure consistence. Medicines were managed safely and people received their medicines as prescribed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health and to meet their nutritional needs.

People told us staff were caring. Staff consistence enabled people to receive good care from staff who knew them well. People had access to a variety of activities to prevent social isolation. However, activities could be improved and be more linked to people’s interests and hobbies.

Yarnton was well-led by a manager who was making positive changes. Staff culture had significantly improved, and this had resulted in provision of good care. The service had a clear management and staffing structure in place. Staff worked well as a team and had a sense of pride working at the service. The provider had quality assurance systems in place to monitor the quality and safety of the service.

The service was an important part of the local community. The team facilitated various community links that reflected the needs and preferences of the people who used the service.

Rating at last inspection:

At our last inspection we rated the service requires improvement. Our last report was published on 11 June 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Yarnton is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 60 people in a purpose built building. The accommodation is spread over two floors and divided into four units namely Oriel, Magdelan, Trinity and Keble. Oriel is a nursing unit, Magdelan specialises in providing care to people living with dementia and Trinity and Keble are residential care units. On the day of the inspection there were 52 people living at the service.

There was no registered manager in place. 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 home was led by an interim manager.

People at risk of developing pressure sores were not always protected from these risks. People's pressure mattresses were not always set to correct pressures. People's medicines were not always stored safely. Fire evacuation measures were not always correct. Staff supervision, appraisal and refresher training records were not up to date. Some of the provider’s quality assurance systems were not used effectively.

People told us they felt safe living at Yarnton. Other risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicines as prescribed. Infection control measures were in place to help reduce the risks of cross infection.

Yarnton continuously recruited staff to ensure people’s needs were met. The home had staff vacancies which were covered by regular agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team were doing all they could to ensure safe staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People’s needs were assessed prior to living at Yarnton to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The interim manager and staff understood the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The interim manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

People’s care plans gave details of support required. The provider had a complaints policy and people knew how to complain. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independence. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.

There was an open and inclusive culture in the home and people and staff felt they could approach the management team and were comfortable to speak with the interim manager if they had a concern. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. We saw evidence that arrangements were in place to formally assess, review and monitor the quality of care provided at the home. The home had established links with the local communities which allowed people to maintain their relationships.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was 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. The registered manager worked closely with the deputy manager, care development manager as well as the regional manager.

People who were supported by the service felt safe. Staff had a clear understanding of how to safeguard the people and protect their health and well-being. People’s medicines were stored and administered safely.

There were enough suitably qualified and experienced staff to meet people's needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005. Where people were thought to lack capacity, assessments in relation to their capacity had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff who benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

People’s nutritional needs were met and people had a good dining experience. People were given choices and received their meals in timely manner. People were supported with meals in line with their care plans.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. Staff knew how to best support people and what activities and changes to the home would suit the needs of people.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

Leadership within the service was open and transparent at all levels. The provider had quality assurance systems in place. The provider had systems to enable people to provide feedback on the support they received.

The registered manager informed us of all notifiable incidents. The registered manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager.

On the day of our visit 57 people were using the service. They were supported by two nurses and twelve care workers. We spoke with 10 people who used the service and three people's relatives. We also spoke with five care workers, two nurses, the registered manager and regional manager. Three inspectors carried out this inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Our inspection findings have been shared with the local safeguarding authority and a safeguarding strategy has been implemented for the home. The local authority have stopped placing people at Yarnton due to these concerns. In addition, we asked the management team at the home to make safeguarding alerts to the local authority about four people. We did this to ensure that action would be taken to make these people safe.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The service was not safe. People were not protected from the risk of pressure damage or from risks associated with moving and handling. Care staff did not follow the plans that were intended to meet people's care needs. Care staff did not always have knowledge of people's health and wellbeing, or the risks to their health and welfare.

Systems were not in place to ensure people's medicines were administered safely or recorded appropriately. The service maintained records of the stock of people's prescribed medicines but these were not always accurate.

Instructions around authorisations to restrict people's liberty were not followed. Clear instructions were not followed by care staff to protect one person from harm.

Is the service effective?

The service was not effective. People's care plans did not always contain up to date and accurate guidance for care workers on how to meet people's needs. This meant that people could be at risk of inappropriate care or treatment.

People did not always receive the support they needed to meet their nutritional needs and did not have access to appropriate choice over their diet. Staff did not always respect people's choices and did not respond to people's requests for certain foods and drinks.

Is the service caring?

The service was not always caring. People were not always treated with kindness and respect. While some care staff treated people kindly, other care staff did not engage with people or assist them when they required support.

People could not always be sure that their dignity and privacy would be respected. We observed one person being supported with their personal care. Care workers did not close their door to ensure their privacy was maintained.

Is the service responsive?

The service was not always responsive. Care staff did not always respond to people's needs. People who were experiencing pain could not always be sure that staff would respond to this by taking appropriate action.

The welfare of people with dementia was not always maintained. People spent long periods of the day without engagement from care staff. Care staff were focused on tasks such as updating people's daily notes in care plans and undertaking laundry tasks.

People and their relatives did not always feel their concerns were acted upon. People's complaints were not always concluded and concerns raised at meetings were not always acted upon.

Is the service well-led?

The service was not well-led. Although the provider had engaged a consultancy firm to help identify why so many concerns had been raised, sufficient action had not been taken to ensure people's safety. Audits conducted by the manager identified concerns, but did not seek to address these concerns. We saw a range of audits which were implemented but did not lead to improvements within the service.

The manager did not look at accidents and incidents to identify trends in the service. There wasn't a system in place to identify concerns and use this information to help improve the service.

Risks to people and their health and welfare had not been identified through the risk and quality monitoring systems.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service safe?

People told us they felt safe. One said "I'm very safe. My wellbeing is protected and I don't feel the need to hide my possessions". Care workers had been trained in safeguarding vulnerable adults from abuse. All the care workers we spoke with demonstrated a good knowledge of abuse and the signs of abuse. Care workers also knew what action to take if they suspected abuse was happening. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. These safeguards protect people from abuse relating to restrictions of their liberty and freedom for safety or medical reasons. No applications had been made to authorise depriving anyone of their liberty. The service had policies and procedures in place relating to this. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and their needs had been met. We conducted a Short Observational Framework for Inspection (SOFI). We observed four people over the lunchtime meal on the residential unit for people living with dementia. All the interactions with care workers were positive. Care workers were attentive and caring and we saw that where care workers spoke to people they demonstrated genuine warmth and respect. People gave valid consent to care. One person said "they are very good, they always ask for my consent with everything". Appropriate steps were taken to ensure valid consent was given to care, treatment and support and where people could not give consent, relatives and advocates were consulted.

The provider did not have suitable arrangements in place to ensure that all care workers received regular supervision. Not all supervision documents for care workers were complete and one care worker had not had a supervision meeting recorded for one year. This meant care workers were not appropriately supervised. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. One person said "it is wonderful here. The carers are great, it's clean and I cannot find any faults at all". We saw that care workers showed patience and gave encouragement when supporting people and that they treated people with dignity and respect. They worked hard to engage people and showed genuine warmth and acknowledgement towards the people they were caring for.

Is the service responsive?

Care plans confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One person said "the care is good and the staff are very thoughtful". People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. We saw that complaints were dealt with appropriately and in a timely fashion.

Is the service well-led?

The provider sought the opinions and views of people who used the service. Surveys were conducted and the results were analysed, published and displayed around the home. Accidents and incidents were investigated and recorded and any actions were carried forward. Audits were conducted and actions were allocated to individuals or teams with completion dates set. We saw that these were followed up and completed. Care plans and risk assessments were reviewed regularly and changes to care in relation to risks were recorded. This meant people's care plans reflected their needs and reduced the risk of unsafe or inappropriate care.

We found that care plans and assessments contained detailed information about people's preferences and choices. One relative told us, 'They were wonderful, the manager came and saw my husband and completed an assessment with him and then we discussed his care before he was admitted'.

We found that choices of food were offered and people were supported to eat and drink. One relative told us, 'I have lunch here and the food is excellent now they have a new chef'. One person told us, 'The food now is lovely, I love the treacle sponge'.

We found improvement in medication procedures. One senior carer told us, 'The stock control has improved and the audits are an improvement'.

We found people were supported by sufficient skilled and experienced staff. One relative told us, 'The staff are always very kind and helpful, we can always find someone to help or answer our questions'. Two relatives told us, 'The staff here are wonderful, we know most of the staff now but there are some changes sometimes'.

We found improvement since our previous inspection. Staff were supported and trained to enable them to deliver good care. One care worker told us, 'I have just completed my Diploma in Health and Social Care Level 3.'

People told us felt safe in the home and made positive comments about the support offered by the staff. People had been asked their views on the support provided in the home. They felt that if an issue was raised it was addressed.

People liked the home and there rooms which they had personalised. people's friends and relatives were made welcome to the home. People did raise an issue about access to the building after reception has closed. The manager had this in hand and will add a keypad system to the front door.