Yaxley House

Yaxely House is a residential care home providing personal care for up to 34 older people, some of whom may be living with dementia. At the time of our inspection 30 people were living at Yaxley House.

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

Risks to people had been assessed before they moved to Yaxley House and staff understood how to keep people safe. There were enough staff available to meet people’s needs, and robust recruitment procedures were followed. Medicines were managed safely by staff who had received appropriate training. The service was clean throughout and well maintained. The registered manager held meetings with their managers and senior staff to review how the service could improve and develop.

Staff had been provided with training and developed skills which linked to the needs of the people they cared for. People enjoyed their mealtime experiences, which reflected their choices, and people were provided the assistance they required so they would have enough to eat and drink. People were taken to or were visited by health and social care professionals promptly when needed. 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.

People informed us the staff cared for them and treated them with dignity and respect. Each person had a care plan which was reviewed at regularly intervals or sooner should the need arose. People benefitted from working with designated activity staff which arranged games and events in line with peoples choices. The service had a complaints policy and also a grumbles book which was reviewed frequently by the registered manager and resulting action taken to resolve any issues. The service staff worked closely with other professionals following agreed care plans that people had made regarding their end of life care.

People and their relatives told us the service was managed well and the staff team provided good care. The registered manager and senior team carried out quality checks to ensure that care was being carried out safely.

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 21 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). However, the home had recently appointed manager and they were in the process of submitting their application to become the registered manager of 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 our last inspection on 19 September 2016 we found that the service needed to make improvements in staffing levels and deployment and to ensuring people’s social needs were met. At this inspection we found that improvements were underway. The service had recruited staff to the laundry and to provide activities and further staff were waiting the outcome of pre-employment checks before starting work in the service. The provider had also introduced a new care recording and planning system whereby staff used a smart phone to input data. This saved staff spending time sitting at a computer away from people.

Care plans did not demonstrate people’s involvement in their care planning. However, people were aware of their care plans and the manager told us how they liaised with people and their relatives in an informal way.

Risk assessments were in place to minimise the risk of harm to people. The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff knew how to respond if they had any concerns. There were systems in place to ensure people received their medicines as prescribed.

Staff received appropriate training. Checks were carried out before staff began work to ensure they were appropriate to work in the service.

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.

There were audits in place to check the quality of the service people received. The provider was actively improving the service with implementation of a new care planning and recording system. The system was smart phone based for care staff and meant they did not have to spend time away from people recording the care that had been provided.

There were 34 people living in the service when we inspected on 19 September 2016. This was an unannounced inspection.

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.

Improvements were needed in the staffing levels in the service and how staff were deployed to meet people's needs. The registered manager told us about how this was being addressed, including the recruitment of an activities coordinator and the relocation of the computer terminals to allow staff to update records without having to leave the communal areas. Whilst it is positive to note the improvements being made, we have recommended that the service seek guidance from a reputable source on staffing levels which takes into account the needs of people and the layout of the building.

Improvements were needed in the social activities and stimulation provided to people. Improvements were being made to the environment, however, we found that the limited use of signage made it difficult for people to navigate around the service and, for example, find their bedrooms. We have recommended that the service seek guidance from a reputable source to improve the environment to be more accessible for people living with dementia.

There were systems in place to store, obtain, dispose of and administer medicines safely and to maintain records relating to medicines management. However, documents were not fully completed to show that people had received their creams as prescribed. This had been identified as an issue by the service for improvements and actions were being taken.

There were systems in place to keep people safe, this included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff were trained and supported to meet people’s needs effectively. People’s nutritional needs were assessed and met. People were provided with support to manage good health.

People were treated with respect and care by the staff working in the service. People were provided with personalised care which met their needs.

There was a system in place to manage complaints and use them to improve the service. There was an open and empowering culture in the service. Quality assurance processes were used to identify shortfalls and address them. As a result the service continued to improve.

This is a summary of what we found;

Is the service safe?

One person we spoke with told us, "I sometimes don't feel safe", but didn't wish to share the reasons why they didn't feel safe. Another person we spoke with told us, "I feel safe, I think I'm OK."

We found that people were not always being protected from the risks of malnutrition or dehydration. However, the service already had some plans in place to address these issues.

We found that people were not always being protected from the risks of developing a pressure sore, or a worsening in a current pressure sore. The service did not always take preventative steps to protect people at risk. However, the service had already identified some of the issues raised, and already had plans in place to rectify these issues.

Is the service effective?

People's care records showed that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. The care records for people were regularly reviewed, but contained information that was out of date, or conflicted with other care documents.

Is the service caring?

We observed that staff did not always interact with people using the service in a caring way. We observed staff displaying annoyance or frustration with people using the service, whom they were trying to support. We observed staff speaking to people using the service in a way which did not promote the person's right to choice, or encourage them to allow staff to help them.

We observed that care staff repeatedly ignored one person using the service throughout our inspection, who would have benefited from interaction with staff.

People using the service told us they did not have a lot of interaction with staff. One person told us, "Oh, it's nice to speak to someone." When asked if they had conversations with people often, the person told us "No, staff don't have time to speak to me, and I'm stuck in this bed."

Another person using the service told us, "Thank you for talking to me. People don't often have time to talk to me."

This meant that we did not feel assured that people's emotional and social needs were being met by staff.

Is the service responsive?

The service had already taken some action to address shortfalls in the service, which were identified by the Suffolk Safeguarding team.

However, some issues identified during our inspection had not been previously identified by the management of the service. This meant that we could not be assured that the staff working at the service, and the management of the service were responsive to people's changing needs.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed.

We looked at medication records and found that action had now been taken to improve the recording of medicines which we had found to be unsatisfactory during our last inspection in August 2013.

We looked at people's care records. These were detailed and up to date and showed staff how the person's individual needs should be safely met. Staff records showed that suitable recruitment checks were in place and that regular training was provided to all staff.

The premises were well maintained and records we looked at showed that required checks and maintenance were being done.

We looked at records for the administration of medication and at procedures followed when giving people prescribed medication. We found that records were not being completed accurately and that required checks had not been carried out. Audits to ensure accuracy were not effective. We were therefore not satisfied that medication was managed safely.

We did not speak directly with any people who used the service but looked at a range of records relating to their care and treatment.

We did not speak directly with any people who used the service on this occasion, although we did speak with relatives who were visiting two of the people who used the service.

We found that although the service were now compliant with outcomes 4 and 14, the records held by the service in respect of care planning were not adequate.

One person who used the service told us that staff were "Very good" and another person said they had never had a problem. Another person told us that the staff "Help me when needed."

Although people told us that they felt well cared for, records we looked at did not show how the individual needs of the people were always identified or met. This meant that care and support did not always reflect individual need and choice.

People were protected against the risk of abuse by the provider's policies and procedures but not all staff had received appropriate training in safeguarding or other areas.