York House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were monitored to ensure lessons could be learnt, if required, to reduce risk. Trends and patterns were analysed by the management team. People told us they felt safe at the home.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People’s needs were assessed before they commenced using the service.

The provider kept in contact with staff from the hospital when people had been admitted due to deterioration in health, and plans were put in place, when appropriate, to support people to get back to the home.

We received feedback from a healthcare professional who told us the provider worked well with them to meet the needs of people.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There were safeguarding policies and procedures in place. The registered manager knew their responsibilities in this area and safeguarding incidents had been reported, when required.

Staff had completed relevant training and knew how to identify and report any safeguarding concerns.

Overall, risks to people's care were managed well and staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, during our assessment we found some areas where further work was required around the quality of records linked to risk management. For example, the recording of risks for people who choose to have their meals in their own in their bedrooms was not always detailed and did not provide enough guidance to staff on how to manage risks to people, such as how people should be seated and how often should be monitored.

We found examples where care plans did not detail how often people should be repositioned, for people who had been assessed as high risk of developing pressure ulcers, in line with best practice guidance. We did not find concerns about incidents while people were having meals in their bedrooms or people developing pressure ulcers. We discussed these issues with the registered manager on our first visit and on our second visit we reviewed records that confirmed appropriate action had been taken.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. On our first visit, we discussed risks linked to people accessing some areas of the home unsupported by staff, such as stairs and the garden, with the registered manager.

We reviewed evidence confirming risks to the environment had been assessed. The provider had plans in place to continue to improve the environment, to further review risks and to redecorate the home.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective, supervision and development. People and relatives shared positive feedback about staffing, but staff told us staffing levels were low at times.

The provider used a dependency tool to determine the number of staff on shift and in our review of the rota, we found this was in line with dependency assessment. We discussed the concerns raised by staff with the registered manager. The registered manager showed us how they observed care to monitor staffing levels and staff deployment.

Staff shared mixed feedback about how the team worked together. We discussed this with the registered manager who was aware of the issues and had taken action on specific concerns raised by staff, but no records had been kept of reflective practice or additional supervision sessions being completed with staff. The registered manager told us they would make sure these records were kept and were detailed for future reference.

Staff had completed appropriate training to do their jobs safely.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Domestic staff and care staff followed cleaning schedules and procedures to help ensure people were protected from the risk of infection.

The provider had identified ongoing maintenance and redecoration work was required and this was planned. We observed staff using personal protective equipment (PPE) for personal care tasks and when supporting people at mealtimes.

Staff understood their responsibility to ensure PPE were disposed of appropriately. People and relatives did not raise any concerns regarding the cleanliness of the home.

The provider was previously in breach of the legal regulation in relation to safe care and treatment linked to medicine management. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

Overall, we did not find medication errors, but we found examples where medication records had gaps or were not always detailed enough. For example, we found examples where protocols for medicines to be taken ‘as and when’ required needed additional detail. We raised this issue with the registered manager and we reviewed evidence of action taken.

We found examples of gaps in medication records linked to eye drops; we raised this issue with the registered manager. Medication audits were being regularly completed and some of the issues had been identified, but others either had not been identified or action had not been taken to prevent reoccurrence. The registered manager told us they had recently changed their medication audits from weeklyto monthly but would go back to doing them more weekly so issues were identified and acted upon in a timely way. Staff had been assessed as competent to administer medication.