Background to this inspection
Updated
20 October 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
York House and Aldersmore 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.
The manager in post at the previous inspection had left and the service had employed a new manager. They were not currently registered with the Care Quality Commission at the time of inspection. Where a manager is registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with seven people who used the service about their experience of the care provided. We spoke with three members of staff during the visit and the manager on the telephone the day after as they could not be available on the day.
We looked at four people's care plans, daily notes for eight people and four people’s medicine records. We also viewed a range of records about infection control procedures and fire safety. Information regarding the management of the service was not available on the day of the inspection.
After the inspection
We requested information and clarification from the manager the day after the inspection to validate our evidence found. We provided verbal feedback of our inspection findings to the manager.
Updated
20 October 2021
About the service
York House and Aldersmore is a residential care home providing accommodation and personal care to 12 people, including people with a learning disability, autistic people, people with a physical disability and people with dementia. The service can support up to 18 people.
The service accommodated people in one large building, which was in keeping with other large domestic properties on a residential street with access to shops and the sea front.
People's experience of using this service and what we found
The provider had made some significant improvements to the service since the last report. However, there was still some improvements needed. The provider did not have robust quality monitoring processes in place to ensure oversight of the service. Risk assessments and care plans were in place but had not all been reviewed and updated in order to understand people’s needs. The auditing and oversight of medicines needed improvement. However, people received their medicines as prescribed and had them in a way they preferred.
We have made a recommendation that the provider seek up to date good practice guidance in relation to medicines management.
The service did not have a manager registered with the Care Quality Commission at the time of inspection, although a manager was employed but had not yet made an application. Where a manager is registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Improvements had been made to the care, safety and wellbeing of people who used the service. We observed staff being respectful, aware and knowledgeable of people’s needs and personalities. There was a warm and caring atmosphere where people and staff interacted and spent quality time together. There was enough staff to meet people’s needs who had been safely recruited. The manager and staff team had strong person-centred values which had made a difference to people at the service. Staff told us they felt supported in their role. The environment was clean and bright. Interior decoration, furniture and bathroom facilities had been improved, although there was still some building and remedial work to be done.
Infection prevention and control measures were in place and staff were following the correct government guidance. Some improvements were still needed to ensure the service continued to be safe.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to autistic people and people with a learning disability.
As there were fewer people living at York House and Aldersmore, the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The model of care and setting should maximise people's choice, control and independence. The service was a domestic style house on a residential street with access to local amenities.
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; Whilst we did not see any policies in relation to capacity and consent, people’s care plans supported this practice.
Right support:
People were encouraged and empowered to make their own decisions. Care staff ensured that people were supported and gave people daily choices which were appropriate to their needs and level of understanding and ability.
Right care:
Care was person-centred and promoted people’s dignity, privacy and human rights. Staff knew people well and had established positive relationships with them. People were treated and supported as an individual, and we saw that the service had made improvements around providing individual stimulating social and leisure choices.
Right culture:
The ethos, values, and attitudes of the manager and care staff ensured people lead confident, inclusive and empowered lives. People took part in a wide range of community-based activities of their choice.
Rating at last inspection and update. The last rating for this service was requires improvement (published 28 January 2021) with a breach in Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing).
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
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 remains Requires improvement. This is based on the findings at this inspection. We found the provider needs to make improvements.
Please see the safe and well led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for York House and Aldersmore 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 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 identified one continued breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will 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.