Archived: York Court

Updated 17 November 2015

We undertook an unannounced focused inspection of York Court on 29 September 2015. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our inspection on 19 and 20 January 2015 had been made.

This unannounced inspection was undertaken by an inspector, an inspection manager, an expert by experience and a specialist advisor. An expert by experience is a person who has personal

experience of using or caring for someone who uses services like this. On this inspection the specialist advisor was a nurse with extensive experience of caring for older people in a nursing home.

Before we visited the service we checked the information that we held about it, including notifications sent to us informing us of significant events that occurred at the service and safeguarding alerts raised.

During our inspection we spoke with eight people who use the service, five relatives and a friend of a person using the service. We also spoke with the peripatetic manager, two nurses, five care staff, two kitchen staff, the activities co-ordinator and a visiting healthcare professional. We made general observations on each of the floors and we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed eight care records and nutrition risks assessments, food and fluid charts for four people. We also reviewed records relating to the management of the service including incidents and accident records, complaints records, staff supervision records, training records and kitchen records in relation to people’s dietary needs. After the inspection, the provider emailed us some samples of quality assurance audits they had undertaken. Both before and after the inspection, we attended a number of meetings with the local authority and the local clinical commissioning group to discuss concerns about the service and reviewed minutes of these meetings.

Updated 17 November 2015

We carried out an unannounced comprehensive inspection of this service on 19 and 20 January 2015. We found breaches of legal requirements relating to safeguarding people, staff support, person centred care, receiving and acting on complaints and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified.

We carried out a focused inspection on 9 June 2015 to check that they had followed their plan and to confirm that they now met legal requirements in relation to the more serious breaches that related to care and welfare. We found that some improvements had been made.

This inspection was carried out to check that the provider had met the legal requirements in relation to breaches related to safeguarding people, staffing, person centred care, receiving and acting on complaints and good governance.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for York Court on our website at www.cqc.org.uk

York Court provides accommodation, nursing and personal care for up to 59 older people over three floors. There were 38 people using the service when we visited. On the ground floor there is a mixed nursing unit, with some people who are living with dementia. On the first floor, there is a dementia unit and on the second floor a residential unit for people who are more independent.

There was a registered manager at the service; however he was not managing the service at the time of our inspection. A peripatetic manager was overseeing the management of the home. 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 this inspection, we found that improvements had been made in some areas but concerns remained with other aspects of care being delivered. Prior to the inspection we were informed that the home would be closing and staff would be offered redundancy. Arrangements were being made to find alternative suitable placements for people using the service and the provider was working with the local authority to facilitate this process.

Although people told us they felt safe, safeguarding procedures at the home were not always effective. There had been a number of safeguarding concerns at the home since our previous inspection which CQC had not been notified of and one of the concerns was identified and reported by a visiting healthcare professional.

People gave us mixed feedback about the quality of food. We found that people who were at risk of malnutrition and had food and fluid charts in place did not have their needs met. Staff did not complete these records in sufficient detail to enable people’s needs to be met effectively. Other aspects of record keeping at the service were poor. Risk assessments did not always reflect people’s changing needs and some care plans that had been developed were based on conflicting information in the risk assessments.

Some people at the service had restrictions placed upon them. The provider had not followed procedures and submitted applications to the local authority for these restrictions to be authorised formally.

Although staff received supervision and we found that staff numbers at the home were adequate to meet the needs of people, the high use of agency staff had an impact on the provision of care. Staff were not always familiar with people’s needs and there were occasions where people were left without adequate support.

Regional and peripatetic managers were on site the majority of the time, overseeing the service and carrying out audits. However, we found that these were not always effective and actions were not always assigned for people to follow up which meant that we could not be assured that identified shortfalls would be addressed.

A number of service level concerns meetings had been held in relation to York court where concerns had been raised by the CCG and social services.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care, staffing, consent, meeting nutritional needs, safeguarding and good governance. You can see what action we told the provider to take at the back of the full version of this report.