Archived: Yanwath Care Home

We checked the information we held about the service and asked the views of health and social care commissioners.

Due to the frailty of the people who lived at the home we were unable to speak to them about their experience of life at Yanwath. We observed staff providing care and support to some of the people that used this service. This helped us to formulate our judgements.

The provider had sent us action plans each month to help keep us up to date with improvements. An evaluation of the action plans showed that little progress had been made in improving the quality of the service received by people who lived at Yanwath Care Home.

We found that people had care plans in place but some of the information recorded in them was not up to date or accurate. 'New' care plans were in the very early stages of development and introduction.

We did see some positive work that had taken place, particularly where people required monitoring and support with eating and drinking. We found that people had been referred to the dietician for help and advice.

We saw that most of the planned, environmental improvements had been carried out. Communal areas had been repainted and were bright and fresh. We did not detect any unpleasant odours in the home during the time of our visit.

We noted that infection control and medication audits had been carried out, identifying where improvements could be made. However, they failed to identify the infection control issues in the laundry and errors that had occurred around the administration of medicines.

People who used this service had complex needs. We judged that there were insufficient numbers of skilled staff on duty to ensure the safety of people who used this service.

We judged that the processes for reporting abuse and keeping people who used the service safe did not ensure people were protected. Safeguarding concerns had not been reported as quickly as they should have been.

We asked people who commissioned services about their views on staffing at the home. Their comments included:

'They (the home) are heavily reliant on agency staff. The carers are exhausted and are supporting the agency nurses too. However, we have observed that the carers are providing excellent care.'

And

'Care plans are not an accurate reflection of needs and are not updated regularly. By far the biggest issue is poor documentation not reflecting care needs.'

One of the relatives we spoke to during our visit to the home commented on the support their relative had experienced. They told us, 'We couldn't have asked for anything more. Staff have persevered. They have tried all sorts of different food.'

As part of this inspection we looked at medicines records, supplies and care plans relating to the use of medication. We observed medicines being handled and talked with staff. Due to the frailty of the people living at the home we were unable to gain information about their experience of how their medicines were managed.

Overall we found that people who used the service did not receive their medicines in a safe way.

Although we found some good evidence of detailed care planning, the quality of up to date information varied between different parts of the home. We spoke to the manager about this and were told that the documentation in care records had not yet 'been addressed'. The manager could not say when this would be completed.

We found that there were times when the home did not have sufficient numbers of staff on duty. To try to overcome this problem the home engaged agency nurses and carers on a daily basis. The manager told us that they 'always tried to get the same people to work at the home to help with continuity of care for people living at Yanwath.'

Some of the staff told us that they did not always have time to read each individual care plan. Daily shift handover sheets had been put in place to help ensure that the staff on duty had been provided with up to date information about the people they were supporting.

We received varied comments from visitors to the home. One person told us that their relative's condition had recently changed, but that no one had spoken to them or informed them of the care and treatment plan for the future care and support needs of their relative.

Another person told us, 'I couldn't ask for more. The staff are fabulous. If there has been problems, they are on the phone.'

We found that people received an assessment of their dietary needs to help identify any risks of poor nutrition. People identified 'at risk' had been seen by a health care professional and had provided advice on supporting people with their nutritional needs. However, records that had been kept in relation to people's body weight, food and fluid intake were not adequately detailed. It was impossible to tell if people had been offered and supported to take sufficient amounts of a nutritious and suitable diet.

A visitor to the home told us 'I keep telling them (staff) about my relative's dietary needs but they don't listen. I have seen pizza and smiley faces potato waffles. It's not nutritious and it is not something my relative would choose to eat."

We found that there were poor practices at the home with regard to food safety and food hygiene. We spoke to the Food Safety Officer about our concerns.

We found that some progress had been made with regard to the general environment at the home. Windows had been replaced and some re-decoration work was taking place. There were no unpleasant odours on the day of our visit and one of the housekeepers told us of the processes that were in place to try and minimise this matter.

There were still areas of the home that caused concern for example, repairs to uneven flooring, service user bedrooms and replacement of furniture, some of which was badly stained.

We were particularly concerned about the arrangements in place to ensure the safety of people who used the service, visitors and staff at the home in the event of a fire outbreak. We spoke to the Fire Safety Officer and the provider about our concerns.

CQC has talked to the administrators and is meeting with the management consultancy to discuss the way forward and the action plan that needs to be put in place to fully meet the remaining compliance actions which will include a monthly written update to be provided from them to show progress.

The Clinical Commissioning Group and the Local Authority are aware of the issues in the home and are also monitoring the care delivery on a regular basis.

We will continue to closely monitor and inspect this home.

We found that the provider had made improvements and progress towards achieving compliance with the essential standards of quality and safety.

We found that there were still areas of concern that required attention. The areas of most concern were the general environment at the home and the infection control processes that were in place at the home.

Areas of the home were not properly cleaned, raising the risks of infection and cross contamination. Furnishings were in poor condition, particularly the chairs, which were badly stained. The condition of the building and furnishings had an impact on the effectiveness of the cleaning and infection control processes.

We found that arrangements for managing medicines needed improving. Medication was not kept safely and we saw discrepancies in medication administration records and care plans.

We saw some good examples of quality monitoring but the processes needed to be more robust as they failed to identify issues that were highlighted during this inspection.

Some of the improvements we saw included 'life story books' and memory boxes that were being developed for each person that used the service. The examples that we saw during our inspection were personalised to individual people and provided very detailed information about their past lifestyle, interests, friends and families. They were very good examples of this type of memory aid.

Improvements had been made to the way in which people were supported with their nutritional needs. Assessments had been carried out and where concerns about nutrition had been identified, people were monitored and professional advice had been sought. We saw that there were sufficient numbers of staff on duty to help people at meal times, although a visitor to the home told us that this was not always the case, especially at weekends.

We observed staff working directly with people who used this service. There were good interactions between staff and residents. Staff spoke to residents in a respectful and warm manner, involving them in conversations to make sure no one was left out.

We received comments from relatives and visitors to the home as well as via the CQC website. People told us: 'The staff are caring and respectful of the residents and their families. The staff at Yanwath care deeply for the people in their care and always to the extra mile, giving up their own time to participate in fundraising activities. Yanwath Care Home is just that, a home, and the residents and staff there are a caring and supportive family.' Another person said; 'The staff genuinely love the residents and nowhere I have visited or worked has shown more compassion and empathy toward these most vulnerable people.'

One of the people who lived at Yanwath told us that they were 'very happy' and that staff were 'lovely and would do anything for me'. They said they could have a bath or shower when they liked; 'I only have to ask and the staff will attend to it.'

Relatives we spoke with said that they were happy with the care and support their relatives received. One person said 'they (the staff) are very good with my relative and they make sure they are always nice and clean'. Another commented that 'the standard of care is much better now'.

We looked at a sample of care records. We found in some that people's needs had changed since their admission to Yanwath, but these changes had not been reflected in their care plans.

We saw that staff were very busy throughout the day due to the high dependency needs of the people who used the service. Many people needed the assistance of two staff to help them with their personal care or mobility and there were times when there was not enough staff on duty to meet the needs of the people who used this service.

The provider had a quality monitoring policy and system in place. Some auditing of the service had been undertaken but processes were not robust enough and left gaps which created risks for the people who used this service.

As part of this inspection we looked at medicines records, supplies and care plans relating to the use of medication.

We found that people who used the service did not receive their medicines at the times they needed them and in a safe way. Appropriate arrangements were not in place in relation to the recording of medicines.