Archived: York House Care Home

York House is located in the garden of the St Valery Care home but is registered separately as a care home. All staffing , activities and meals are provided by the main home St Valery. York House is comprised of two self-contained flats. Accommodation and personal care support are provided for a maximum of three people, over the age of 65 years with dementia type conditions who have lower dependency needs. The provider and registered manager have chosen to use the two units for single occupancy only. The number of people accommodated at any one time is therefore two. At the time of the inspection the service was full. York House is in the garden area of the larger service St Valery which is registered with the Care Quality Commission separately. People from York House are supported by staff from St Valery and make full use of the facilities at St Valery for their day to day support, meals and activities.

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

We spoke with one of the people from the York House accommodation during our inspection and their relative. They told us that they were happy living at the service but now wanted to move into the main home and this was under discussion. Their relative commented that the whole service had a “lovely family atmosphere”, and that they were very happy to leave their relative there as they knew that they were well looked after. People from York house chose when they wished to make use of the main home facilities or could have their meals provided to them in their accommodation. The person we spoke with came into the main home every day for their meals and activities.

The registered manager fostered a culture of placing people at the centre of everything they do and aspire to do at St Valery. They and staff were passionate about the people they supported living their life to the fullest in the least restrictive way.

People and relatives spoke positively about the service. People told us that they felt safe and found the service homelike. “It’s like living at home really.” The provider had ensured that people lived in a safe well-maintained environment, risks were assessed and managed. Any improvements made were with a view of enhancing peoples experience. There were enough suitable staff available to meet people needs.

Staff were highly trained and motivated. The registered provider and manager fostered a nurturing and empowering environment so that staff could develop and feel confident in their knowledge and skills. Staff enjoyed working in the service and felt valued and supported. Staff retention was therefore very good and provided people with excellent continuity of high-quality care. Peoples dietary and health needs were managed well, and health professionals told us the service referred to them appropriately. 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 and their relatives universally told us that staff were kind and caring. Their support was compassionate and there was thought given to way in which they supported to uphold people’s dignity. There was a busy but relaxed atmosphere within the service with lots of chatter, laughter and smiles between people and the staff supporting them. The culture was open and friendly, and visitors were made welcome. There was a sense that people, their relatives and staff knew each other well. A York house relative told us that they were really happy with the service offered to their family member which was not “institutionalised. Another relative told us that they thought people in the service were “treated as equals by staff and given their self-respect.” This approach extended to relatives with one who visited many times in the week saying they were treated by staff “like a pal.”

Staff were very knowledgeable about people's needs and supported people to remain as independent as possible. The service had earned a good reputation with local health and social care professionals who described the service as “one of the best” and “I have always found this service as one that others should take notes from,” The registered manager was a strong advocate for people needing the service who were diagnosed with dementia type illnesses. They and their staff continued to find new ways in which to support people in little but important ways that made their day to day experiences and outcomes consistently good.

The registered manager was a visible presence in the service and knew all the people, their histories and their status well. Both relatives and professionals we spoke with were complimentary of the service and the registered managers leadership and caring values which she promoted across all staff. People received high-quality person-centred care that met their individual needs.

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. (Report published 22 December 2016)

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.

This service was last inspected in September 2015 when we found the provider was not meeting all the regulations inspected at that time in regard to staff recruitment and training. We also found that the systems in place for monitoring and assessing service quality were not effective. We asked the provider to send us an action plan of what they intended to do to address these shortfalls which they did. This inspection found that the provider had implemented all the improvements they had told us about.

This service is registered as a single provider. The provider was therefore responsible for undertaking day to day operational management. For personal reasons the provider had to withdraw from direct management of the service and had delegated day to day operational management of the service to an interim manager. The interim manager knew people in the service well and had worked at this and the adjacent service St Valery for approximately 25 years. The interim manager had the appropriate knowledge and qualifications to take on this role. An application to add the interim manager as the registered manager for this service was currently being processed by the Care Quality Commission.

A registered manager is a person who is 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.

One person told us they felt safe living in their flat and felt lucky that they had the support of staff. People were provided with a safe, clean environment that was maintained to a high standard, with all safety checks and tests routinely completed. There were enough skilled staff to support people and provide continuity. Recruitment processes ensured only suitable staff were employed. New staff were inducted appropriately into their role, they received training to give them the knowledge and skills they needed to meet people’s needs. Staff felt listened to and supported and were given opportunities to meet regularly with senior staff on an individual basis or within staff meetings.

Staff understood how to keep people safe and protect them from harm, they understood how to respond to emergencies that required them to evacuate the building quickly and safely. It was recognised that some restrictive practices were necessary to maintain people’s safety, for example, restricted access onto the street although there was a clear culture of least restrictive practice embedded in the service. Risks were appropriately assessed to ensure measures implemented kept people safe. Medicines were managed appropriately.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The interim manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). A DoLS application had been made on behalf of one person who lived in York House to ensure the least restrictive measures were in place to keep the person safe. People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA) where people could not do so. The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.

People’s privacy and dignity was respected. Staff spoke to people in a dignified way and intervened discreetly if they thought people were becoming agitated and needed support to de-escalate the situation without drawing undue attention to them, this approach ensured the person's dignity was maintained.

Staff demonstrated kindness and patience in their contacts and engagement with people. They took time to listen and interact with people so that they received the support they needed. We saw many positive interactions between people and staff.

People’s health needs were monitored and referrals to health professionals made where needed. People were provided with a varied nutritious diet that took account of any specialist requirements they may have.

People referred to the service had their needs assessed prior to admission to ensure these could be met. Care plans were detailed and personalised to guide and inform staff about individual needs and how these were to be supported.

Staff were enabled to spend time with people and facilitate activities to provide stimulation; external entertainers provided variety to the activities offered. People choose whether to join in with activities held at St Valery, sometimes preferring their own company with a paper or book to read. Relative’s views were sought about service quality to inform improvements and service development. People and relatives felt confident of expressing any concerns they had to the interim manager and staff and thought these would be acted on. A range of audits provided assurance to the provider and interim manager that service quality was being maintained.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them, and from looking at records.

Is the service safe?

We saw that the service had reliable assessment processes in place prior to admitting new people. Care plans contained comprehensive details to instruct the staff in the individual care that people needed. They included risk assessments for maintaining people's safety and security.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. While no DoLs applications had needed to be submitted, proper policies and procedures were in place. We saw that relevant staff had been trained to understand when a DoLs application should be made, and how to submit one. Policies and procedures had been developed by the registered provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

We were informed that one person using the service had been assessed as lacking capacity to make decisions although no applications had needed to be submitted to deprive a person of their liberty. Training records highlighted that the majority of staff had completed Mental Capacity Act training and Deprivation of Liberty Safeguards training.

Is the service effective?

Feedback received from people using the service was positive and confirmed people were happy with the standard of care provided. Comments included: 'The care I get is excellent'.

In relation to meals, one person told us: "The food is delicious; staff get me a cup of tea whenever I want one".

We found that staff providing health care had specific knowledge about their areas of work, and were able to support people in making progress with their health needs. The staff recognised people's changing health needs, and were quick to make referrals to additional health staff if the person's condition indicated this was appropriate.

Is the service caring?

On the day of our visit the atmosphere in the home was calm and relaxed. The people living at the service were observed to be comfortable and relaxed in their environment and were able to follow their own plans and preferred routines.

Staff were attentive to the diverse needs of the people living in the service and we saw they communicated and engaged with the people they supported in a respectful, dignified and caring manner.

We found that people living at the service had been invited to take part in their own plan of care. The manager and staff were observed knocking on doors and calling people by their preferred name.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records we saw confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

One person told us 'I go to bingo whenever it's on'.

People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. They confirmed they had been listened to.

We looked at staff training records and saw that the staff received mandatory training in relevant subjects and were able to take further training if it was in line with their job roles. One staff member told us 'We are always training, it really helps'.

Is the service well- led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

The manager was aware of the day to day culture of the home and kept this under review. The service had a quality assurance system, and records seen by us showed that identified shortfalls were addressed promptly.

We found that people were supported to make their own decisions about their care and to consent to their care and treatment. Staff respected people's wishes and sought their consent before providing care, for example before helping them with their prescribed medication or before entering their accomodation.

People had their health and care needs assessed and met. One person told us 'I am very happy with the care I get'. Staff understood people's needs and how to provide the care they needed. Where people received care from more than one provider, for example other healthcare professionals such as a physiotherapist, the service coordinated their care to ensure it met their needs. People that used the service told us "I can see the GP when I need to".

The service employed sufficient numbers of staff to meet people's needs. Staff were qualified and ensured they provided the support people needed whilst encouraging their independence. People that used the service knew how to get support from staff when they needed it by using their call bells. Staff responded promptly to people's needs.

Staff treated people with respect and were positive in the way they supported them. They listened to their views and respected their decisions. We saw that the staff respected the privacy of people's flats and only entered after knocking on the door.

The provider of the service had effective systems in place for checking that new staff were suitable to work in the home before they started work. There were systems for checking on the quality of the service at regular intervals and this included asking people that used the service, and their relatives, for their views.