Archived: Daniel Yorath House

We found the following examples of good practice.

Staff and people at the home were part of a testing and immunisation programme for COVID-19. Staff had been trained in the use of personal protective equipment (PPE) and were observed to be using it appropriately during the inspection. There was a plentiful supply of PPE for staff to use and stock was regularly monitored. Hand sanitiser was readily available on the premises and additional dispensers had been put on walls throughout the building.

Appropriate arrangements were in place for new admissions to the home, such as requesting confirmation of a negative COVID-19 test before each person moved into the home and following the guidance in terms of isolating once there for 14 days.

The provider had a policy in place to support visits in line with government guidance in place at the time. All visits were pre-booked, and a system was in place to carry out risk assessments and testing of visitors prior to the arranged appointment to reduce the risk of transmission of COVID-19. There was a designated temporary outdoor structure for visitors to meet with people. The service could accommodate indoor visits, and these were starting, but the registered manager told us people still preferred the outdoor area. People were supported to maintain relationships and contact with others through electronic devices and there was WIFI throughout the building.

The service was on the whole clean throughout, and there were procedures to ensure any infection control risks were minimised. The home was due to undergo a full refurbishment which will support good infection control practices as some areas needed painting. Additional cleaning schedules had been introduced since the beginning of the COVID-19 pandemic. Areas that were frequently touched, such as door handles and light switches, were cleaned several times a day although this was not always recorded. The full cleaning task sheets were not completed when domestic staff were not on duty, but we were assured staff were carrying out tasks in their absence.

At our last inspection in February 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

Daniel Yorath House 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. Daniel Yorath House can accommodate up to 20 people with an acquired brain injury. At the time of our inspection there were 15 people using the service.

Daniel Yorath House is a specialist neurobehavioural rehabilitation centre for people aged 18-65 with acquired brain injury. It can also support people aged 16-18 and over 65 years. It forms part of the nationwide network of rehabilitation support services provided by The Brain Injury Rehabilitation Trust (BIRT).

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of our visit, the registered manager had been on sick leave and had just left the organisation. The manager had been in post for 11 months and was now in the process of registering with CQC.

People we spoke with told us they felt safe at Daniel Yorath House. Staff had been trained in safeguarding issues and knew how to recognise and report any abuse.

People’s medicines were managed and stored safely.

There were enough staff to meet people's needs. Any new staff were appropriately vetted to make sure they were suitable and had the skills to work at the service. The staff were given support by means of regular training, supervision and appraisal.

The therapy team of qualified health professionals worked alongside support staff to deliver a holistic rehabilitation approach to people.

Peoples dietary needs were fully understood and people told us staff encouraged them to eat a healthy diet.

People were supported, where appropriate, to manage their health needs. Staff responded promptly to any changes in the person’s health or general demeanour.

People told us they knew how to raise a concern if they were unhappy with anything regarding their stay and we saw people were asked about their views of the service

Systems were in place for auditing the quality of the service and for making improvements. We saw the manager was keen to share learning from incidents and to take forward improvements they had identified through their quality assurance process.

Daniel Yorath House is a specialist neuro-behavioural rehabilitation centre for up to 20 people over the age of 18 with acquired brain injury. The service forms part of the nationwide network of rehabilitation support services provided by The Brain Injury Rehabilitation Trust (BIRT).

There was a registered manager in post. 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.

We found the provider had policies and procedures in place to ensure risks to the safety of people who used the service were minimised. For example, there was regular training in safeguarding and staff we spoke with understood the signs of potential abuse and what they should do if they had any concerns. People’s care plans contained individual risk assessments covering aspects of their rehabilitation and daily lives, and environmental risk assessments had been undertaken to make sure risks associated with the premises and any activities were also well managed.

The provider’s recruitment practices were robust and we saw checks were made to ensure staff were not barred from working with vulnerable people. We concluded there were sufficient staff to meet people’s needs based on speaking with staff, making observations and looking at staffing records.

Medicines were managed and stored safely, and we found stocks of medicines were accurate. When we found a discrepancy the Head of Care investigated immediately and was able to provide a satisfactory explanation.

People lived in a safe, clean environment. We saw the provider ensured equipment and fittings were regularly inspected, serviced and repaired when required.

Staff told us they were supported to be effective in their roles through regular training, and we saw records which showed this was kept up to date. The provider had a thorough induction programme in place which included training, shadowing and observation of new staff’s practice. Further support was given through a programme of regular supervision and appraisal.

Care plans we looked at showed how people who used the service accessed healthcare services when needed. They also included appropriate mental capacity assessments and best interests decisions. Staff received training in the Mental Capacity Act 2005 and understood the implications of this for their work.

Deprivation of Liberty Safeguards (DoLS) were well managed and we found documentation relating to these was completed appropriately. Systems were in place to ensure referrals were followed up and renewals submitted on time.

People’s nutritional needs were understood and met well. People who used the service were consulted about the menu which changed weekly.

Care plans contained information relating to people’s likes, dislikes and preferences and staff were able to demonstrate they knew people well. People’s privacy and dignity was respected, and staff received regular training in this area to support their practice.

People who used the service were involved in setting their daily and weekly programmes of activity, and we saw people were engaged in a variety of recreational and rehabilitation activity throughout the day of inspection. We saw people had been actively involved in setting goals for their rehabilitation. These were regularly reviewed.

The provider had complaints management policies in place, and staff told us they received information about these during staff meetings. We saw positive feedback was also recorded and shared at staff meetings.

People who used the service had regular opportunities to attend feedback meetings, but we found not all actions identified had been followed up.

Staff we spoke with gave good feedback about leadership at Daniel Yorath House and said they found the management approachable and visible in the service.

Staff and people who used the service had regular opportunities to give feedback at meetings, and we saw the provider undertook an annual satisfaction survey which was sent to people who used the service, their relatives and people who commissioned the service.

There was a rolling programme of audit in place; however we found these had not always been undertaken at the frequency determined by the provider. We saw action had already been taken to improve this.

We spoke with four people who used the service and one relative to gain their views of the service. All four people told us they were happy to be on the rehabilitation programme. One person explained: 'I really value the opportunity to be here. It's my best chance to get right and have a normal life in the community.' However all four said they were not consulted about what activities were included on their schedule. The managers agreed to consider how they could do more to ensure people felt involved in planning their schedule and choosing meaningful activity.

We saw a recent complaint had been investigated through the local safeguarding procedures. We saw the service had co-operated fully with partner agencies to investigate the concern. We saw the service had learned from the incident and had put plans in place to reduce the risk of another person having the same experience. This showed the service had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. A relative commented: 'I have no worries or concerns at all. I feel very reassured to know [my relative] is here".

The service users we spoke to knew how to raise any concerns they may have. They felt that staff would listen to what they had to say and felt involved in planning their care and treatment.

We saw that service users were treated with respect by the staff. Staff told us that they enjoyed working at the unit because they could see the change in people. Staff told us that they felt supported by management and that the training they received was good. We saw evidence that staff received regular supervision and had annual personal development plans in place.

The quality of the service is monitored through monthly internal audits and includes monthly service user feedback questionnaires. We saw that there was a service user meeting each month and this was well attended. The service user we spoke to told us that staff would ask them to be involved in developing their care plan and in any reviews of care and treatment.

We saw that risk assessments were regularly updated and the care plans accurately reflected the needs of the service user. We saw that the care plans were focussed on rehabilitation, safety and well being. The service users we talked to told us that they agreed to the care plans and were actively involved in the reviews that took place on a regular basis.