York House

York House is a residential care home providing accommodation for persons who require personal care to up to 13 people. The service provides support to people with mental health needs. At the time of our inspection there were 13 people using the service, 3 of whom needed support with personal care.

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

Risks to people had not always been assessed and staff did not always report incidents. The registered manager had not ensured enough staff were trained in medicines administration and competency checks were not completed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found there was room for improvement to involve people in decisions about their care and with promoting their independence.

People and their relatives were happy with the care provided. However, people had very limited support with activities, and no one had any goals. Staff were not trained in end-of-life care and there was no information about people’s wishes at the end of their life in their records. At the time of our inspection no one required end of life care.

The systems to monitor the quality of the service were not robust. The registered manager lacked oversight of incidents. They were responsive to our concerns and worked well with other professionals. People, their families and staff spoke positively about the staff and manager.

Staff received training and supervision. People were involved in menu planning and given choices of what they ate and drank.

People’s care plans included details of their communication needs. There was a complaints procedure which people were aware of.

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 (27 July 2016).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to risk assessments, incident management, staff training and competency checks, personalised activities and governance processes. We found no evidence during this inspection that people have experienced harm from these concerns.

We have made a recommendation related to mental capacity assessments.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

York House is a family run business and provides care and accommodation for up to 13 people who have mental health needs. At the time of our inspection there were 12 people living at the home.

The home had a registered manager in post at the time of our inspection. 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were enough skilled, qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills to care for and support the people who lived at the home and were supported by way of supervisions and appraisals.

People’s needs had been assessed before they moved into the home and they had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People decided what food and drink they had and a variety of nutritious food and drink available to them. Snacks and fruit were available to people throughout the day. People received their medicines as they had been prescribed and were supported to administer medicines themselves when it was safe to do so.

Staff were kind, caring and protected people’s dignity. They treated people with respect and supported people in a way that allowed them to be as independent as possible.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to and the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being.

People and staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place and the provider was an active participant in the day to day running of the service. .

We found that people had been encouraged to participate in a variety of activities or to access the local the community facilities and amenities. Staff told us that the home was 'quite good' and that the provider supported them to provide people with good care. The care plans we reviewed demonstrated that people's identified needs had been reflected, met appropriately and reviewed regularly. Staff had ensured that they gained consent from people before providing any form of care. There was a system in place for the recruitment of staff to ensure only staff suitable to work with vulnerable people were employed and all the required checks had been carried out before an offer of employment had been made.

We found that the home had addressed the issues we raised at our last inspection and were now meeting the needs of the people who lived there. We found that the people had care plans in place that reflected their needs and gave good directions to staff on how to meet the needs of the people. We found that the staff understood their duty of care to the people and were aware of how to raise concerns should they need to. There were sufficient staff on duty to meet the people's needs and the manager had systems in place that ensured the home ran smoothly and in the best interests of the people who lived there.