Archived: York House and Aldersmore

York House and Aldersmore is a residential care home providing accommodation and personal care to 12 people, including people with a learning disability, autistic people, people with a physical disability and people with dementia. The service can support up to 18 people.

The service accommodated people in one large building, which was in keeping with other large domestic properties on a residential street with access to shops and the sea front.

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

The provider had made some significant improvements to the service since the last report. However, there was still some improvements needed. The provider did not have robust quality monitoring processes in place to ensure oversight of the service. Risk assessments and care plans were in place but had not all been reviewed and updated in order to understand people’s needs. The auditing and oversight of medicines needed improvement. However, people received their medicines as prescribed and had them in a way they preferred.

We have made a recommendation that the provider seek up to date good practice guidance in relation to medicines management.

The service did not have a manager registered with the Care Quality Commission at the time of inspection, although a manager was employed but had not yet made an application. Where a manager is registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Improvements had been made to the care, safety and wellbeing of people who used the service. We observed staff being respectful, aware and knowledgeable of people’s needs and personalities. There was a warm and caring atmosphere where people and staff interacted and spent quality time together. There was enough staff to meet people’s needs who had been safely recruited. The manager and staff team had strong person-centred values which had made a difference to people at the service. Staff told us they felt supported in their role. The environment was clean and bright. Interior decoration, furniture and bathroom facilities had been improved, although there was still some building and remedial work to be done.

Infection prevention and control measures were in place and staff were following the correct government guidance. Some improvements were still needed to ensure the service continued to be safe.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to autistic people and people with a learning disability.

As there were fewer people living at York House and Aldersmore, the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The model of care and setting should maximise people's choice, control and independence. The service was a domestic style house on a residential street with access to local amenities.

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; Whilst we did not see any policies in relation to capacity and consent, people’s care plans supported this practice.

Right support:

People were encouraged and empowered to make their own decisions. Care staff ensured that people were supported and gave people daily choices which were appropriate to their needs and level of understanding and ability.

Right care:

Care was person-centred and promoted people’s dignity, privacy and human rights. Staff knew people well and had established positive relationships with them. People were treated and supported as an individual, and we saw that the service had made improvements around providing individual stimulating social and leisure choices.

Right culture:

The ethos, values, and attitudes of the manager and care staff ensured people lead confident, inclusive and empowered lives. People took part in a wide range of community-based activities of their choice.

Rating at last inspection and update. The last rating for this service was requires improvement (published 28 January 2021) with a breach in Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains Requires improvement. This is based on the findings at this inspection. We found the provider needs to make improvements.

Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for York House and Aldersmore on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified one continued breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

York House and Aldersmore is a residential care home providing accommodation and personal care to 17 people, including autistic people, people with a learning disability, and/or physical disability and people living with dementia. The service can support up to 18 people.

The service accommodates people in one large home, which is in keeping with other large domestic properties on a residential street.

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

During the inspection we identified serious concerns about Infection Prevention and Control (IPC). This included concerns about the cleanliness of the service and poor practice in the use of Personal Protective Equipment (PPE), which placed people at the risk of infection. We wrote to the provider setting out the urgent nature of our concerns and asked them to provide an action plan on how they would address this.

The provider employed a consultant to visit the service and created an action plan alongside the

management team to address these concerns.

The service did not have a manager registered with the Care Quality Commission at the time of inspection, although a manager was employed and had made an application. Where a manager is registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The manager told us they had been working to try to change the culture in the service. We found that governance and oversight systems were not robust and did not identify areas of concern in order to effectively mitigate risk. Whilst the service had received some compliments, it was not demonstrated that lessons were learned following complaints or other incidents and effective action taken as a result. The service had also failed to notify the CQC of safeguarding concerns, which is a legal obligation on providers so that CQC can monitor the safety and quality of care.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The model of care and setting should maximise people's choice, control and independence. Whilst the service is a domestic style home on a residential street with access to local amenities, the number of people living at York House and Aldersmore is greater than best practice guidance. We were also told by the manager that people living at the service were not always from the local area. We had concerns about the varied mix of people of different ages with diverse and complex needs, which alongside the number of people living at the service could impact upon the quality of care. We raised this with the provider's representative, who told us that people are assessed upon entry to the service to see whether their needs can be met, and any possible impact on others living there. However, as the service could not demonstrate the assessment process was robust and effective, we raised this as a concern with the local authority.

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 (published 23 October 2019).

Why we inspected

We received concerns in relation to Infection Prevention and Control (IPC) and management and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We have been provided with an action plan on how urgent concerns relating to IPC and cleanliness of the environment have or will be addressed to keep people safe from the risk of infection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment, staffing, governance and oversight and lack of notifications to CQC at this inspection. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

York House and Aldersmore is a residential care home which provides accommodation and personal care for nine people who have a learning disability. The service can support up to 18 people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 18 people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going from the service.

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

People received support from a staff team who understood how to keep them safe and protect them from avoidable harm. Staff were recruited safely, were visible in the service and responded to people quickly. People’s medicines were managed safely. Systems were in place to ensure the environment was safe.

People's needs were assessed, and support plans were in place. Staff received relevant training, support and supervision to enable them to carry out their roles and responsibilities. People had access to healthcare professionals. 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Staff were caring and supportive and respected people's privacy, dignity and individual differences. People were involved in reviewing their care and supported to be as independent as possible. People took part in organised activities in the service, however, some improvements were required to ensure people could access community activities more regularly.

The management team had a good oversight of the service and were visible and approachable. There were systems in place to monitor the quality of the service and to continue to develop and improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21st August 2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

At a comprehensive inspection on 23 May, 24 May and 01 June 2017, we found continued breaches of Regulation 9 and 17 and further breaches of 12, 14 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service was rated ‘Inadequate’ and placed into special measures. As a result of our concerns the Care Quality Commission met with the provider who voluntarily agreed to restrict admissions to the service and we were sent regular improvement plans.

We undertook this comprehensive inspection on 22 May, 01 June and 16 June 2018 to check that the registered provider had made the required improvements and to confirm they now met legal requirements.

You can read the report from our last inspections by selecting the ‘all reports’ link for York House and Aldersmore on our website at www.cqc.org.uk

York House and Aldersmore 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. The care home accommodates up to 18 people who have a learning disability or autistic spectrum disorder and may also have mental health needs or a physical disability.

York House and Aldersmore is situated in a quiet residential area in Holland-on-Sea and close to the seafront and amenities. The premises is on two floors with each person having their own individual bedroom and communal areas are available within the service. At the time of our inspection, eight people were using the service.

There was no registered manager in post. A new manager who had been previously registered at the service recommenced in post on 18 April 2018.

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.

Improvements were still needed to ensure that all risks to people’s safety and welfare were identified and acted on, specifically in relation to one person choking. Equipment used to support people with their mobility had not been checked and was unfit to be used.

The cleanliness of the service had improved but further improvements were required, for example ensuring taps were free from lime scale and shower drains were free from grime and debris. Improvements were also required regarding food hygiene practices.

Staffing levels had recently been reviewed at the service and were adequate to ensure that people’s needs were met, and they received a good quality of care.

Improvements were required to ensure that care plans contained accurate information and provided guidance on how to meet people’s needs.

People had some opportunities to be involved in the running of their home to maintain their daily living skills. We have made a recommendation that the service continues to further develop the opportunities for people to be involved in daily living activities within the service to promote their independence and well-being.

Staff had received training to ensure that they had the necessary skills and knowledge to carry out their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The requirements of the Mental Capacity Act (MCA) were understood and in place.

Staff were kind and caring and had developed good relationships with people who used the service.

We received mixed feedback regarding the effectiveness of the leadership and management team at York House and Aldersmore. While the atmosphere and culture in the service was much improved, some relatives had lost confidence in the service due to a lack of communication. Although some auditing and monitoring systems were in place to ensure that the quality of care was consistently assessed, they had failed to identify the issues we found during our inspection.

Since our last inspection of the service, some improvements had been made, however, we found continued breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). Steps had been taken to strengthen the management team of York House and Aldersmore and this was seen to be a positive step, however further improvements were still required to ensure the registered provider’s oversight and quality assurance arrangements were robust and effective to drive and sustain improvements; and to achieve compliance with regulatory requirements.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

York House and Aldersmore provide personal care and support for up to 18 people who have a learning disability or autistic spectrum disorder. People who use the service may also be living with mental health needs, a physical disability or dementia. At the time of our inspection there were 16 people living in the service.

In March 2015 we found the service to be good in all key areas and rated the service as Good overall. However we recieved information from local authority safeguarding and quality monitoring teams about the management and care practices which identified the quality of the service had deteriorated. Therefore we carried out an unannounced focused on the 18 March 2016 and looked at two key areas: Safe and Well-Led. We rated Safe as Requires Improvement and Well-led as Inadequate. Multiple breaches of legal requirements were found. These related to the safety and cleanliness of the environment, care being provided in a routine and regimented manner, and governance. You can read the report from our focused inspection on 18 March 2016 by selecting the 'all reports' link for ‘York House and Aldersmore' on our website at www.cqc.org.uk

Following that inspection the provider sent us an action plan to tell us what improvements they were going to make, and stated the work would be completed by December 2016. During this inspection we found some improvements had been made. However, the oversight of management was still failing to effectively identify, manage and embed systems to ensure the quality and safety of the service. This resulted in new and ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These breaches were in relation to staffing, safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.

There was no registered manager in post as the previous registered manager had left the service in February 2017. Action was being taken by the provider to recruit to this position. 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 the time of the inspection, a registered manager from one of the provider’s other services was on site, providing management support.

In February and March 2017 we became aware through information we received from multiple sources of concerns relating to the culture and leadership of the service. This included that the improvements referred to in the provider’s action plan had either not been embedded fully or where deteriorating further. This inspection confirmed that the service quality had deteriorated and that the provider had failed to take effective action to intervene or prevent its occurrence.

The systems in place to reduce risks associated with people’s care and support were not always in place, effective or fully explored. This included risks associated with fire safety, physical and mental health needs, environment, mobility, nutrition and support from effects of anxiety and stress were not always being identified or effectively managed. Staff were not being given enough guidance, information and training to proactively identify and take action to minimise any potential risks. Care records provided insufficient guidance for staff in providing safe care and in supporting people’s wellbeing.

Whilst some action had been taken to improve the environment and cleanliness, this was not applied to the whole service which meant improvements were not always sustained and other risk areas had not been proactively identified and dealt with. Provider audits and governance was not robust enough to manage this and ensure results were achieved and sustained.

Some improvements had been made in breaking down ‘institutional’ routines, but work was still ongoing in this area. This led to many people experiencing very different levels of quality in the care provided. Staff were not keeping updated on what ‘Good practice’ looks like. Training did not reflect the levels of competency and skills needed to support the identified needs of people, some of whom were living with very complex needs. This included having sufficient staff over the 24 hour period to ensure any routines were person, and not staff and/or task led.

People, their relative’s, health and social care professional’s feedback that the quality of care and interactions with leadership and staff varied greatly. Some provided examples where staff demonstrated a compassionate and caring approach. However others shared serious concerns about how people were not always provided with consistently kind and caring support. Some described this as different depending on which staff were on duty. There were examples where individuals interests and preferences where not explored or fully considered. Risk assessments and care planning was not detailed enough to demonstrate that people’s needs were understood and met. Further work was needed to ensure people’s care records demonstrated how they were being supported to have access to fulfilling and purposeful everyday lives.

Development of care did not always consider how to involve people more through the use of new or innovative models of care, technology and/or best practice guidance. This included care records that were in a format that met individual’s communication needs. The service supported people, whose mental age may not reflect their physical age, people living with dementia and those with sensory loss. All of which can impact on their ability to communicate and have their voice heard. We have made a recommendation around the use of communication aids to support people in this area.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. We have made a recommendation to support the staff in developing their working knowledge around the use of best interest decisions to ensure they always follow correct procedures.

The service had systems in place to support people with their medicines as prescribed. Improvements were needed in the safe storage and record keeping including staff completing records accurately to confirm the level of support they have given. Improvements were needed in monitoring for signs of where people were at risk of being over / underweight, and in encouraging diets to support their health needs.

The provider had failed to make necessary improvements and prevent further deterioration in the quality of service because of a lack of robust and accurate systems of oversight and governance. The service has been rated Inadequate in Well-led for over a year and has not had the necessary resources or input to ensure a timely turn around and improvement for the people using the service.

Following the inspection we met with the provider’s representatives including the Director of Eleanor Nursing and Social Care Limited. This enabled them to tell us the plans they had started to implement and those which were being worked on to address our concerns. They were committed to driving continuous improvements for those in their care. CQC is now considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

York House and Aldersmore is a care service for up to 18 people who have a learning disability or autistic spectrum disorder. People who use the service may also be living with mental health needs, a physical disability or dementia. On the day of our inspection there were a total of 17 people at the service, including one person who was staying for a period of respite care and one person who was accessing day services.

A registered manager was in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection of the service took place on 6 March 2015 and the service was found to be good in all key areas. However since the previous inspection we had received information of concern from the local authority safeguarding team. Further information was received raising concerns about care practices by the local authority quality monitoring team.

There had been a number of changes at the service since the last inspection. The provider had carried out extensive improvements to the environment including building an extension and completing extensive refurbishment of communal lounges and dining areas. We found that, although improvements had been made as a result of the refurbishment, older areas of the premises had deteriorated. This applied in particular but not exclusively to bathrooms, toilets and ensuite facilities where the standard of cleaning and maintenance was not carried out in line with current legislation and guidance.

Staff and the management team did not deliver individualised and person centred care. This was evidenced by care delivery that relied on routines and was task orientated.

We found that systems in place to monitor the quality of the service were insufficiently robust to identify risks to people from areas where the environment was poorly maintained.

The service had breached regulation 9 of the HSCA 2008 (Regulated Activities) Regulations 2014 relating to person centred care, regulation 15(1)(a)(e)(2) relating to premises and equipment and regulation 17(2)(b) relating to good governance.

You can see what action we told the provider to take at the back of the full version of the report.