Background to this inspection
Updated
7 November 2020
The inspection
This was a targeted inspection looking at infection control and prevention measures to check whether the provider had met the Requirement Notice in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The inspection was also prompted in part due to continued concerns received about poor standards of hygiene and cleanliness at the service.
Inspection team
The inspection was completed by an inspection manager and an inspector.
Service and service type
Yarborough House Care Home 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced from the car park of the service. on the first day of inspection.
What we did before the inspection
We reviewed information available to us about this service. This included details about incidents the provider must notify us about. We sought feedback from the local authority, local safeguarding team and community infection control team. The provider submitted an action plan following the focused inspection in August 2020 and we reviewed the improvement action they said they would make and the timescales for completion. We used all this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three people who lived at the service and with the nominated individual, the registered manager, the deputy manager, the maintenance person and a domestic worker.
We completed a tour of the environment and grounds. We looked at cleaning schedules, staff rotas and training records, maintenance records, the renewal programme, quality assurance audits and invoices for new bedding and equipment purchased.
Some of the documentation was reviewed at the service and some the nominated individual sent to us.
Updated
7 November 2020
About the service
Yarborough House Care Home is a care home providing accommodation and personal care for up to 25 older people, some of whom may live with dementia. At the time of our inspection 23 people lived at the service.
People’s experience of using this service and what we found
There were not enough staff to give people timely care, provide the reassurance and support people required when they were distressed and keep the home clean. Standards of cleanliness were poor and expected infection control guidance and procedures were not followed.
Risks to people were not always identified and managed. Accidents and incidents were not effectively monitored to consider lessons learnt and reduce the risk to people. There were several incidents that should have been notified to Care Quality Commission (CQC), but this had not been done.
Areas of the service needed redecoration, refurbishment and maintenance. We contacted the local environmental health agency to request a visit to the service and support the provider with the disposal of items left in the grounds.
Staff morale was mixed and staff turnover was high. Some staff did not feel listened to. Staff did not have training in some key areas and some staff had not received formal supervision. One area of the recruitment process required improvement to ensure safe and robust recruitment of new staff.
Quality assurance systems were not operated effectively and failed to ensure compliance with regulations. Where issues had been identified the provider did not act in a timely manner to address these.
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. Medicines were managed safely, and people’s nutritional and health needs were met. People were safeguarded against the risk of abuse.
The service worked with local agencies and had developed close community links. People told us they liked the staff and were happy and settled in the service.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 21 March 2018).
Why we inspected
The inspection was prompted due to concerns received about infection prevention and control, the environment, staffing levels and the management of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. Following the inspection, we requested an action plan from the provider which detailed the improvements they needed to make.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yarborough House Care Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to infection prevention and control, the management of risk, staffing, staff training and support, the environment, notification of serious incidents and safeguarding matters to CQC and failure to operate effective monitoring systems to improve the quality and safety of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.