The Care Quality Commission
  • Care Home
  • Care home

Archived: York Court

Overall: Inadequate read more about inspection ratings

313-315 Battersea Park Road, London, SW11 4LU (020) 7720 4170

Provided and run by:
Four Seasons 2000 Limited

All Inspections

29/09/2015

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 19 and 20 January 2015. We found breaches of legal requirements relating to safeguarding people, staff support, person centred care, receiving and acting on complaints and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified.

We carried out a focused inspection on 9 June 2015 to check that they had followed their plan and to confirm that they now met legal requirements in relation to the more serious breaches that related to care and welfare. We found that some improvements had been made.

This inspection was carried out to check that the provider had met the legal requirements in relation to breaches related to safeguarding people, staffing, person centred care, receiving and acting on complaints and good governance.

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

York Court provides accommodation, nursing and personal care for up to 59 older people over three floors. There were 38 people using the service when we visited. On the ground floor there is a mixed nursing unit, with some people who are living with dementia. On the first floor, there is a dementia unit and on the second floor a residential unit for people who are more independent.

There was a registered manager at the service; however he was not managing the service at the time of our inspection. A peripatetic manager was overseeing the management of the home. 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 this inspection, we found that improvements had been made in some areas but concerns remained with other aspects of care being delivered. Prior to the inspection we were informed that the home would be closing and staff would be offered redundancy. Arrangements were being made to find alternative suitable placements for people using the service and the provider was working with the local authority to facilitate this process.

Although people told us they felt safe, safeguarding procedures at the home were not always effective. There had been a number of safeguarding concerns at the home since our previous inspection which CQC had not been notified of and one of the concerns was identified and reported by a visiting healthcare professional.

People gave us mixed feedback about the quality of food. We found that people who were at risk of malnutrition and had food and fluid charts in place did not have their needs met. Staff did not complete these records in sufficient detail to enable people’s needs to be met effectively. Other aspects of record keeping at the service were poor. Risk assessments did not always reflect people’s changing needs and some care plans that had been developed were based on conflicting information in the risk assessments.

Some people at the service had restrictions placed upon them. The provider had not followed procedures and submitted applications to the local authority for these restrictions to be authorised formally.

Although staff received supervision and we found that staff numbers at the home were adequate to meet the needs of people, the high use of agency staff had an impact on the provision of care. Staff were not always familiar with people’s needs and there were occasions where people were left without adequate support.

Regional and peripatetic managers were on site the majority of the time, overseeing the service and carrying out audits. However, we found that these were not always effective and actions were not always assigned for people to follow up which meant that we could not be assured that identified shortfalls would be addressed.

A number of service level concerns meetings had been held in relation to York court where concerns had been raised by the CCG and social services.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care, staffing, consent, meeting nutritional needs, safeguarding and good governance. You can see what action we told the provider to take at the back of the full version of this report.

09/06/2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 19 and 20 January 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to safeguarding people, staffing, person centred care, receiving and acting on complaints, good governance and care and welfare.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to the more serious breaches that related to care and welfare. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for York Court on our website at www.cqc.org.uk

York Court provides accommodation, nursing and personal care for up to 59 older people over three floors. There were 45 people using the service when we visited. On the ground floor there is a mixed nursing unit, with some people who are living with dementia. On the first floor, there is a dementia unit and on the second floor a residential unit for people who are more independent.

There was a registered manager at the service; however he was not managing the service at the time of our inspection. A deputy manager was overseeing the management of the home, with support from a peripatetic manager. 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 our previous inspection we found that risk assessments for people were not up to date, staff were not aware of which people had Do Not Attempt Resuscitation (DNAR) orders in place, incidents of behaviour that challenged the service were not being managed appropriately, and there was a lack of meaningful activities for people.

At this inspection, we found that improvements had been made.

Risk assessments were updated every month and action taken where it was found risks had changed and people needed extra support.

Discussions had been held with people, and if appropriate, relatives, about their wishes with respect to resuscitation in the event of an emergency. A GP had reviewed and signed DNAR forms and where people did not have the capacity to consent, decisions were made in their best interests. Staff were aware of which people had DNAR’s in place.

Where people displayed behaviour that challenged the service, staff made referrals to specialist behaviour management teams within the community for specialist input. Recommendations were followed.

A part time activities co-ordinator had been recruited and a staff member was allocated on each unit to take a lead on activities in the absence of the activities co-ordinator. People’s care plans had been updated to reflect individual preferences.

At our previous comprehensive inspection on 19 and 20 January 2015 we also found breaches of legal requirements relating to safeguarding people, staffing, person centred care, receiving and acting on complaints, good governance. We will carry out another unannounced inspection to check on all outstanding legal breaches.

19 and 20 January 2015

During a routine inspection

This inspection took place on 19 and 20 January 2015 and was unannounced. At our last inspection in July 2014 the service was not meeting the regulations looked at. These related to the care and welfare of people using services, meeting people’s nutritional needs, cooperating with other providers and staffing levels within the home.

York Court provides accommodation, nursing and personal care for up to 59 older people over three floors. There were 53 people using the service when we visited.

At the time of our inspection the manager was in the process of registering with the CQC. Following our inspection the manager left the organisation and an interim manager has been managing the service since.. 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 and associated Regulations about how the service is run.

Since our last inspection there had been three different managers at the service. There had been a high number of safeguarding alerts during this period which had caused concern to the Care Quality Commission (CQC) and the local authority safeguarding team. As a result, the local authority had imposed an embargo on the home and had held regular meetings with managerial staff to monitor the quality and safety of the service.

Safeguarding concerns were not always reported as required. We were alerted to five allegations of abuse which had not been reported to CQC.

Risks were not always managed appropriately and people and their relatives were not always involved in decisions regarding risks. We saw two examples where risks to people had not been fully assessed and sufficient preventative measures had not been put in place.

Staff told us they had received first aid training every three years and were able to explain how they would respond to a medical emergency. We were told that nursing staff were expected to know who did not want to be resuscitated in the event of a medical emergency. However, one nurse was unable to tell us this.

Safe practices for administering and storing medicines were followed. Nurses had completed medicines administration training and appropriate auditing procedures were in place to ensure medicines were stored and administered appropriately.

Adequate numbers of staff were safely recruited into the service. However, staff training and development was not suitably monitored.

People’s behaviour that challenged was not consistently managed in a way that maintained their safety and protected their rights. We were made aware by watching the practise of the staff of two people whose behaviours were not being managed according to expert advice.

People were generally supported to maintain good health by having access to healthcare services and people were supported to eat and drink sufficient quantities to maintain a balanced diet.

Staff were trained in the Mental Capacity Act 2005 (MCA) which is a law to protect people who do not have the capacity to make decisions for themselves. Staff were also trained in the Deprivation of Liberty Safeguards (DoLs) which are part of the MCA and exist to make sure that people’s freedom is not inappropriately restricted where they lack the capacity to make certain decisions. Staff demonstrated a good understanding of their responsibilities.

People and their relatives were not consistently involved in making decisions about their care. Relatives complained about not being kept informed about people’s care.

People’s privacy and dignity was not being consistently respected. Four relatives and one healthcare professional expressed their concerns to us.

There was inadequate provision of activities. People, relatives and staff confirmed that there were not enough meaningful activities to engage people. We observed people having very little to do for most of our inspection.

Complaints, and accident and incident records were incomplete and some were not recorded, reported or investigated.

There was an absence of effective quality monitoring and auditing.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 relating to care and welfare, safeguarding, respecting and involving people, quality monitoring and supporting staff. You can see what action we told the provider to take at the back of the full version of the report.

3 July 2014

During a routine inspection

This inspection was carried out by an inspector, a specialist in dementia care and an expert by experience. The expert by experience focussed on speaking to people who use the service and some staff members and the specialist in dementia care gave specialist advice to us on the day of the inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and their relatives/friends told us, the records we looked at and what staff we spoke with also told us.

If you would like to see the evidence that supports our summary then please read the full report.

Is the service safe?

York Court is a registered nursing home for older people. There were 59 people living at the home at the time of our visit. We looked at seven care records and these contained a variety of risk assessments which included those in relation to the environment, personal care and fire safety. However, the quality of care records varied and we noted that some information was incorrect.

People were not always treated in a manner that promoted their health and safety. We saw that one person was being moved without the aid of a hoist which presented a health and safety risk to them.

There were arrangements in place to deal with foreseeable emergencies. Staff had received first aid training which was repeated annually. There was a policy in place for dealing with accidents and incidents and a senior staff member was always on call in case of an emergency.

Is the service effective?

Food was not always prepared to meet people's dietary needs. Menus were rotated on a weekly basis and food was prepared onsite, but staff had a limited understanding of people's specific dietary requirements.

Is the service caring?

People were generally happy with the care being provided. Comments included 'The staff are very good. The majority are very kind', 'Carers here are very good, kind and thoughtful' and 'Staff are nice. They help me if I ask them to.'

However, some people told us that they sometimes had to wait for a response when they rang their call bell and some people said that they often had to wait for staff assistance.

There were some activities available for people who used the service. These included board games, garden activities and pampering sessions for example manicures. However, most of the people we spoke with living at York Court and their relatives complained to us about activities provision in the home.

Is the service responsive?

People we spoke with told us staffing levels were low. We observed that there were not enough staff to meet peoples' needs on the day of our inspection.

Is the service well-led?

The service had a registered manager in post. The service did not work well with outside agencies. We spoke with representatives from four organisations. Three out of four people we spoke to expressed concerns about their working relationship with staff at York Court.