We undertook this inspection of North Yorkshire County Council – 5 Whitby Road on 17 November 2016.

Our previous inspection of 5 Whitby Road took place in August 2015, when the service was given an overall rating of requires improvement. There was no registered manager at that time and improvements were required to ensure that systems and processes were operated effectively to assess, monitor and improve the quality of the service and risks to people’s health and wellbeing. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014, Good Governance, and we required that the provider made improvements. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. This said that the required improvements would be completed by April 2016

North Yorkshire County Council – 5 Whitby Road is registered to provide personal care and accommodation for up to 40 people. The home focuses on providing care to older people. At the time of this inspection the home was providing care to 33 older people.

The service had a registered manager, who had registered with us during December 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their relatives told us people were safe at the home. Risks to people living and working at the service had been assessed by the manager since out last inspection, to help keep people safe.

Staff knew what to do if they had concerns about someone’s welfare or suspicions of abuse. Safeguarding alerts had been made appropriately when needed.

There were enough staff on duty to support people safely and the manager had flexibility to change staffing in response to increases in dependency, occupancy or to facilitate outings. The registered provider’s recruitment process reduced the risk of unsuitable staff being employed.

People’s medicines were stored and managed safely. Staff competency checks and medicine audits took place. However, we have recommended that the provider considers making improvements to records relating to ‘as required’ medicines and the administration of creams, taking into account the latest guidance.

Staff received training and support relevant to their roles. This included encouragement to complete formal qualifications and regular supervision and appraisal. People spoke positively about the staff and their approach.

Staff worked within the principles of the Mental Capacity Act 2005. The manager knew how to seek authorisation under the Deprivation of Liberty Safeguards to deprive people of their liberty when needed.

People received a varied choice of meals, snacks and drinks throughout the day. Nutritional needs were screened and people’s weights were monitored. Staff supported people to eat if needed and equipment was provided to help people remain independent.

Staff supported people to access other healthcare professionals to maintain and improve their health. This included the involvement of specialist healthcare professionals when needed.

People and their relatives spoke positively about the care they received. Staff were described as kind and caring. Staff knew people well and chatted to people in a friendly way. There were no restrictions on visiting, other than individual arrangements specifically requested and agreed by a person using the service.

People and their relatives had been involved in reviewing their care needs and care plan. Records included information about people’s wishes and preference and decisions they had made about their care.

A varied programme of group and individual activities took place, including trips outside of the home. These were facilitated by three m

This inspection took place on 6 August 2015 and was unannounced. At out last inspection on 12 February 2014 we found a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) 2010 which related to record keeping. At this inspection we saw that there had been improvements in some records but others were not completed and up to date.

At this inspection we saw that the service had sought the views of people who used the service in order to learn from them and make improvements but had not included relatives or staff in the surveys. Audits had been used to monitor areas of the service and improve some of them but they had not identified where improvements were needed to care plans and risk assessments. While we saw some improvements there was room for further improvement in a number of areas. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and you can see what action we have asked the provider to take at the back of the full version of this report.

North Yorkshire County Council operates 5 Whitby Road which is in the town of Pickering. The service can accommodate up to 40 older people who require assistance with personal care. It is located close to local facilities and transport routes. There is a small car park for visitors to use. On the day we inspected there were 30 people using the service.

The registered manager who previously worked at this service had retired and another manager had been recruited and was in the process of applying for their registration with the commission. 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.

People at this service were not consistently safe because risks to their health and wellbeing had not always been identified and acted upon. We have recommended that the provider look at good practice guidance around risk assessment and management plans.

Staff had been recruited safely with checks being made as to their suitability to work in this setting.

They were trained in subjects which enabled them to provide care for people who used the service and were well supported by managers. Staff had been trained in recognising abuse and knew how to report any incidents.

The equipment and premises were maintained to a safe standard. Equipment was serviced and maintained regularly.

Medicines were managed safely and staff who administered medicines had received appropriate training.

The service was working within the principles of the Mental Capacity Act (MCA) 2005.

People told us that they felt cared for and that their family and friends could visit them whenever they wished. While people felt the manager and staff were approachable and that they could raise issues with them, they were not all aware of the formal complaints procedure available.

People we spoke with told us they were satisfied with how staff assisted them with their medication. One person said “The staff seem very careful when handling medication. They do not rush with anything. I think it is alright. I get it when I am meant too.” Another person said “I do take medication. The staff bring this when I need it.” We visited to check if improvements had been made to this outcome area since our last inspection in October 2013. We found that the medication systems in operation within the home still did not protect people’s health and wellbeing. We have again asked the provider to address the issues we found. We will re-inspect this service to ensure that the necessary improvements have been made.

We looked at staffing levels during the inspection because concerns had been raised with us that staffing levels may have not been suitable to meet people’s needs and that staff may be working excessive hours. We observed that there were enough skilled and experienced staff to meet people's needs. Staff we spoke with told us that people received the care and support they required and were never neglected. Staff said they worked as a team to support people.

The manager monitored the quality of the service provided to people. Medication audits had been improved since our last inspection and were now taking place more regularly. However, this service still remains none compliant with the management of outcome people's medicines.

People had care records and risk assessments in place which detailed the help and support people required. This information helped staff to understand and meet people's needs. During the inspection we saw that people looked well cared for. We received the following comments from people that we spoke with: “They (the staff) look after me very well. The care is quite good, especially when the work is quite intense." And “The staff are very good they know what I need a hand with.”

A person we spoke with said “Staff help me with medicines. They bring the pills round and give you them.” However, we found that the medication systems in operation within the home did not protect people’s health and wellbeing. We have asked the provider to address this.

During the inspection we saw that there were enough skilled and experienced staff to meet people's needs. One person said “The staff do an amazing job. They are on the go all the time.” Another person said “If staff are busy I may have to wait a minute. They can be short staffed due to sickness at times.” We saw that staffing levels were being constantly monitored by the manager.

People told us they were asked about the quality of service they received. General monitoring of all aspects of the service was in place, however, this had not been effective in relation to the medication systems. Records relating to medication need to be improved.

People's rights were respected by the staff. We saw that people made decisions about how they wanted to spend their time. We observed staff treated people with dignity and respect. People we spoke with said “I love it here. I make my own decisions.” Another person said “I can take part in activities if I want.” Residents meetings were held to gain people’s views which were acted upon. We saw that people's rights were being respected.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. We saw people were encouraged to maintain their independence. A person said “The staff look after me well.”

People were being protected from abuse by staff who understood the signs and symptoms of abuse that they must look out for and act upon. A person we spoke with said “I feel safe here.”

People told us they got help from staff in a timely way. We saw there was enough staff on duty on the day of our visit to look after people. Comments we received included “The staff look after me well. They know what they are doing.” And “The staff have the skills to look after me.”

People's views were being sought about the quality of the service provided. There was a complaints system in place. People we spoke with said “If I were not happy with anything I would tell the manager.” We saw that people’s views were being acted upon to make sure that people remained happy with the service they received.

People who use the service told us that they were consulted regularly about what happens in the home. One person told us when the next residents' meeting was and said they looked forward to going. People also told us that all the staff were kind and always treated them with respect and dignity. They said that there was always something to do. People told us they felt safe and would tell someone if they had any complaints or concerns.

People visiting the service told us that the staff were wonderful and always gave people the time they needed and never rushed what they were doing. A GP said that when the doctors are called in the staff are aware of the reason for the call and are knowledgeable about the people they are caring for.

Staff told us that they can access training when they required it and during their annual appraisal they identified training they wanted to do and whenever possible it was organised for them. They said the management team were supportive and always approachable if they needed to discuss anything.