We carried out a focused, unannounced inspection of Yatton Hall Care Home on 8 August 2017. Prior to this inspection, we had received concerns from external sources about the health, safety and welfare of some of the people living at the service. The concerns related to some people not receiving their medicines as prescribed and the deployment of staff within the service and the impact this had on the care and support people received. Additional concerns we received related to the identification and reporting of potential safeguarding concerns and moving and handling practice.

We undertook this focused inspection to ensure that people living in the service were safe, and that there were sufficient staffing arrangements in place to make sure people’s care needs were being met. We reviewed the medicines management in the service, and spoke with staff to establish their knowledge in relation to identifying and reporting safeguarding concerns. We looked at the training staff received in relation to moving and handling people and what systems were in place to review falls or incidents. This report only covers our findings in relation to these areas.

When we last inspected Yatton Hall Care Home in November 2016, we found no breaches of the legal requirements and the service was rated ‘Good’ overall. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Yatton Hall Care Home on our website at www.cqc.org

Following this inspection, the current overall rating for the service remains at ‘Good.’

Yatton Hall Care Home is registered to provide accommodation for up to 48 people. At the time of our visit, 38 people were living at the service.

A registered manager was in post at the time of our inspection. 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.

People were not fully protected against the risks associated with medicines. Records had not been accurately maintained by nursing staff. This placed people at risk as staff were unable to confirm if a person had received their prescribed medicine the day prior to our inspection.

We found that some records were not clear when detailing how to meet people’s care needs in relation to reducing their risk of developing a pressure ulcer. This was due to no record detailing the support people received during daytime hours. We found some air mattresses were also incorrectly set. Improvements were required in the risk management of epilepsy management. Improvements were also required when people were identified as losing weight and the recording of all referrals made when nutritional risks were identified.

People at the service were very positive when speaking about their care experiences and the staff that supported them. All said they felt very safe in the service. People told us there were sufficient staff to support them and staff told us there were sufficient staff to meet people’s needs, but expressed frustration at frequent short notice sickness from colleagues.

Staff understood their obligations around safeguarding adults and felt confident matters would be addressed by the service management. Staff were knowledgeable about external agencies they could contact to raise safeguarding concerns with should the need be required. Staff received moving and handling training to ensure safe practice and their competency was assessed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 08 and 09 November 2016 and was unannounced. Yatton Hall provides nursing and personal care and accommodation for up to 59 people. At the time of our inspection there were 40 people using the service of whom 32 required nursing care. Eight people were supported and cared for in the home because of a physical disability and were under the age of 65.

There is a registered manager in post. 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.

There were good arrangements for the administration of "as required" medicines, storage and management of medicines. Action had been taken to ensure one person's health was not at risk because of their inability to swallow medicines safely.

There were varied views from people about the staffing arrangements in the home. Some were satisfied with how staff responded to requests for assistance whilst others thought it could be improved. Comments from people included: "It’s poor trust me” – when referring to staffing levels. Another person commented, "Serious staffing problems here, agency staff are variable with knowing needs” and "They could do with an extra one in the mornings." This was also commented on by staff. However, other people spoke positively about the staffing arrangements. One person told us "I feel safe with staff, they will come when needed” and another said "Staff always seem to be there when we need them."

We observed staff responded in a timely manner however, there were delays on some occasions specifically in the morning with people wanting to get up but having to wait. The registered manager provided their staffing assessment based on people's dependency and the numbers of staff on duty fitted the recommendation from this assessment. In discussion with the registered manager they recognised staffing arrangements would benefit from being looked at.

People told us they felt safe in the home. One person said, "Best bit, in short, is that I’m safe”. Another person said, "I am safe because I can trust the staff they know what they are doing. A relative told us "Girls are amazing, mum has been in the home since May and has found it to be excellent and safe." Staff had a good understanding of their responsibilities in protecting people from abuse. They spoke of reporting any concerns and being confident they would be listened to and action taken to address their concerns.

Improvements had been made in ensuring people's rights were protected especially when consent was required for the use of equipment such as bed rails and sensors which detected people moving in their rooms. There were systems in place to make decisions on behalf of people who lacked mental capacity and ensure they were taken in people's best interests.

People told us they felt staff were competent to provide the care they needed. One person commented, "Staff skills are very good." another said, "Staff all seem well trained." Staff were all very positive about the training provided by the provider.

There were good arrangements to ensure people's nutritional needs were met with liaison with specialists where this was needed to provide advice and guidance about supporting people. However, comments from people reflected differing views about the quality of meals and food. One person said, "Food is patchy here" and another "Food is alright sometimes but it has deteriorated. The quality has dropped overall”. Whilst others told us how they enjoyed the meals: "I always enjoy the food" and "There is always good choice."

Staff were described by people and relatives as caring, friendly and kind. Staff were observed interacting in a warm and caring way with people. There was respect for people's digni

During this inspection we followed up on actions set during our last inspection on 5 November 2012. During our previous inspection we found that the provider was not meeting two of the essential standards. The provider sent us an action plan of how they were going to improve in these areas and we checked that they were meeting these standards.

All the people we spoke with told us they liked the home and were happy with the care and support they received. One person told us “I enjoy living here, this place has given me a new lease of life”.

We saw that the home assessed people's needs and care plans were developed to meet these needs.

During our inspection we observed that call bells were answered quickly and efficiently and people’s needs met appropriately by care staff. Although one person we spoke with was not able to reach their call bell.

People told us they felt safe living at the home and felt confident that staff would take any concerns seriously.

Staff demonstrated to us that they were aware of the providers safeguarding procedures and knew how to respond to allegations of abuse appropriately.

We found that staffing levels were appropriate to the needs of people living at the home.

The provider had systems in place to monitor the quality of the service. Where checks identified shortfalls, these were addressed and action plans put in place to ensure these areas were addressed.

We found inconsistencies around the recording of people's involvement in their care arrangements and a lack of a robust system around making sure people's choices and preferences were respected around getting up. People told us that they were treated with respect and some people told us how they were able to express their views and involvement about how they were to receive the care they needed and agreeing the care they required.

We found care plans reflected the needs of people living in the home and the provider had taken appropriate steps to address risks associated with people's health and welfare needs. We found that care plans did not reflect a person centred approach to the providing of care.

We found that staff had a good understanding of safeguarding vulnerable adults and their responsibilities in relation to reporting any concerns about possible abuse.

We found that the provider had experienced difficulties around maintaining staffing levels but had made efforts to address the shortfall specifically in relation to staff sickness and need for recruitment. However there was not a robust system in place to help make a judgement about the level of staffing required in the home.

We found the provider did not have an effective system to assess and monitor the quality of the service that people receive.

People we spoke with when we visited told us “I like it here. I have lived in other homes but they were not as good as here”, “I am very satisfied with everything” and “we are all treated very well and we can have a say about a lot of things”. We found that people were being offered choices and included in making decisions about their day to day care.

We were told “I am well looked after and the staff could not do more for me”, “I get a bit low at times, and the staff do their best to cheer me up” and “I have lived here a while now and I am quite content. My family say I am in better health now than I have been for years”.

We were able to speak with some visitors who were in the home. They told us “my relative is well looked after”, “we were very worried when they had to come into a home. But the care they receive is excellent. The staff are marvellous” and “couldn’t have chosen better”.

We observed the staff supporting and caring for people. There was a good rapport between the staff and people living in the home and we found that the staff were attentive to people’s individual needs. Staff were kind and friendly in their approach.

We did not ask those people we spoke with during our visit whether they felt that staff were supported to do their jobs, but we did ask them about the staff in general. People told us “the staff are very good and some I consider to be my friends”, “they are all very kind and good at their jobs” and “in general all the staff are pleasant towards me”.

The inspection took place on the 29 and 30 April 2015 and was unannounced.

We inspected Yatton Hall Care Home in July 2014. At that inspection we found the provider to be in breach of regulation 12 infection control and regulation 9 records of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to Regulation 12 (2) (h) safe care and treatment and Regulation 17 (2) (d) good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider wrote to us with an action plan of improvements that would be made. During this inspection we saw improvements identified had been made.

Yatton Hall Care Home is a care home providing accommodation for up to 48 people who require nursing and personal care. During our inspection there were 36 people living at the home. The home is set out over three floors and provides support to older people, younger people with physical disabilities and short stay accommodation.

There was a registered manager 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 in the Health and Social Care Act and associated Regulations about how the service is run.

We found people’s rights were not fully protected as the registered manager had not followed correct procedures where people lacked capacity to make decisions for themselves. Staff did not always seek consent when supporting people. Deprivation of Liberty Safeguards (DoLS) applications were not always made to the local authority where people were subject to continuous supervision and lacked the option to leave the home without staff supervision .

People and their relatives told us they were happy with the care they or their relative received at Yatton Hall Care Home. One person told us “ Staff are good, they know how to look after me well” and another told us “I am cared for by trained staff who know me well”. A relative told us “staff look after (my family member) so well”. People’s needs were set out in individual care plans. Whilst care plans included information relating to people’s needs and the support required, we found they lacked details of preferred choices and routines. A new care planning format was in the process of being introduced. It was anticipated that once completed and fully embedded, the new system would reflect people’s preferences in relation to their support.

People appeared calm and relaxed during our visit; call bells were answered promptly and people were not waiting for long periods for assistance. Staff did not always involve people when supporting them with tasks.

The service had appropriate systems in place to ensure medicines were administered and stored correctly and securely. Systems were in place to protect people from harm and abuse and staff knew how to follow them.

Staff received appropriate training to understand their role and they completed training to ensure the care and support provided to people was safe. New members of staff received an induction which included shadowing experienced staff before working independently. Staff supervision wasn’t always held in line with the frequency identified in the organisation’s policy. There were sufficient numbers of staff available to meet people’s needs.

The registered manager and senior management had systems in place to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.