About the service:

Yorklea is a care home for older people and people living with a physical disability. The home provides nursing accommodation and personal care for up to 35 people. There were 28 people living at the home when we completed the inspection.

People’s experience of using this service:

People and their relatives spoke fondly of the staff and the care provided. People said staff were kind and caring and provided them with care and support that showed they were respected and promoted their dignity and privacy.

The home was well supported by community health professionals and they spoke highly of the home and the care provided.

People were supported with their health when their needs changed and referrals to other services were completed promptly.

Risk assessments and care plans were person centred, organised and easy to follow.

There was equipment in use to support pressure care, but this wasn’t being used correctly and staff didn’t have required guidance to follow in care plans. This was addressed following the inspection through training, the care plans were updated to include the required setting of each persons mattress and a daily mattress audit was introduced.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood how to support people who were unable to make decisions for themselves and sought their consent to provide care and support to meet their needs.

Staff received regular training, had breakpoint reviews which included a one to one discussion and reviewed changes in policies.

People had sufficient meal choices and had a positive dining experience. The chef took pride in making well presented, home cooked meals and devised menus based on people’s preferences. There was an effective system in place to meet people’s dietary needs, but documentation required strengthening to ensure an audit trail was maintained when people had specialist dietary requirements.

There was an enthusiastic activities coordinator at the home who completed one to one activities and group-based events based on people’s abilities.

The registered manager sought feedback through regular meetings, surveys and visitors described being able to call in and speak with the registered manager anytime as their door was always open.

There was a range of monitoring systems in place as the registered manager continued to strive for improvement. We found them to be receptive to feedback during the inspection and when issues had been identified, we received an update following the inspection to detail how this had been addressed.

Rating at last inspection:

Good and the last report was published 01 November 2016.

We found the service continued to meet the characteristic of Good in all domains at this inspection.

Why we inspected:

This was a planned inspection based on the previous rating for the home.

Follow up:

We will continue to monitor information and intelligence we receive about the home and re-inspect the home in line with our inspection timescales for Good services. However, if we receive any information of concern, we may inspect sooner.

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

The inspection took place on 9 September 2016 and was unannounced. This meant the provider did not know we were coming. Yorklea nursing home was last inspected in August 2014. The service met all the regulations we inspected against at that time.

Yorklea is a care home with accommodation for up to 35 people who require nursing and personal care, some of who are living with dementia. At the time of our inspection 26 people were living there.

The service had 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.

We found the environment was in need of some refurbishment. The development plan did not specifically target the areas which required immediate remedial work.

We made a recommendation the provider should gain advice and guidance to ensure the premises are fit for purpose.

People and relatives were extremely complimentary about the service and staff. They told us they felt the service was safe and were happy with the care and support they received at Yorklea. One person said, “I am happy here, safe and sound. If you ask them for anything they get it for you.” One relative said, “They really do look after my [relative] well, they are protected.”

Recruitment practices at the service were thorough and safe. When agency staff were used, the service received identification sheets to confirm nurses’ registration and competencies. Staff received regular supervision and appraisals. Staff training was up to date.

We made a recommendation that where health care professionals are registered with a health care regulator they are enabled to provide evidence to the regulator in question demonstrating they continue to meet the professional standards which are a condition of their ability to practice.

We looked at current and recent staffing rotas for the service. People felt staff levels were sufficient to meet their needs. One person told us, “Oh, they often pop in just for a chat, that’s lovely isn’t it.” Relatives told us their family members had the correct level of staff supporting them.

Staff had a clear understanding of safeguarding and whistleblowing and told us they would speak to the manager if they had any concerns. They felt management would listen and act on any concerns they raised. One care worker told us, “You might notice a change in behaviour in someone. If I had any concerns at all I would report to management.”

The registered provider had policies and procedure in place to ensure medicines were managed in a safe way. We found medicine management in the service was safe.

Systems and processes were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. People and relatives told us they knew how to make a complaint. On person told us, “If I had a concern, [manager] would act, they do listen to you.” We found no formal complaints had been made to the service. The registered manager told us, “Relatives tend to call in to speak with me or the nursing staff so concerns can be addressed immediately.”

People’s health needs were regularly monitored and assessed. The service contacted other health care professionals when necessary, such as tissue viability and diabetic nurses. The service was part of a pilot scheme where Yorklea was aligned to one GP practice in the local community. The service also had the support of a care home support team provided by the local authority. The GP carried out weekly visits to the service to review people’s health needs. People also had the choice of remaining with their own GP.

People were given choices appropriate to their needs. We observed that staff knocked on bedroom doors before entering. Staff used people’s preferred names a

When we visited we met most of the people who lived at the home and examined seven care plans. We spoke with two people who were able to communicate their views and with two other people who had visitors who could help us communicate with their relatives. We also made a pre-arranged telephone call to a relative’s visitor. We met with seven staff including the manager, one Advanced Nurse Practitioner, a District Nurse and an Occupational Therapist.

The home catered for people with a range of highly complex nursing needs, which included both challenging and varied social and psychological aspects. The staff worked in teams and during our visit they were observed to be unhurried, respectful and considerate to the people who lived at the home. The visiting professionals we spoke with had no concerns related to the care people received and one who was more familiar with the home rated the manager “very highly”.

The people who lived at the home told us it was “lovely here” and they were “very happy with their choice of home”. Another person thought that although it was a good home they would not like to think they would be “here for life”. The relatives we spoke too considered the staff to be friendly as well as “kind and warm” toward their relatives. Staff told us they “loved the home” and that the manager was “very supportive” and considerate even when they had personal difficulties. We saw that the home operated a detailed quality assurance programme that ensured the service was assessed and monitored appropriately.

People who used the service described the staff were ‘lovely’ and ‘very kind’. They said they were always polite and respectful when providing personal care and they were very happy with the service provided. They had no complaints to make. Their comments included:

“The staff are all lovely”.

“The staff are great, nothing is ever any trouble.”

“The girls are very nice, I have never been treated badly.”

“The girls are great, I’ve got nothing to complaint about.”

“The staff are all very kind, if I use the call bell, I only have to wait a few minutes.”

“The manager is lovely, she’s always around.”

Relatives of the people who used the service said they were very happy with the way their relative was looked after. They described the staff as ‘very good’ and ‘very patient’. Their comments included:

“The staff are great, they look after my relative very well, I think he is very happy here.”

“We are always kept informed about what’s going on. I have no complaints to make at all.”

“The staff are great, my relative is well looked after. The staff always give me ring if there is a problem, we are always kept informed about what’s going on which reassures me.”

“I have never heard my relative speak badly about any of the staff, he is always treated very well.”

We met with six members of staff, the registered manager and the provider. For the purposes of the report, the registered manager is referred to as, manager, and the registered nurses as nurses.

We also met seven visitors to Yorklea Nursing Home and a visiting GP.

When asked, people living in Yorklea Nursing Home said they were able to make their own decisions, one person said: "I like to stay in my room. I enjoy the television, I prefer my own company. I like the staff, both day and night, they are kind and you have no need to worry here."

One person told us: “I would and have recommended it (Yorklea Nursing Home)."

Another person told us: "The staff are kind, genuinely nice people."

When we asked about care and support another person living in the home said: "I'm well looked after.”

One person told us: "I feel safe here, there are good safeguards in place they have a stable staff group with very few new members of staff."

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, one of the managing directors, speaking with Manchester City Council Contracts, Dietician and Tissue Viability Nurse. We also looked at records relating to people's care and the management of the service. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Yorklea provides support for up to 35 people with complex health and personal care needs. The premises are located in a quiet residential area of Chorlton. The building is a large Victorian detached house that has been converted from two semi-detached houses.

Two maintenance personnel are responsible for the day to day maintenance and decoration of the home. They are qualified to carry out fire risk assessments and identify the range of fire protective and preventative measures required.

The premises were clean, tidy and well maintained both inside and outside of the building.

Training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) took place which ensured that people who were not able to make decisions or choices were protected and kept safe. Best interest meetings and any other legal requirements such as applications to DoLS or Court of Protection were completed in conjunction with other health care professionals such as social workers.

We saw people had received an assessment of their care needs and that these had been discussed with the person concerned.

There were a sufficient number of people in the staff team to ensure that people were supported with their care needs.

Is the service effective?

Recruitment and selection procedures were in place to ensure that as far as possible only suitably qualified and experienced people were employed. Induction and training was in place to ensure that that the people who lived at Yorklea had their needs met and were kept safe.

We saw from looking at the care plans that people had received an assessment and that there was a good understanding of the person's needs and the support they required.

The people we spoke with said that they were happy with the care they received. They also spoke well of the staff team and had no complaints.

Is the service caring?

We spoke with four people who used the service and a family member. They told us "I feel that my relative is usually well looked after" and that their relative had told them they were satisfied with the care they received. Another person told us; “I would tell one of the workers if I was not happy with anything”; and another said “I have been in two other care homes and this is the best, neither was as nice as this.”

People's preferences were recorded in the care plan and they were able to express their views and opinions through talking to members of the staff team, taking part in reviews and resident meetings.

Is the service responsive to people's needs?

We saw that people's needs were assessed before they were offered a place at Yorklea Nursing Home.

A Physiotherapist and activities organiser were employed by the organisation. The physiotherapist conducted the moving and handling training for the staff team and also did exercises with the people who lived at home. The activities organiser took people out and organised games, resident meetings and crafts.

We saw that people were referred to other healthcare professionals as and when necessary; these included GP, dietician, tissue viability nurse and podiatrist.

Is the service well led?

Yorklea is one of two homes which are part of the Olea Care Group. A third home is due to open later in September.

Surveys were conducted regularly and replies were analysed in order to improve the service provided.

The manager aimed to have a residents meeting every month where items such as food and menus were discussed.

The organisation had the Investors in People (IIP) Accreditation. IIP assess and accredit organisations on the management and quality of the service they provide to both people who use the service and those who work for the service.

Yorklea had also been awarded The National Gold Standards Framework Centre (GSF) award in End of Life enabling a 'Gold Standard' of care for all people nearing the end of life.