This inspection took place on 2 and 3 August 2018 and was unannounced.

Goole Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Goole Hall accommodates up to 28 older people, including people who are living with dementia. On the day of the inspection there were 19 people living at the home. The premises have three floors and the lift operates between all levels.

We were supported during our inspection by a manager who was registered with the Care Quality Commission (CQC). 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 last inspection in December 2017, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations for Regulation 12: Safe care and treatment, Regulation 17: Good governance and Regulation18: Staffing. We asked the provider to complete an action plan to show what they would do and by when. At this inspection we found the provider had implemented the actions and was no longer in breach of these regulations.

Improvements to the oversight of systems and processes that were in place to monitor, and where appropriate to improve the service were required to ensure they were fit for their purpose and included any actions with appropriate timescales for completion. This included provider review of service checks and audits completed.

Audits and reviews of records associated with people’s care and support were in place but required oversight to ensure they were effective for their purpose because they had failed to ensure information about people’s care and support was always accurate, and up to date in all formats.

Systems and processes were in place to record decisions made under the Mental Capacity Act 2005. However, improvements to checks on records was required to ensure information was always up to date and comprehensively documented.

The provider completed pre-employment checks for staff. However, oversight of audits of staff files failed to ensure staff checks against the Disclosure and Barring Service had always been returned by the provider prior to commencing their duties. These checks were reviewed and actions implemented during our inspection.

People were assessed to ensure they received appropriate support to take their medicines safely as prescribed. Medicines were managed and administered according to national guidelines and best practice by staff who had been assessed as competent in this role.

The provider had implemented actions to ensure the home was free from odours that are offensive or unpleasant. However, the actions implemented had not been reviewed for their effectiveness and at this inspection there was an unpleasant odour in a communal area on both days.

Systems and processes were in place to ensure staff recognised signs of abuse and any concerns were appropriately investigated. Lessons were learnt and actions put in place to reduce the risk of reoccurrence.

The provider continued to utilise a staff dependency tool which helped evaluate people's individual needs against the support they required.

People were supported with their health and wellbeing. Drinks were provided throughout the day and a menu was provided with a choice of food for people. People received additional support from dietary and nutritional specialists where this was required.

People received information in a format they could understand and the provider discussed further planned improvements for implementation in this area. People's personal preferences and wishes were recorded

The inspection took place on the 5 and 18 December 2017 and was unannounced.

Goole Hall is required to have a registered manger. There was a new manager in post who told us they were awaiting further checks before submitting an application for their registration with the CQC. We made checks after the inspection and evidenced the new manager had submitted an application to register with the CQC. 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.

Goole Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Goole Hall accommodates up to 28 older people, including people who are living with dementia. On the day of the inspection there were 18 people living at the home. The premises have three floors and the lift operates between all levels. Most people have single bedrooms and 17 bedrooms have en-suite facilities. There is a communal bathroom on two floors but no shower room.

At our last inspection in November 2016, we found the provider was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Premises and equipment and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 Notifications of other incidents. We asked the provider to complete an action plan to show what they would do and by when. At this inspection we found the provider had implemented the actions and was no longer in breach of the two regulations.

The provider had implemented actions to ensure the home was free from odours that are offensive or unpleasant. However, the actions implemented had not been reviewed for their effectiveness and at this inspection there was an unpleasant odour in the entrance hall on both days.

The provider had failed to implement measures to prevent the spread of infection and possible contamination of people’s clothing. The laundry room was not used solely for the purpose it was intended which along with the design and layout of the room meant it was not clean.

The provider had failed to ensure systems and processes that were in place to manage risks from the environment were effective. Areas of maintenance and checks around the home were not completed following the providers procedure and failed to highlight areas that required attention to keep everybody safe from harm.

People were at risk from not receiving their medicines as prescribed. Systems and processes in place to store, manage and administer people’s medicines did not always follow best practice or manufacturer’s guidance.

Risks associated with peoples care and support was recorded with associated support plans in place. However, these were not always robust or completed for all activities of care and support or for the environment which meant the service provided was not always safe for everybody.

We found people who used the service were not assured a quality service because there was not effective system in place to assess, monitor and improve the quality and safety of the services provided in the carrying out of the regulated activity.

Systems and processes in place to assure the service of a skilled and supported workforce were not checked for their completeness. The provider had failed to follow their procedure to ensure care workers received regular, appropriate supervision and appraisal of their performance in their role. Provision to ensure any induction, training, learning and development needs were identified, planned for and supported were ineffective.

People were protected from avoidable harm and abuse and

This inspection took place on 15 November 2016 and was unannounced. The home was last inspected on 9 November 2015 when we issued requirements in respect of two breaches of regulation. We were concerned about the safety of the stairs down to the basement of the home and also that health and safety audits at the home had not identified these safety issues.

The home is registered to provide accommodation and care for up to 28 older people, including people who are living with dementia. On the day of the inspection there were 22 people living at the home. The home is situated in Old Goole, on the outskirts of the town of Goole, in the East Riding of Yorkshire. The premises have three floors and the lift operates between all levels. The home is located along a drive way from the main road and sits within its own grounds. Most people have single bedrooms and 17 bedrooms have en-suite facilities. There is a communal bathroom on two floors but no shower room.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

The premises were clean but there was an underlying odour in the entrance hall and some communal areas of the home. In addition to this, some carpets needed to be replaced, the lift was very noisy, the gate at the front of the premises was open when we arrived and there were pot holes in the drive. This meant that the premises were not always suitable for the purpose for which they were being used.

This was a breach of Regulation 15 of the Care Quality Commission (Registration) Regulations 2009: Premises and equipment. You can see what action we asked the provider to take at the end of the full version of this report.

People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults and understood their responsibilities in respect of protecting people from the risk of harm. There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, the registered manager had not informed us when DoLS authorisations had been authorised, which is a legal requirement.

This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notifications of other incidents.

Quality audits undertaken by the registered manager and senior managers were designed to identify that systems at the home were protecting people’s safety and well-being. However, we were concerned that health and safety audits had not identified the safety aspects of the main stairs. Although this was rectified following the inspection, this was only as a result of us raising this during the inspection. We have made a recommendation in respect of this shortfall.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs although the deployment of staff needed to be reconsidered over lunchtime. There were recruitment and selection policies in place and these had been followed on most occasions, although not in all. This could have resulted in people who were not considered safe to work with vulnerable people being employed. We have made a recommendation in respect of this shortfall.

Staff told us that they were well supported by the registered manager. They confirmed that they received induction training when they were new in post and told us that they were happy with the training provid

We carried out an unannounced comprehensive inspection of this service on 27 November 2014. In October 2015 we received information of concern and, in addition to this, the local authority shared information with us following a quality monitoring visit they had made to the home. We carried out a focused inspection to look into the concerns we had received. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Goole Hall on our website at www.cqc.org.uk.

This inspection took place on 9 November 2015 and was unannounced.

The service is registered to provide accommodation for a maximum of 28 people, some of whom are living with a dementia type illness. Most people are accommodated in single rooms and some have en-suite facilities. The property is a listed building and is located within its own grounds close to the town of Goole, in the East Riding of Yorkshire.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was not registered with the Care Quality Commission (CQC). 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.

During our inspection we identified two breaches in regulations. This related to the safety of the premises and the lack of quality auditing to ensure the premises were safe for the people who lived there. You can see what action we told the provider to take at the back of the full version of the report.

The reporting of serious incidents in the service was not robust; there had been a delay in the home notifying us of some serious incidents.

An environmental risk assessment had been completed but this did not identify areas of potential risk to people using the service and did not include an assessment of all areas of the home. Risk assessments and documentation in respect of people who lived at the home required updating to show the current needs of people who used the service.

The records we looked at in respect of the risk of malnutrition and tissue viability were seen to be complete and monitoring records in respect of food and fluid intake and positional changes were being completed consistently.

Although accidents had been recorded accurately, there was little evidence of consultation with health care professionals to check that people had not been injured, and the auditing of accident records was behind schedule. We have made a recommendation in the report in respect of this shortfall.

We saw that there were sufficient numbers of staff on duty. However, the manager was regularly required to work as senior care worker or care worker due to staff vacancies and this meant they were not able to manage the home effectively.

Audits of care plans had not been carried out, resulting in information in some care plans not being up to date. This meant that staff did not always have current information about a person to ensure they received optimum care and support.

We found that there were unpleasant odours in some communal areas of the home and that the laundry room required attention to reduce the risk of the spread of infection. We have made a recommendation in the report in respect of this shortfall.

This inspection took place on 27 November 2014 and was unannounced. We previously visited the service in November 2013 and found that the registered provider met the regulations that we assessed.

The service is registered to provide personal care and accommodation for 28 older people, some of whom have a dementia related condition. A day care unit has recently been created on the ground floor; this is used by people who live at the home as well as people who visit for the day. The home is on the outskirts of Goole, in the East Riding of Yorkshire and is located within its own grounds.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 29 January 2014. 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 told us that they felt safe living at the home. Staff had completed training on safeguarding adults from abuse and were able to describe to us the action they would take if they had concerns about someone’s safety. They said that they were confident all staff would recognise and report any incidents or allegations of abuse.

Staff told us that they were happy with the training provided for them and the training records evidenced that staff took part in a variety of training that would equip them to carry out their roles effectively. People who used the service, relatives and health care professionals told us that staff were effective and skilled.

The registered manager was aware of guidance in respect of providing a dementia friendly environment and progress had been made towards achieving this. Staff had undertaken training on dementia awareness and the Mental Capacity Act 2005 (MCA). This helped them to understand the care needs of people with a dementia related condition.

Staff had been recruited following the home’s policies and procedures to ensure that only people considered suitable to work with vulnerable people had been employed. We saw that there were sufficient numbers of staff on duty to meet the needs of people who lived at the home.

People’s nutritional needs had been assessed and people told us that they were satisfied with the meals provided by the home. We found that medicines were safely managed.

We observed good interactions between people who lived at the home and staff on the day of the inspection. People told us that staff were caring and this was supported by the relatives we spoke with.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided.

People who lived at the home, relatives and staff told us that the home was well managed. A senior member of staff had been promoted to the position of deputy manager and this meant that there was a manager on duty when the registered manager was not at the home.

At the last inspection of this service we were concerned that people's nutritional needs may not have been met, that care plans did not include information about a person's life history and that some quality audits had not been taking place.

At this inspection we spoke with the regional manager, the senior care worker on duty and the cook. We also chatted with people who lived at the home but did not ask them specific questions to help us make a judgement about compliance. We found that the home was now compliant with these outcomes.

We found that care records included care needs assessments and individualised care plans, and that they included information about a person's life history. Care plans had been reviewed regularly to ensure they were up to date. They included thorough information about a person's dietary needs. Discussion with staff and observation on the day of the inspection evidenced that these needs were being met.

Staff had monitored the quality of the service provided and people had been given the opportunity to express their views about the care they received. Audits had been carried out by staff to evidence that the systems in place at the home had been followed consistently. This helped to ensure that people received safe and good quality care.

At the previous inspection on 17 and 18 July 2013 we had found the home to be non-compliant in outcome 8: Cleanliness and infection control and outcome 9: Management of medicines. We had asked the provider to take action and they had produced a satisfactory improvement plan. At the inspection on 25 September 2013 we found that improvements had been made and that the home were now compliant with these regulations.

We spoke with the manager and staff as part of the inspection. We chatted to people who lived at the home but did not ask them specific questions about these outcome areas.

We found that policies and procedures on the control of infection had been updated and there were audits in place to monitor that staff were following them. Some action had been taken to eradicate unpleasant odours; the lounge chairs and some bedding had been replaced and a regime had been introduced for cleaning curtains. Staff had undertaken or were due to undertake training on the control of infection.

The management of medicines had also improved. A new pharmacy supplier had been sourced and systems had been introduced by the home to record the use of medication prescribed as 'as and when required' (PRN) and boxed medication. We found that medication administration records were being completed correctly, including those for anticoagulation medication. Regular audits had been carried out to monitor that staff were following the policies and systems that had been introduced.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. The food offered to people was well cooked and offered them a choice of meals and staff had time to sit and talk to people throughout the day.

People we spoke with said they like living in the home and that their care and support was very good. One person told us, “Staff are friendly and give us the support and help we need” and another said “There is a lovely atmosphere in the home, very friendly and welcoming.”

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity.

We found that the service was clean, tidy and there were no malodours in the building. However, we had a few minor concerns about infection control practices which we have addressed in our report.

We found that appropriate arrangements were not in place in relation to recording, handling and safely administering medicines to people who used the service.

We raised a number of minor concerns about the environment with the manager. We found there were areas of health and safety that could be improved.

Staff were suitably trained and supported to ensure they could offer the appropriate care to people. People told us they saw the manager most days to talk to and they were confident of using the complaints system if they needed to.

People we spoke with were complimentary about the care they received at the home. People told us there were many activities available and the staff ensured that if people wished to be involved, they could be. People told us their rooms were kept clean, their privacy respected and the food was good with plenty of variety.

Our inspection visit of 17 and 18 July 2013 was a follow up visit to check that action had been taken to secure improvements following earlier visits where essential standards had not been met in three outcome areas. This visit was incorporated into our annual scheduled inspection.

People who used the service told us they were asked for their consent before staff provided any personal care. One person told us “What I like about it is they are always saying ‘are you sure you are alright?’”

Although the majority of people told us they were satisfied with their care we found that people had not been supported to meet their assessed dietary requirements appropriately.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We found this had led to arrangements to loan medicines between service users where one person had run out of their anticoagulant medication.

We found improvements were required to ensure that cleanliness and infection control was maintained at the service.

The provider had made improvements regarding the safety and suitability of the premises since our last visit; though continuing maintenance was required due to the age and nature of the building to ensure on-going compliance. Records were not always available at the service to evidence where maintenance had been completed. The provider forwarded this information to us following our visit.

The provider had systems in place to ensure staff who worked at the service were recruited and pre-employment checks were completed to ensure the safety of people who used the service.

We found that although the provider had quality assurance systems in place they did not always implement action plans to secure identified improvements.