We inspected York House on 14 February 2017. The visit was unannounced. Our last inspection took place in October 2015 where we identified two breaches of legal requirements in premises and equipment and good governance. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations and a clear time frame in which they would complete this. On this visit we checked and found improvements had been made in all of the required areas.

York House provides support and personal care for up to 23 adults with learning and physical disabilities, including complex needs. There were 18 people living at the home at the time of the inspection. The accommodation is accessible for people with physical disabilities, with private rooms and communal bathrooms, communal lounge and communal dining area. There is a self-contained flat that is available for visiting relatives to use. There is an enclosed, well maintained, and garden.

The service had a registered manager in place. 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 a 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 they felt safe in their home. People were comfortable with staff and there was a positive atmosphere in the service.

There were systems in place to ensure that people received their medication as prescribed.

People were cared for by sufficient staff who knew them and their needs. Recruitment procedures were robust to ensure that staff were suitable and fit to be employed.

Staff were aware of the processes in place to report incidents of abuse; and had been provided with training on how to keep people safe from abuse and harm. Processes were in place to manage identifiable risks and to promote people’s independence.

Staff received an induction and training and were provided with these skills and knowledge in a timely fashion to fulfil their role. Staff were given effective supervision and appraisals.

People were supported to eat and drink well and to maintain a varied balanced diet of their choice. People had access to healthcare facilities and support that met their needs.

People had developed good relationships with the staff team who treated them with kindness and compassion. Systems were in place to ensure that their views were listened to; and their privacy and dignity was upheld and respected.

People's needs had been assessed and care plans outlined their preferences and how they should be supported. Staff showed a good knowledge of these preferences.

People were able to enjoy activities of their choice. Arrangements were in place for people to maintain links with the local community, friends and family. However we did not see evidence of in house activities on the day of inspection. The home previously had an activity coordinator who supported this in the home. We spoke to the registered manager about this and the benefit this would have in the home when recruiting staff in the near future.

The service had quality assurance systems in place which were used to drive continuous improvements.

The service had completed some renovation within the home and improvements were noticeable on the day of inspection. A refurbishment plan was in place to replace the carpets in the home.

This inspection took place on 5 October 2015 and was unannounced. The previous inspection, which had taken place on 8 September 2014, had found the service was in breach of health and social care regulations, in relation to staffing. We had requested an action plan from the provider to outline what action they would take to improve and to meet the regulations. This inspection found that improvements had been made in relation to staffing. However, we found breaches relating to other areas of the regulations; premises and equipment and good governance.

York House provides support and personal care for up to 23 adults with learning and physical disabilities, including complex needs. There were 18 people living at the home at the time of the inspection. The accommodation is accessible for people with physical disabilities, with private rooms and communal bathrooms, communal lounge and communal dining area. There is a self-contained flat that is available for visiting relatives to use. There is an enclosed, well maintained, garden.

The service had a registered manager in place. 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 a 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 they felt safe living at York House. Staff had received appropriate safeguarding training and had a good understanding of safeguarding procedures in order to keep people safe.

We found concerns relating to the health and safety of the home and the environment. This demonstrated a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us they felt confident that staff knew what they were doing and that they were well trained. We saw evidence that staff had undertaken appropriate training.

We were told by people that staff were caring and we observed some caring interactions.

People were able to participate in a range of activities. People’s care plans were personalised, person-centred and they were regularly reviewed.

Some audits had not been regularly completed and, as a result, areas for improvements such as storage of hazardous substances had not been identified. Where risk was identified and recorded as a result of auditing, for example when water temperatures were found to be outside the limits of the safe temperature policy, the registered provider did not introduce measures to reduce or remove the risk. This demonstrated a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the registered manager to be open and transparent.

You can see what action we told the provider to take at the back of the full version of the report.

This visit was carried out by two inspectors. We spoke with the deputy manager, 2 staff and 6 people who used the service.

We asked our 5 questions;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were systems were in place to monitor the service. Auditing tools were completed by the manager at the service and regional managers for the organization.

We found the home to be clean with no offensive odours in communal areas.

We found some issues regarding the number of staff at the service, where staff did not have time to carry out meaningful daytime activities with the people who used the service.

Is the service effective?

People’s care records were assessed with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people’s care records were up to date and contained relevant information.

Is the service caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People’s preferences, interests, aspirations and diverse needs had been recorded in care records.

Is the service responsive?

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges and listening to the radio. We also observed people who used the service sitting in lounges and dining areas with no interaction from staff members for a considerable length of time. People who lived at the home told us they would like more activities to partake in and would like staff to be able to spend more quality time with them.

Is the service well led?

Audits at the home were up to date. There was clear documented evidence of the provider’s management of the service. We saw regular audits were carried out and actions identified were followed up and ‘signed off’ when completed.

Staff told us they were clear about their roles and responsibilities.

We reviewed the care records of two people who used the service. We found people's needs were assessed and care was planned and delivered in line with their individual plan.

We saw the service had its own corporate safeguarding and whistle blowing policies in place and staff had received safeguarding training.

We observed that the home was clean and did not have any unpleasant odours. We saw there were cleaning schedules in place which detailed the standard of cleanliness required and the frequency of cleaning.

We reviewed staff rotas and found there were sufficient staff on duty to respond to people’s needs. People who used the service told us that they liked the staff who worked there and said they felt there were generally sufficient numbers of staff to meet their needs.

We spoke with three people who used the service who told us they were aware of the complaints process and felt complaints were responded to.

People told us they like living at York House. One person said that ‘they use to live at York House previously, but decided to return as the support and care is fantastic’. They went on to say that they ‘are saving up to go to Memphis Tennessee as they like Elvis and want to go to visit Graceland’. People told us the food is great and they help write the menus.

People told us they like living in the home and they like the people caring and supporting them. People said they feel safe and one person said ‘if the have any problems of concerns they see the manager who sorts things out pretty quickly’.

One person told us that they ‘like interviewing people who have applied to work at York House and asking them questions’.

People told us they like the people caring for them. One person using the service said the staff are ‘fantastic’. Another said that ‘sometimes staff can talk over you, but they tell the manager and things are usually sorted out’.

One person tod us the staff are ’fantastic’, others said ‘the staff are great and they don’t know what they would do without them’.

The compliments book records one visiting district nurse as saying how the care plans at York House are ‘refreshing due to them containing holistic sheets for everyone visiting people using the service’. Another says ‘The care plans are very thorough and person centred, they are very useful when completing their own care plans for service users’.

A hospital staff nurse contacting the home and commented on the good quality of the care plans sent with a poorly service user.