Yarborough House Care Home is a residential care home for 25 older people, some of whom may be living with dementia. It is situated on a main road and close to community facilities and bus routes. Accommodation is provided over two floors, the first floor being accessible via stairs or a passenger lift. At the time of our inspection visit there were 16 people using the service.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People gave us positive feedback about the management team. There were a range of audit systems in place to monitor the quality of the service. We found some shortfalls in the re-decoration and renewal programmes, which were addressed following the inspection.

People who used the service were supported by caring staff. People were treated with dignity and respect by staff who knew their needs and understood their preferences. Staff showed a genuine interest and affection for the people they cared for.

We observed a positive and inclusive atmosphere within the home with people and staff getting on well. People's views were sought during care reviews, resident meetings and surveys. The provider had systems in place to respond to complaints about the service.

People were involved in planning their care and support. Care plans contained person-centred information about people’s needs and guidance for staff on how best to support them. Staff explored people’s wishes about how they wanted to be cared for at the end of their life.

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.

People were provided with the opportunity to participate in meaningful activities which interested them and were encouraged to maintain links with the local community.

People told us they felt safe. There was sufficient staff deployed to ensure safe care and treatment.

Systems in place minimised the risk of harm to people. These included effective risk assessment of people’s needs, safeguarding matters, management of medicines, safe recruitment and effective management of accidents and incidents. The provider ensured safety checks and servicing of equipment was completed regularly.

Staff received regular training; supervisions, observations and appraisals were used to monitor their performance and support their continued professional development. There were staff meetings which enabled them to receive information and express their views. Staff told us they felt supported by management.

The registered manager was very experienced and had managed this service for many years. People and relatives spoke positively about the service and said it provided good quality care in a personalised and friendly way.

Further information is in the detailed findings below

We undertook this unannounced inspection over one day, on the 29 September 2015. The service was last inspected on 08 July 2013 and 25 September 2013, the latter being a follow up inspection from the July 2013 inspection, when a compliance action was made concerning the management of medicines and improvements were found to have been appropriately made.

Yarborough House is registered to provide personal care and support for up to 25 people older people, some of whom may be living with dementia. It is situated on a main road and close to community facilities and bus routes. The service has two floors, the first floor being accessible via a passenger lift. At the time of our inspection visit there were 23 people using the service.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Whilst people’s human rights were protected by staff who had received training in the Mental Capacity Act 2005 [MCA] capacity assessments and best interests decisions had not always been fully completed for people unable to make informed decisions about aspects of the service provided. People were supported by staff to access their GP and district nursing service when required. People who used the service were given a variety of wholesome meals and could have alternative choices about these if they wished. People’s weight and nutritional intake was monitored with the involvement of health care professionals when needed. Staff received regular professional supervision and were supported to gain further qualifications to help them develop their careers.

Staff understood their responsibility to keep people who used the service safe from harm and knew how to recognise and report potential abuse. Staff were recruited safely and were provided in enough numbers to meet people’s needs. People’s medicines were handled and administered safely by staff who had received training in this aspect of practice.

People were cared for by staff who were compassionate and caring and who understood their needs and respected their wishes for privacy and dignity. People and others with an interest in their welfare were involved in decisions about their support which was regularly reviewed. A range of opportunities were provided for people to participate and engage in meaningful social activities

A complaints policy and procedure was in place to ensure the concerns of people who used the service could be addressed. People and others with an interest in their wellbeing were consulted about the running of the service and their opinions were sought on regular basis. The registered manager undertook a range of audits to ensure people lived in a service that was safe and well-run and met their needs.

Our inspection of 25 September 2013 evidenced that the home had made appropriate changes to ensure the risks associated with medication were managed effectively.

The registered manager told us, “We changed our supplying pharmacy not long ago so asked them to come and audit us, a couple of minor changes were recommended.” We saw that the one concern highlighted by the pharmacy had been implemented.

We spoke to a person who used the service and were told, “I really like it here, there is lots to do and I get well looked after.” A second person said, “Oh I am very happy here” and then commented, “This is my home.” A relative told us, “It’s a very friendly place all the staff are very caring.”

The chef explained, “I get all the information about people provided but you build up knowledge over time, people’s likes and dislikes, portion sizes that sort of thing, we have a couple of people who are diabetic but its tablet controlled so they can still eat certain desserts” and went on to say, “We have a picture book to show people what options they have.”

Fridge and room temperatures were recorded on a daily basis to ensure that medicines were stored as directed by the manufacturer. However there was no guidance for staff in relation to maximum and minimum temperature ranges.

A staff member told us, “The staff meetings are good, we can all talk about any issues or changes and share how we support people if there are any changes.”

We saw evidence that personal and sensitive information was retained for the appropriate period of time. The home had specific arrangements to ensure specific information was securely destroyed.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an expert by experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

During lunch we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People spoken with told us that staff respected their privacy and dignity and enabled them to make choices about aspects of their lives. One person told us that some younger staff could be bossy – the manager was to address this. Comments included, “The staff are very friendly and helpful. Nothing is too much trouble”, “It’s a home from home” and “I am able to have my own space when I need it.” A relative said, “My mother is provided with the same care as I would provide them with at home.”

One person spoken with told us meals were served in the dining room but they could have meals in their bedroom if they chose to eat it there. They also stated that biscuits and fruit were always available. People told us they enjoyed their meals and said they were cooked and presented well.

People told us they could bring up concerns with the manager. They also said that all concerns were taken seriously and addressed immediately.

People spoken with were complimentary about the staff. They told us they were attentive and able to deal with most situations. They confirmed that staff responded very quickly to call bells. Staff were observed speaking to people in a courteous way and having a caring attitude. Comments included, “They take care of all of our worries”, “Brilliant care - I have everything I need” and “The staff always have time for us.”

Some people were unsure if they had seen their care plan and signed it and others told us they had not seen it. We did find that some people or their relatives had signed a record that summarised their needs.