We carried out an unannounced focused inspection of this service on 18 March 2016 following concerns that the service was not sustaining it’s ‘Good’ rating which it achieved in March 2015. We found breaches of legal requirements in relation to Regulations 9, 15 and 17. The provider submitted an action plan stating that these breaches would be addressed by December 2016.

At a comprehensive inspection on 23 May, 24 May and 01 June 2017, we found continued breaches of Regulation 9 and 17 and further breaches of 12, 14 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service was rated ‘Inadequate’ and placed into special measures. As a result of our concerns the Care Quality Commission met with the provider who voluntarily agreed to restrict admissions to the service and we were sent regular improvement plans.

We undertook this comprehensive inspection on 22 May, 01 June and 16 June 2018 to check that the registered provider had made the required improvements and to confirm they now met legal requirements.

You can read the report from our last inspections by selecting the ‘all reports’ link for York House and Aldersmore on our website at www.cqc.org.uk

York House and Aldersmore is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 18 people who have a learning disability or autistic spectrum disorder and may also have mental health needs or a physical disability.

York House and Aldersmore is situated in a quiet residential area in Holland-on-Sea and close to the seafront and amenities. The premises is on two floors with each person having their own individual bedroom and communal areas are available within the service. At the time of our inspection, eight people were using the service.

There was no registered manager in post. A new manager who had been previously registered at the service recommenced in post on 18 April 2018.

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.

Improvements were still needed to ensure that all risks to people’s safety and welfare were identified and acted on, specifically in relation to one person choking. Equipment used to support people with their mobility had not been checked and was unfit to be used.

The cleanliness of the service had improved but further improvements were required, for example ensuring taps were free from lime scale and shower drains were free from grime and debris. Improvements were also required regarding food hygiene practices.

Staffing levels had recently been reviewed at the service and were adequate to ensure that people’s needs were met, and they received a good quality of care.

Improvements were required to ensure that care plans contained accurate information and provided guidance on how to meet people’s needs.

People had some opportunities to be involved in the running of their home to maintain their daily living skills. We have made a recommendation that the service continues to further develop the opportunities for people to be involved in daily living activities within the service to promote their independence and well-being.

Staff had received training to ensure that they had the necessary skills and knowledge to carry out their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The requirements of the Mental Capacity Act (MCA) were understood and in place.

Staff were kind and caring and had d

The inspection took place over three days: 23 May 2017 and 1 June 2017, which was unannounced, and 24 May 2017, which was announced.

York House and Aldersmore provide personal care and support for up to 18 people who have a learning disability or autistic spectrum disorder. People who use the service may also be living with mental health needs, a physical disability or dementia. At the time of our inspection there were 16 people living in the service.

In March 2015 we found the service to be good in all key areas and rated the service as Good overall. However we recieved information from local authority safeguarding and quality monitoring teams about the management and care practices which identified the quality of the service had deteriorated. Therefore we carried out an unannounced focused on the 18 March 2016 and looked at two key areas: Safe and Well-Led. We rated Safe as Requires Improvement and Well-led as Inadequate. Multiple breaches of legal requirements were found. These related to the safety and cleanliness of the environment, care being provided in a routine and regimented manner, and governance. You can read the report from our focused inspection on 18 March 2016 by selecting the 'all reports' link for ‘York House and Aldersmore' on our website at www.cqc.org.uk

Following that inspection the provider sent us an action plan to tell us what improvements they were going to make, and stated the work would be completed by December 2016. During this inspection we found some improvements had been made. However, the oversight of management was still failing to effectively identify, manage and embed systems to ensure the quality and safety of the service. This resulted in new and ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These breaches were in relation to staffing, safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.

There was no registered manager in post as the previous registered manager had left the service in February 2017. Action was being taken by the provider to recruit to this position. 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 the time of the inspection, a registered manager from one of the provider’s other services was on site, providing management support.

In February and March 2017 we became aware through information we received from multiple sources of concerns relating to the culture and leadership of the service. This included that the improvements referred to in the provider’s action plan had either not been embedded fully or where deteriorating further. This inspection confirmed that the service quality had deteriorated and that the provider had failed to take effective action to intervene or prevent its occurrence.

The systems in place to reduce risks associated with people’s care and support were not always in place, effective or fully explored. This included risks associated with fire safety, physical and mental health needs, environment, mobility, nutrition and support from effects of anxiety and stress were not always being identified or effectively managed. Staff were not being given enough guidance, information and training to proactively identify and take action to minimise any potential risks. Care records provided insufficient guidance for staff in providing safe care and in supporting people’s wellbeing.

Whilst some action had been taken to improve the environment and cleanliness, this was not applied to the whole service which meant improvements were not always sustained and other risk areas had not been proactively identi

The inspection took place on 18 March and was unannounced.

York House and Aldersmore is a care service for up to 18 people who have a learning disability or autistic spectrum disorder. People who use the service may also be living with mental health needs, a physical disability or dementia. On the day of our inspection there were a total of 17 people at the service, including one person who was staying for a period of respite care and one person who was accessing day services.

A registered manager was 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection of the service took place on 6 March 2015 and the service was found to be good in all key areas. However since the previous inspection we had received information of concern from the local authority safeguarding team. Further information was received raising concerns about care practices by the local authority quality monitoring team.

There had been a number of changes at the service since the last inspection. The provider had carried out extensive improvements to the environment including building an extension and completing extensive refurbishment of communal lounges and dining areas. We found that, although improvements had been made as a result of the refurbishment, older areas of the premises had deteriorated. This applied in particular but not exclusively to bathrooms, toilets and ensuite facilities where the standard of cleaning and maintenance was not carried out in line with current legislation and guidance.

Staff and the management team did not deliver individualised and person centred care. This was evidenced by care delivery that relied on routines and was task orientated.

We found that systems in place to monitor the quality of the service were insufficiently robust to identify risks to people from areas where the environment was poorly maintained.

The service had breached regulation 9 of the HSCA 2008 (Regulated Activities) Regulations 2014 relating to person centred care, regulation 15(1)(a)(e)(2) relating to premises and equipment and regulation 17(2)(b) relating to good governance.

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

The inspection took place on 6 March 2015 and 11 March 2015 and was unannounced.

York House and Aldersmore is a care service for up to 18 people who have a learning disability or autistic spectrum disorder. People who use the service may also be living with mental health needs, a physical disability or dementia. At the time of our inspection there were 14 people who lived at the service and two people who received short term respite care.

A registered manager was 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 2008 and associated Regulations about how the service is run.

People were safe because staff understood their roles and responsibilities in managing risk and identifying abuse. People’s care needs were identified and they received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in ways they needed and preferred.

People’s health needs were managed by staff with input from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs.

People were treated with kindness and respect by staff who knew them well. When people were unable to make their views known verbally, staff understood their individual ways of communicating what they needed or how they felt.

People were encouraged to take part in interests and hobbies that they enjoyed. They were supported to keep in contact with family and develop new friendships so that they could enjoy social activities outside the service.

There was an open culture and the management team demonstrated good leadership skills. Staff were enthusiastic about their roles and they were able to express their views.

The management team had systems in place to check and audit the quality of the service. The views of people and their relatives were sought and feedback was used to make improvements and develop the service.