The inspection took place on 25 and 26 April 2018 and was unannounced.

York house 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. York House accommodates up to 16 people who need care due to old age, dementia, physical disabilities or sensory impairment in one adapted building. There were 14 people living at the home on the day we visited.

The provider also provides a domiciliary care agency which it promotes under the name LJ Home Care. It provides personal care to people living in their own houses and flats in the community. It provides a service to people who need care due to old age, dementia, physical disabilities or sensory impairment. Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were 17 people using the homecare service on the day we visited.

There was a registered manager for 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.’

At the last inspection the service was rated as requires improvement at this inspection we saw that the provider has made improvements and the service was now rated as good.

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.

Checks were completed before staff started to work at the service to ensure they were safe to work with vulnerable people. There were enough staff to meet people’s needs and people who received care in their own homes were provided with a consistent group of staff who knew their needs to support them. Staff received training and support which supported them to provide safe effective care. There were good relationships between staff and other healthcare professionals and we received positive feedback about the care from healthcare professionals.

Risks to people were identified and care was planned to keep people safe while receiving care or in an emergency. Medicines were safely managed and available to people when needed. Infection control processes kept people safe from the risk of infection. However, we recommend that the provider follow the national guidelines on the use of different coloured cleaning cloths in each area.

People were offered a choice of food and staff monitored people to ensure they could eat safely and had enough to maintain a healthy weight. People told us that the staff were excellent. They told us that they were kind, caring and put the needs of the people at the centre of everything they did. People had been involved in developing their own care plans and we saw that care plans contained the information needed to provide safe care tailored to people’s individual needs. People and their relatives received compassionate care at the end of their lives which ensured they were comfortable and had people around them.

The registered manager was open and inclusive and people, relatives and staff felt comfortable raising issues with them. Audits monitored the quality of care provided and external expert audits were also used to drive improvements. If any issues were identified action was taken quickly to resolve the concern.

The inspection took place on 20, 21 and 22 July 2016 and was unannounced.

York House is situated in the village of Billinghay in Lincolnshire. It is registered to provide accommodation and personal care for 16 people who need care due to old age, dementia, physical disabilities or sensory impairment. There were 16 people living at the home when we inspected. The home is also registered to provide personal care to people in their own home. It does this under the name LJ Homecare. There were 25 people using the domiciliary care service when we inspected.

There was a registered manager for 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. The registered manager ran the care home and there were two managers who ran the domiciliary care service with regular oversight from the registered manager.

Care plans for both the care home and the domiciliary care service had not identified all the risks to people while receiving care. However, where risks had been identified care had been planned to keep people safe. In addition, the registered manager and the domiciliary care managers reviewed accidents and incidents and where necessary made changes to people’s care to reduce the risk of further accidents in the future. People’s support needs relating to their medicines were clearly recorded. However, there was a lack of recording around topical medicines such as creams. People’s dietary needs were identified and recorded in their care plans. People were supported to make choices about their meals and to maintain a healthy weight.

People were involved with planning their care and were able to make decisions about the way their care was tailored to meet their individual needs. This level of detail was reflected in the care plans. There were systems in place to ensure any information about people’s changing needs were made available to care workers.

There were some activities for people living at the care home to engage with and people were supported to access the local community. In addition, the provider had developed links with community groups so that they could visit the home. However, people felt that more activities would enhance their experience of living at the home.

There were systems in place to ensure that there were enough care workers available to meet the needs of people who lived at the care home and people who received care in their own homes. However, at busy times in the care home communal areas were not fully monitored. The domiciliary care service had systems in place to ensure care workers were available to provide care to people at the correct times. However, staff application forms for the domiciliary care service did not contain enough information for the domiciliary care managers to assess if people had appropriate skills and experience.

Care workers were kind and caring and had good relationships with people. In addition, care workers were supported to get to know people’s needs, abilities and communication skills and so could identify when people deteriorated or were unwell. Staff working for the provider were supported with appropriate training and supervision. Care workers had received training in the Mental Capacity Act and supported people to make decisions about the care they received. Where people were unable to consent to living at the home and were under constant supervision appropriate Deprivation of Liberty Safeguard applications had been submitted.

People had received information on how to complain from the provider and people told us they knew how to make a complaint. However, no recent complaints had been received. People living at the home and care workers told us the registered manager was a

Prior to our inspection we reviewed all the information we had received from the provider about the home.

As part of our inspection visit we spoke with three people who lived at the home and a community nurse who visited the home. We also spoke with the manager and four staff members.

People told us they felt safe and staff were caring and responsive to their changing needs. One person said, “I moved here a few weeks ago and I have to say it is great. Staff met me at the door when I arrived and the welcome has continued.” Another person commented, “The staff are friendly, I feel safe here and comfortable in my room. The place is homely.”

Staff told us they received the training, supervision and leadership they needed from senior staff and the manager to enable them to meet people’s needs effectively.

We found the service was well led and the home owners and manager monitored the quality of the service provided.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. The care plans we reviewed showed people’s individual health care needs were addressed.

We noted people’s care plans contained a ‘consent to care’ form which provided people with a description of their rights as well as a promise from the provider they would be treated with respect, dignity and compassion.

We looked at the menus and saw they offered a wide range of hot and cold meals. We asked people what they thought about the food. One person said, “The food is really good, it’s always good.”

We asked people about cleanliness in the home. We were told they had no concerns about the overall standard of cleanliness in the home. One person commented, “The cleanliness is excellent, it always is.”

The people we spoke with said they found the home comfortable and that it met their needs. One person said, “This has a real homely feel to it, we’re surrounded by things we like and I think it’s kept well.”

We observed staff provided support and engaged with people who lived at the home positively. People appeared relaxed and comfortable in the presence of their support staff. In discussion, it was evident staff understood the needs of people they supported.

One person we spoke with told us “It’s lovely here. Couldn’t be better.” This person also said they were very warm and comfortable. A relative we spoke with told us “I can’t fault it. The care is brilliant and the staff really know my relative.” This person had been visiting the home regularly for more than three years and told us that they had never had any reason to be concerned about anything or make a complaint.