We conducted this inspection because we had received concerns from relatives of people who used the service. These concerns were focused on the care and welfare of people, management of medicines and the management of the service. On the day of our visit 57 people were using the service. They were supported by two nurses and twelve care workers. We spoke with 10 people who used the service and three people's relatives. We also spoke with five care workers, two nurses, the registered manager and regional manager. Three inspectors carried out this inspection.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Our inspection findings have been shared with the local safeguarding authority and a safeguarding strategy has been implemented for the home. The local authority have stopped placing people at Yarnton due to these concerns. In addition, we asked the management team at the home to make safeguarding alerts to the local authority about four people. We did this to ensure that action would be taken to make these people safe.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
The service was not safe. People were not protected from the risk of pressure damage or from risks associated with moving and handling. Care staff did not follow the plans that were intended to meet people's care needs. Care staff did not always have knowledge of people's health and wellbeing, or the risks to their health and welfare.
Systems were not in place to ensure people's medicines were administered safely or recorded appropriately. The service maintained records of the stock of people's prescribed medicines but these were not always accurate.
Instructions around authorisations to restrict people's liberty were not followed. Clear instructions were not followed by care staff to protect one person from harm.
Is the service effective?
The service was not effective. People's care plans did not always contain up to date and accurate guidance for care workers on how to meet people's needs. This meant that people could be at risk of inappropriate care or treatment.
People did not always receive the support they needed to meet their nutritional needs and did not have access to appropriate choice over their diet. Staff did not always respect people's choices and did not respond to people's requests for certain foods and drinks.
Is the service caring?
The service was not always caring. People were not always treated with kindness and respect. While some care staff treated people kindly, other care staff did not engage with people or assist them when they required support.
People could not always be sure that their dignity and privacy would be respected. We observed one person being supported with their personal care. Care workers did not close their door to ensure their privacy was maintained.
Is the service responsive?
The service was not always responsive. Care staff did not always respond to people's needs. People who were experiencing pain could not always be sure that staff would respond to this by taking appropriate action.
The welfare of people with dementia was not always maintained. People spent long periods of the day without engagement from care staff. Care staff were focused on tasks such as updating people's daily notes in care plans and undertaking laundry tasks.
People and their relatives did not always feel their concerns were acted upon. People's complaints were not always concluded and concerns raised at meetings were not always acted upon.
Is the service well-led?
The service was not well-led. Although the provider had engaged a consultancy firm to help identify why so many concerns had been raised, sufficient action had not been taken to ensure people's safety. Audits conducted by the manager identified concerns, but did not seek to address these concerns. We saw a range of audits which were implemented but did not lead to improvements within the service.
The manager did not look at accidents and incidents to identify trends in the service. There wasn't a system in place to identify concerns and use this information to help improve the service.
Risks to people and their health and welfare had not been identified through the risk and quality monitoring systems.