Archived: York Lodge Residential Home

York Lodge residential home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. York Lodge accommodates up to 22 people in one adapted building. At the time of the inspection there were 13 people using the service. Of the 13 people, 11 people were using the service on a short term basis as part of the discharge to assess process. This process supports people being discharged from hospital for further assessment about their care needs.

In early 2020 we were informed by the provider that they intended to close the home. Some people living at the home subsequently moved out. Due to the coronavirus pandemic the home remained open to support people being discharged from hospital. The provider has given assurances that there are no plans for the home to close.

People’s experience of using this service and what we found

We found that there were breaches of the regulation.

The home required further modernisation to create a dementia friendly environment for people using the service. The service had not been adapted, in line with best practice guidance, to support people with dementia. Since the inspection the provider has given assurances that they are committed to improving the environment of the home and work has commenced in this area.

Risk assessments were in place to reduce risk to people using the service.

Not all staff had a criminal record check in place before commencing work at the service. This meant the risk to people using the service had not been effectively mitigated.

The registered manager completed weekly audits of the home. The audits did not identify all required updates to the home or ways to create a more dementia friendly environment for people.

Where areas of improvement within the home were identified, the provider had not always acted in a timely manner to drive improvement. Since the inspection the provider has given assurances that they are committed to driving improvement at the home.

We observed kind and respectful exchanges between staff and people using the service.

Staffing levels were good. Staff felt that they had enough time to support people in a person-centred way.

Medicines were administered safely. Improvements had been made to support people with ‘as required’ medication.

The registered manager and wider management team were approachable. People told us that they felt able to raise any concerns.

People were asked for their consent prior to receiving care interventions. People and their relatives were involved in decision making and risk assessments. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff worked well with partner agencies to support people being discharged from hospital for further assessment.

We have recommended the provider pays due regard to national best practice to make reasonable adjustments to support people who used the service to find their way easily and independently around the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 May 2019) and there were four breaches of regulation.

Following the last inspection we took enforcement action including issuing a warning notice relating to the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. Since this inspection we have met with the registered provider and registered manager to seek assurances regarding improvements.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for York Lodge Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a continuing breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

Following the inspection we met with the provider to discuss the improvements required at the service. We will work alongside the provider and local authority to monitor progress. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

At this inspection we found evidence the service did not meet the characteristics of Good in all areas. We have made two recommendations to the service about creating a more dementia-friendly environment and person-centred care. More information is in the full report.

The registered manager had completed audits on the service to help ensure quality of service. However, these did not identify concerns we found during our inspection such as poor record keeping and fire safety concerns.

People’s rights had not always been considered in line with the Mental Capacity Act 2005 and documented to show they had been consulted on all aspects of their care. Fire safety arrangements at the home potentially compromised some people’s safety, dignity and privacy. We have asked the provider to address these concerns with some urgency.

One person’s care plan was not always followed; risks were not consistently monitored to ensure they were kept safe and appropriate action taken in a responsive way.

In the main, medicine administration was managed safely. The recording of thickeners needed to be more consistent and some people’s protocols for ‘as required’ medicines were being updated.

There was sufficient and adequately trained staff to support people safely. Recruitment processes were very robust. This helped to ensure staff were appropriate to work with vulnerable people. The provider had suitable systems in place to protect people from abuse.

Staff had adequate professional support to enable them to support people safely and effectively.

People were supported in a friendly and respectful way. People, relatives and staff got on well and staff were aware of people’s personalities and behaviours. People told us staff supported them in a patient and unhurried manner. People and relatives said that staff were caring.

People knew how to make a complaint. There was an effective complaints process in place. Complaints were thoroughly investigated, and action taken to address the complaint raised.

Care at the end of people’s lives had been considered and recorded in their care plans.

People and relatives told us they were very happy with the care provided. They commented positively about the registered manager, owner and staff

Rating at last inspection:

At the last inspection the service was rated Requires Improvement. The report was published in December 2017.

Why we inspected:

This inspection was planned based on the previous rating. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well Led to at least good. We found the provider had not made sufficient improvements in these areas and we found a further two breaches of the regulation relating to the need for consent and dignity and respect.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

York Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection, 21 people were residing at York Lodge, some of whom were living with dementia. The service also provided day care to for up to ten people on weekdays, during the inspection six people were receiving day care service.

At the time of the inspection the service did not have a registered manager, but there was manager in post who had started the process of registering with the Commission. 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.

During this inspection we checked if the required improvements had been made. We found a number of improvements had been made, however we identified a continued breach in respect of the safety of the home and new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the provider failing to provide information requested by the Care Quality Commission and a breach of the CQC registration regulations for failing to submit Deprivation of Liberty Safeguards (DoLS) statutory notifications.

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

During our inspection the provider made us aware the fire service had visited the home and found shortfalls in relation to fire safety at the premises. The fire service identified the cellar of the home was a potential fire risk due to the inappropriate storage of combustible items. These shortfalls were previously unknown to the current manager or provider. The provider was proactive at following the advice set by the fire service and immediately removed items from the cellar, added an additional night worker to assist in the event of an emergency and implemented 30 minute safety checks of the building. The provider also told us that they had suspended any new admissions to the home until the fire service is satisfied with the safety of the home.

During this inspection, we found other issues affecting the safety of the environment. The provider did not have a risk assessment in relation to legionella. The provider confirmed they had completed routine sampling of the water systems and were awaiting these results, but this information could not be located at the time of our inspection. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease that can be dangerous, particularly to more vulnerable people such as older adults.

During the inspection we identified areas within the home that required remedial works. Two walls had holes in that required plastering and painting. We found one radiator cover had started to come away, which exposed a small area of the radiator. A room within the home stored a bed pan machine; this room required a lockable door to minimise the risk of people who may be confused incorrectly using the machine. These areas were discussed with the provider who was eager to make the necessary improvements to ensure the safety of the home was not compromised. The provider has agreed to keep the Commission fully updated once these tasks have been completed.

Overall people and relatives spoken with were positive and complimentary about the service they received at the home. People told us that they felt safe and were cared for. People received their medicines in a way that protected them from harm. Staff understood their responsibility to keep people safe from abuse and harm.

We examined training records which demonstrated that regular training was provided and staff underwent an induction when starting to work at the service.

The service continued to use an electronic care management system. All care plans had been transferred to this new system, which help with the organisation of records. Care plans were personalised and contained information about people's likes, dislikes and the people who were important to them. We observed staff carrying out care that was person centred.

People's social needs were met. This was because staff were encouraged to interact meaningfully with people and recorded their interactions. People received consistent, co-ordinated and person-centred care. There was a system in place to make sure people could make a complaint about their care and treatment.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, we found the provided adopted an inconsistent approach with the way consent forms had been completed. For example, we found it was not clear from the signed consent forms whether the person's family member was their Power of Attorney (POA) for health and welfare. We discussed this area with the provider who confirmed all care plans consent sections were in the process of being reviewed to ensure people's consent was followed correctly.

People and those important to them had previously had opportunities to provide their views about the home and quality of the service they received. However, we found the provider had not sent surveys out since our last inspection. The provider confirmed these would be sent out in the new year.

People told us that they were very happy with the food provided. We observed that people's nutritional needs had been assessed and individual food and drink requirements were met.

We received consistently positive feedback from people using the service and staff for the current manager and provider. The provider had a clear vision for the continued improvements they wanted to see in the service.

The management team assessed and monitored the quality of the service. A number of audits had taken place. This ensured the service to continue to be monitored and improvements were made where a need was identified.

We took enforcement action after the last inspection. This included serving two notices of proposals (NoP), one to cancel the registration of the service and the second to cancel the registration of the registered manager. The provider put forward representations to the Commission (CQC) in respect of the NoP to cancel the registration of the service. No representation had been received in respect of the NoP to cancel the manager’s registration; therefore a notice of decision (NoD) was served to the current registered manager on the 4 November 2016 to cancel his registration as manager at York Lodge.

We took enforcement action after the last inspection. At this inspection we checked to see if improvements had been made in all the areas we identified. At this inspection we found there had been improvements which were sufficient for the service to be rated as requires improvement overall and good in caring and responsive, with no inadequate domains. This meant the service could come out of special measures.

York Lodge is a family owned residential care home in the Urmston area of Trafford. It has been operating since 1986. The home is registered to provide care and support to a maximum of 22 older people. Accommodation is provided over three floors which can be accessed by stairs or a lift. The home has a conservatory and garden area which people can access.

At the time of our inspection, 22 people were residing at York Lodge, some of whom were living with dementia. The service also provided day care to for up to ten people on weekdays.

The service did not have a registered manager since the NoD had been served. 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 we found some records relating to medicines were confusing, as it was not possible to tell how often medicines had been administered. At this inspection we found improvements had been made, medicines were ordered, stored, administered and disposed of safely.

At the last inspection we noted two downstairs radiators still had no covers and were too hot to touch and an extension lead presented a trip hazard on a stair landing. At this inspection we found these hazards had been rectified, however, during the inspection we found a new hazard with the kitchen gate being left open by staff on three occasions. This was a potential risk factor for people living with dementia entering the kitchen unsupervised.

At the last inspection we found people at risk of pressure ulcers still did not have individualised care plans, although we noted none of the people at York Lodge had pressure ulcers at that time. At this inspection we found the service had reviewed people’s pressure ulcers care plans, ensuring detailed risk assessments were now available to guide staff.

At the time of our last inspection the service could not evidence which training courses staff had attended, which they needed to attend or if any were overdue. At this inspection a newly appointed administrator was responsible for the training and provided new training dates that confirmed staff will soon complete key training. New care workers were signed up to the Care Certificate and all staff received regular supervision and an annual appraisal.

At the last inspection paper-based risk assessments and care plans had not improved and were not fit for purpose. At this inspection we found people’s records had been transferred to the new electronic system. We found that people's health care needs were assessed and care planned and delivered to meet those needs.

At this inspection we found record-keeping had improved, however we found two Antecedent Behaviour Consequence (ABC) forms had not been completed fully. The management team acknowledged this shortfall and confirmed ABC forms will now be a priority.

We found the provider partnership running York Lodge at the time of the inspection, one of whom was the registered manager, did not have the necessary skills and experience to do so properly. The manager was no longer registered with the Care Quality Commission (CQC) and the provider had re-structured their roles and responsibilities within the service. The service was actively looking to recruit an experienced manager, who would then apply to become the registered manager at York Lodge.

At the last inspection people told us they sometimes had to wait for care workers to assist them at busy times. At this inspection people and their relatives had no concerns about the staffing levels. We found from our observations there were sufficient staff to meet people's needs and staff responded in a timely and appropriate manner to people.

Feedback received from people using the service spoken with, was generally complimentary about the standard of care provided. People living at York Lodge told us the management team were approachable and supportive.

We saw people's access to activities had improved and the home had recruited a second activities coordinator. People told us they enjoyed the activities on offer.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

The atmosphere and culture at the home was much improved. The managers each knew their own roles and responsibilities.

The partnership had worked with the local Clinical Commissioning Group and had contracted consultants in human resources, health and safety and care delivery in order to identify and implement improvements to the service.

York Lodge is a family owned residential care home in the Urmston area of Trafford. It has been operating since 1986. The home is registered to provide care and support to a maximum of 22 older people. Accommodation is provided over three floors which can be accessed by stairs or a lift. The home has a conservatory and garden area which people can access.

At the time of our inspection, 22 people were resident at York Lodge, some of whom were living with dementia. The service also provided day care to between two and six people per day on weekdays.

The service had a registered manager. 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.

We took enforcement action after the last inspection. At this inspection we checked to see if improvements had been made in all the areas we identified. We found that whilst some aspects had been addressed either fully or partially, others had not and remained outstanding. We made the decision to keep York Lodge in special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found medicines prescribed to be taken by people when they felt they needed them, for example pain relief, were being administered on a regular basis by staff. Some medicine records were confusing as it was not possible to tell how often they had been administered.

The majority of safety hazards we identified at the last inspection in October 2015 had been remedied, however, we noted two downstairs radiators still had no covers and were too hot to touch and an extension lead presented a trip hazard on a stair landing. Other risk assessments and health and safety checks were up to date.

At the last inspection in October 2015 we noted people assessed as being at high risk of pressure ulcers had no care plans for this. At this inspection we found people at risk of pressure ulcers still did not have individualised care plans, although we noted none of the people at York Lodge had pressure ulcers.

We observed two care staff assisting a person to mobilise in a manner that was highly unsafe.

At the last inspection in October 2015 we found the home had not carried out any assessments for people thought to lack mental capacity to make decisions. At this inspection, apart from capacity assessments for people’s ability to consent to living at York Lodge, no other assessments of people’s capacity had been undertaken.

At the time of our inspection the service could not evidence which training courses staff had attended, which they needed to attend or if any were overdue. New care workers were signed up to the Care Certificate and all staff received regular supervision and an annual appraisal.

Paper-based risk assessments and care plans had not improved since the last inspection in October 2015 and were still not fit for purpose. People whose records had been transferred to the new electronic system were better, but we still found gaps and omissions. Care workers told us they did not read people’s care plans often.

The home still had a structured approach to bathing. People told us they had a bath once a week and some said this was not enough. The home could not evidence when people had last been assisted to bathe.

We found record-keeping was slightly better than at the last inspection but there were still gaps in recruitment records, food and fluid balance charts and repositioning charts. A recent serious injury had not been documented on an accident form.

The registered manager was not aware of his responsibilities to report notifiable incidents to the Care Quality Commission (CQC) as is required by the Regulations. We found two occurrences since the last inspection which should have been notified to CQC.

We found the provider partnership running York Lodge at the time of the inspection, one of whom was the registered manager, did not have the necessary skills and experience to do so properly.

People told us they sometimes had to wait for care workers to assist them at busy times. The registered manager had employed a dependency tool which showed there were enough staff to meet people’s needs, and our observations supported this, except for the occasions when a number of people required support at the same time. However, this was at the current level of service quality, which was not always person-centred.

At the last inspection in October 2015 people gave us positive feedback about the quality of the food served at York Lodge but said they were not given a choice of foods. At this inspection the feedback was similar; people liked the food but not everyone said they got a choice.

Care workers respected people’s privacy and dignity; however, we noted issues with confidentiality relating to use of a computer in the dining area when people were present.

The cleanliness of the home had much improved since the last inspection. We saw handwashing basins had been installed where they were required and gloves and aprons were available in the areas care workers needed them.

People were supported by the home to maintain their holistic health and we saw the home had made environmental improvements to better support people living with dementia.

People and their relatives told us the staff were caring. Care workers could describe people well as individuals, the home’s atmosphere was relaxed and there was friendly banter between the people and the care workers.

We saw people’s access to activities had improved and the home had recruited a second activities coordinator. People told us they enjoyed the activities on offer.

People told us they had never complained about the service but knew what to do if they needed to. We saw the registered manager had treated a relative’s negative survey feedback as a complaint and resolved it properly.

The atmosphere and culture at the home was much improved. The managers each knew their own roles and responsibilities.

The registered manager had worked with the local Clinical Commissioning Group and had contracted consultants in human resources, health and safety and care delivery in order to identify and implement improvements to the service.

We spoke with visiting relatives throughout the day. Comments included; 'My 'x' is happy and settled living here. The staff help 'x' with personal care, washing and dressing. People's needs are met here I'm sure of that. I visit each day and 'x' is always well turned out. I visit most days and there are always bits and pieces of activities taking place. It's easy going here. Very family orientated'.

We undertook a tour of the building to ensure the premises were suitable to meet the needs of people who used the service and we found they were fit for purpose.

We looked at six staff personnel files to ensure staff had been recruited safely. We found some shortfalls including a lack of references from previous employers in some files we looked at, and a lack of staff supervision records.

We looked at how the quality of service provision was monitored. This was done with the use of surveys, staff/resident meetings and the learning from accidents and incidents at the home.