We inspected York Lodge Care Home for the Elderly on 13 and 14 July 2015 and the inspection was unannounced.
York Lodge is located in Crowborough and provides accommodation and personal care for up to 22 older people. The home is set out over three floors and a basement. There is lift access between the ground floor and upper levels. At the time of our inspection there were 21 people living at the home. Everybody living at York Lodge was living with dementia and many people had mobility and sensory challenges.
The home 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 found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of this report.
People said they felt safe living in the home however we found that not all risks had been identified or effectively managed.
People were not protected from the risk of the spread of infection with laundry in shared bathrooms and décor and furnishings that made effective cleaning difficult.
The provider followed safe recruitment procedures to ensure staff working with people were, as far as possible, suitable for their roles. However, staffing levels were not based on people’s needs and did not promote their safety and wellbeing.
The registered provider had not ensured that people received their medicines according to their needs.
Staff did not have the necessary skills and knowledge to ensure they could meet people’s complex needs. Staff had not received the training they needed to enable them to carry out their roles effectively.
Assessments of people’s capacity to make decisions had not always been carried out in line with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
Meal times did not take account of individuals’ needs and people did not receive the support they required.
People received medical assistance from healthcare professionals including district nurses, GPs, chiropodists and the local hospice.
The premises and equipment did not meet the needs of people living with dementia and mobility challenges. We identified a number of maintenance issues that impacted on people’s wellbeing.
Staff were sometimes task-orientated and did not show kindness or compassion in their approach. Staff did not always listen to people or treat them with respect.
Staff did not always respond or know how to respond, to people’s distress. People’s communication needs were not respected or enabled.
People’s needs were not consistently met as assessment and care planning was not always effective. People’s changing needs were not consistently responded to. We observed that the people who required the most care and support were not always given the support they needed to ensure they had meaningful occupation during the day.
People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed and their involvement encouraged.
People and relatives felt the home was well run and were confident they could raise concerns if they had any. However, there were not robust systems in place to assess quality and safety. The registered provider had not adequately monitored the service to ensure it was safe and had not identified or acted upon areas where improvement was required.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.