The service was inspected on 16 May 2018 and was unannounced. The service had previously been inspected on 10 and 24 April 2017 and was rated overall requires improvement with a breach in governance. This inspection was therefore carried out to check improvements had been made. We found the provider was no longer in breach of any regulations and improvements had been made.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental health illnesses. There were 44 people living at the home on the day of our inspection. The accommodation is arranged over two floors with the dementia nursing unit on the ground floor and the nursing and residential unit on the second floor. There is a passenger lift operating between both floors.

There was a registered manager at the service at the time of our inspection. 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 saw the provider had improved systems for the purpose of assessing and monitoring the quality of the service. This showed through audits that this was an effective system. We saw accident and incidents were recorded and analysed to look for any trends. However, further improvements were needed to ensure where actions were completed these were recorded appropriately.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes. People told us they were cared for. There was mixed views in relation to the staffing levels some people and relatives felt there was not enough staffing. At the time of inspection through observations and documentation we felt there were enough staff to support people’s needs.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). The service was meeting the requirements of the Mental Capacity Act 2005 (MCA). We felt staff had confidence in using the MCA to make best interest decisions for people who lacked the capacity to make decisions in relation to their care.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering, storage and disposal of medicines. We discussed with the registered manager about the importance of using body maps to support where topical creams were to be applied.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

People told us the food at the home was good and they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

We saw the home had a range of activities in place for people to participate in. Staff were enthusiastic and people’s relatives told us they felt there was enough activities. This meant people’s social needs were being met. However we did speak to the registered manager in relation to the level of noise in the dementia area. We saw some people enjoyed the music but others stood up and started walking away. The registered manager said they would look into this and discuss at the next staff meeting.

We looked at four staff personnel files and saw the recruitment process in place ensured that staff were suitable and safe to work in the home. Staff we spoke with told us they received supervision and had annual appraisals

The service was inspected on 10 and 24 April 2017 and was unannounced. The service had previously been inspected on 8 December 2016 and as the overall rating for this service was ‘Inadequate’ the service was placed in ‘Special measures’. Services in special measures are kept under review and inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. This inspection was therefore carried out to check improvements had been made.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental health illnesses. There were 31 people living at the home on the days of our inspection. The accommodation is arranged over two floors with the dementia nursing unit on the ground floor and the nursing and residential unit on the second floor. There is a passenger lift operating between the two floors.

There was no registered manager at the service at the time of our inspection. 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 our previous inspection we found people were not protected from harm by other people living at Castleford Lodge as staff were not always available to observe and respond to incidents. At this inspection we found staffing levels had increased which meant staff were more visible and responsive to people at the home. In addition, measures had been put in place to ensure there were more objects around the dementia friendly area to provide occupation for people such as prams, a wheel barrow, dolls and sensory items.

At our last inspection we found moving and handling risk assessments and care plans were not completed adequately and we saw poor moving and handling practice during our inspection. At this inspection we saw improvements had been made in this area and we saw no poor moving and handling practice during this inspection. Systems to ensure assistive equipment was in good working order had improved and we saw a wheelchair with missing footrests had been removed from use and placed in the manager’s office until the plates could be located.

At our last inspection we found areas of the home were not always thoroughly clean to ensure the risk of infection was minimised. At this inspection we found liquid soap and personal protective equipment were in place to ensure good practice was followed and the registered provider had implemented systems to ensure areas were cleaned thoroughly.

We found decision specific mental capacity assessments had been carried out for people living in the dementia unit which were compliant with the Mental Capacity Act 2005 and there had been an improvement on the nursing unit. Staff would be receiving further training to fully embed the principles of the Act. Deprivation of Liberty Safeguards had been appropriately applied for and authorisations were in place or awaiting authorisation by the relevant body. The registered provider had obtained confirmation of Lasting Power of Attorney’s for health and welfare decisions to ensure consent obtained from family members was lawful. Recorded consent in people’s care files had improved to evidence they had consented to care and treatment.

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.

People’s weights had been consistently recorded to ensure those at risk of weight loss were adequately monitored and there had been an increase in people’s weights since our last inspection, assisted by the access to snacks dur

The service was inspected on 7 and 8 December 2016 and was unannounced. The inspection was prompted in part by notification of an incident following which a service user sustained a serious injury. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the risk of unsafe management of medicines.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental illnesses. There were 43 people living at the home on the days of our inspection. The accommodation is arranged over two floors with the dementia nursing unit on the ground floor and the nursing and residential unit on the second floor. There is a passenger lift operating between the two floors.

There was a registered manager who had been registered since October 2016 but they were absent from the service at the time of our inspection. 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 at the service were not protected from harm by other people living at Castleford Lodge. We found staff on the dementia unit were not always observing or responding to incidents between people using the service. This meant there was an under recording of incidents which were not always fully investigated to implement actions to prevent a reoccurrence.

Moving and handling risk assessments and care plans were not completed adequately and we saw poor moving and handling practice during our inspection. Risks around the use of assistive equipment such as wheelchairs, bathing equipment, shower chairs and specialist seating systems were not always recorded to ensure identified risks were reduced to the lowest possible level. There was no robust system in place to ensure faulty equipment was removed from use.

We found areas of the home were not always thoroughly clean to ensure the risk of infection was minimised such as faeces on mattresses, bed rail bumpers and carpets. Not all areas had liquid soap or personal protective equipment to ensure good practice was followed.

We found decision specific capacity assessments had been carried out for people living in the dementia unit which were compliant with the Mental Capacity Act 2005. In contrast, we found capacity assessments on the nursing unit which were not decision specific.

Deprivation of Liberty Safeguards had been appropriately applied for and authorisations were in place or awaiting authorisation by the relevant body. However, we found one person’s conditions attached to their authorisation had not yet been incorporated into their care plan. Staff were not aware who had a Lasting Power of Attorney for health and welfare decisions to ensure consent obtained from family members was lawful. We also found a lack of recorded consent in people’s care files to evidence they had consented to care and treatment.

Not everyone was provided with a meal on the day of our inspection and there was a lack of system in place to ensure people received adequate nutrition and hydration. In addition, people’s weights had not been consistently recorded to ensure those at risk of weight loss were adequately monitored.

We observed some staff were kind and caring when they were supporting people with care. They treated people with dignity and respect. However, we observed some people were ignored by staff and they did not have their care needs met or were left to wait.

Some records contained person centred information detailing people’s preferences and choices. However, other records lacked detail and were incomple