About the service: Danes Lodge is a care home. The service offers accommodation and personal care and support for up to 29 older people and people with a dementia related condition. At the time of the inspection there were 22 people using the service.

People’s experience of using this service: People did not always receive a service that provided them with safe, effective, compassionate and high-quality care. Care and support was not tailored to meet people's specific needs.

Risk management was ineffective and placed people at risk of harm. Medication practice continued to be unsafe. Concerns were raised regarding the environment which posed a risk of spread of infection. There was inadequate staff on a night time to meet people’s needs. Safe recruitment practices had not been followed.

People did always receive person centred care. People's human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to.

The service was not well led and there was an ineffective quality assurance system in place. During this inspection we found multiple failings at the service and risks to people had not been mitigated. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Four of these were repeated breaches which were found at the last inspection, and one of the breaches had been identified at the previous two inspections, which demonstrates learning and improvement had not taken place.

Staff did not always respond appropriately to people who were becoming distressed. People felt staff were caring but did not always have time to spend with them.

People did not receive personal care in a timely manner. Care plans were not reviewed consistently or updated when people's needs changed. Complaints had not always been responded to or investigated.

Rating at last inspection: This service was rated ‘Requires Improvement’ at the last inspection, with the well led domain being rated as ‘Inadequate’ (published 16 August 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Danes Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide personal care and accommodation for up to 27 older people, including those with dementia related conditions. It is located in the seaside town of Bridlington, in East Yorkshire. At the time of our inspection there were 25 people living at the home.

This inspection took place on the 19, 20 and 25 June 2018. The 19 June was unannounced and we told the provider that we would be returning on the 20 June. The 25 June was unannounced and during the evening. This attendance was prompted by anonymous concerns that were received by the local safeguarding team. Some of these concerns were substantiated.

The service had previously been rated Requires Improvement in June 2017. There was a breach in regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider did not ensure adequate standards of cleanliness. During this inspection we have found that there were four breaches in regulations, regulations, 9, 12, 17 and 18.

The service is required to have a registered manager in post. A registered manager is a person who has registered with CQC 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 time of the inspection there was a manager in place and they were in the process of being registered with the CQC.

Processes in place for the administration of medicines at night were not sufficient and put people at risk. There was insufficient staff working at night on a regular basis and night staff were inappropriately trained to meet the needs of people.

Accidents and incidents were not always monitored and investigated effectively to ensure safe practices. Lessons learnt were not evidenced in all incidents. Not all incidents had been notified to CQC or the local safeguarding authority.

There was a lack of provider oversight which meant risks to people’s safety were not picked up by the provider.

Morning routines for some people were service led and not person centred.

Staff received training in safeguarding and had knowledge of whistleblowing procedures. Recruitment processes were in place and were found to be robust.

Infection control measures were in place to prevent the risk of infections spreading to people. Although the domestic staff and night staff felt that recent cuts in cleaning hours had impacted on the cleanliness of the service, we found that standards were maintained during the inspection.

Staff aimed to deliver a good standard of care that was caring. Staff demonstrated knowledge of people and this helped them to provide some person-centred care. Feedback from relatives and friends was very positive about the caring nature of the staff.

Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. Gaps in the reviews meant some care plans did not contain up to date information. Risk assessments were in place to reduce the risk to people. Peoples wider needs were met by the provision of activities and people’s care plans recorded their end of life preferences.

People’s nutrition and hydration needs were catered for however, the provider needed to make changes to the meal time experience to ensure that this followed best practice.

The manager had used a variety of methods to assess and monitor the quality of care. However, the governance systems had not picked up all the shortfalls identified during the inspection. Where shortfalls had been identified, action to address th

This inspection took place on the 3 May 2017 and was unannounced. It was the first comprehensive inspection of this service since registration.

Danes Lodge (also known as Danes Lea) is in Bridlington and provides personal care and accommodation for up to 29 people. There were 25 people using the service on the day of our inspection. The service is a detached property set out over three floors. The top floor is used for storage and other purposes and all bedrooms are located on the ground and first floors. The registered provider of the service has links to three other care homes in the East Riding of Yorkshire and Hull area.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (the 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 provider had employed a manager who was in the process of applying for registration with the Commission

People felt safe at the service. Staff had been trained in safeguarding of adults and knew what to do if they had any concerns and how to report any incidents.

Assessments identified areas where people’s health and safety may be at risk and these were acted upon. Medicines were administered safely by staff but where people administered their own medicines they were not always stored safely. Accidents and incidents were managed appropriately by the service and reviewed regularly by the care services manager.

The service was undergoing a programme of refurbishment but some areas had not been completed and did not have acceptable standards of cleanliness resulting in some odorous areas. Checks and servicing of services and equipment and been completed. The building had been adapted as far as possible to accommodate people’s needs. Where people were living with dementia adaptations to the environment had been made to assist people in finding their way.

You can see what we told the provider to do at the back of the full version of this report.

Recruitment was robust with all relevant checks completed by the registered provider before people started work. There was sufficient numbers of staff on duty who had the skills and knowledge to meet people’s needs.

Staff had been trained in areas which supported their role. Where further training was due it had been planned with dates booked. Staff were supported through supervision and annual appraisals.

People’s communication needs were clearly identified in care records. Information was shared at regular staff, resident and managers' meetings.

The service was working within the principles of the Mental Capacity Act 2005.

People had a choice of what to eat and drink. Specific needs relating to nutrition were identified. Fluids were available to people throughout the day.

Staff were caring and compassionate. Their approach was kind and friendly. They involved people in their care and gave them information and support where appropriate. People were treated with dignity.

Advocacy services were available if people needed them. One person had an independent mental capacity advocate supporting them.

Care plans reflected individuals needs clearly. They were reviewed regularly.

People took part in a variety of activities of their choice.

Complaints had been dealt with in line with the registered providers policy and procedure.

Where necessary the manager had made notifications to CQC. They worked together with other agencies to promote people’s health and wellbeing.

Although there was a quality assurance system in place, quality audits had not identified some areas for concern.