This inspection took place on 30 August and 3 September 2018. This was the first inspection of York House since it was reregistered in February 2018 under a new registered provider. York House is a purpose-built care home providing care for up to a maximum of 36 older people, some of whom are living with dementia. The home stands in its own grounds with an enclosed garden and car parking. On the day of our inspection 31 people were living at the home.

York House 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.

A new manager had recently been appointed but they were yet to apply to be registered with the CQC. 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. It is a condition of the registered providers registration for there to be a registered manager in post.

Staff we spoke with were knowledgeable about safeguarding people and could explain the procedures to follow should an allegation of abuse be made. Assessments identified some risks to people although associated management plans were not always in place to reduce the risks and ensure people’s safety. We found some issues in relation to the identification of suitable equipment in people’s care plans and how equipment was checked.

There were insufficient staff to ensure people’s needs were met at a time of their choosing. There were periods during the day when staff were unavailable in the communal lounge, however the provider’s dependency tool showed there were sufficient staff for the number of people at the home. Staff were observed to be spending time away from the caring role on ancillary tasks.

During our inspection we observed medicines were administered safely, but there were issues with recording as the actual count and records did not tally. In addition, a record of the administration of creams was not always completed.

The manager understood their responsibilities under the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and authorisations had been requested. However, recorded evidence was often missing in relation to the assessment of mental capacity and best interest decisions, where people lacked the capacity to consent to certain aspects of their care and treatment. The provider was still in the process of ensuring each person had a record in place and they had identified the requirement for this.

There had been an issue with weight loss at the home which had been recognised by the regional manager in their audit and people’s weights were regularly monitored. Some improvements in records relating to people’s food and fluid intake was required and there was a lack of consistent recording in relation to what people had eaten. The information held in the kitchen and in people’s care plans did not always tally.

The quality of the record keeping varied and some care records we looked at were not personalised, were inconsistent and in many instances incomplete. The provider had recognised care plans needed to improve to be person-centred and reflective of people’s care needs.

The home had not been well-led and there had been a lack of robust monitoring to drive improvements. Detailed audits had been carried out by the regional manager, which had identified the issues and there were plans in place to improve the home within a set time-frame to ensure they improved the quality of their care provision and were fully compliant with the regulations.

The registered provider was open and honest with people, their relatives and with staff about the issues t