We inspected York Lodge on the 21 April 2017 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 provides respite care for people, at the time of our inspection one person was receiving respite care with the plan to move to York Lodge on a full time basis. 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 20 people living at the home. Everybody living at York Lodge was living with dementia and people had mobility and sensory challenges.

There was a registered manager in post. 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 in March 2016, we identified area of improvement in relation to care plan audits, fire safety, infection control and end of life care plans. Recommendations had been made and at this inspection, we found improvements had been made.

People, staff and relatives spoke highly of the registered manager and their leadership style. However, despite people’s praise, we found areas of care which were not consistently well-led. The provider’s quality assurance framework had not consistently identified shortfalls and the audit of incidents and accidents was not consistently robust. We have identified this as an area of practice that requires improvement. We have a made a recommendation for improvement in the body of the report.

There were sufficient numbers of skilled, competent and experienced staff to ensure people's safety. People were cared for by staff that had a good understanding of adult safeguarding and who knew what to do if there were concerns over people's safety. People told us that they felt safe. One person told us, “I feel very safe here.”

Staff were knowledgeable about people's behaviours which might challenge and areas of care which might pose a risk to people. A range of risk assessments were in place and people's ability to use the call bell was considered. Positive behaviour support plans were in place and staff were knowledgeable about people’s behaviour and any potential triggers that may upset them or cause distress.

Positive relationships between people and staff had been developed. There was a friendly, caring and relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. People were complimentary about the caring nature of staff. One relative told us, “Everyone is lovely. I am very happy.”

People's privacy and dignity was respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this. Care plan reviews, as well as residents meetings, enabled people to make their thoughts and suggestions known. People's right to make a complaint was also acknowledged, however, people told us they were happy and had no complaints. One person told us, “I love it here.”

People received personalised and individualised care that was tailored to their needs and preferences. Person-centred care plans informed staff of people's preferences, needs and abilities and ensured that each person was treated as an individual. Staff had a good understanding of people's needs and preferences and supported people in accordance with these. People spoke highly of the activities available.

Staff understood their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and acted appropriately to seek consent from people.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people w

We carried out an unannounced comprehensive inspection at York Lodge on the 13 and 14 July 2015. Breaches of Regulation were found. As a result we undertook an inspection on 22 and 23 March 2016 to follow up on whether the required actions had been taken to address the previous breaches identified. Although we found significant improvements had been made there remained some areas that required improvement.

York Lodge is located in Crowborough and provides accommodation and personal care for up to 22 older people. The home provides respite care for people, at the time of our inspection one person was on respite. 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 13 people living at the home. Everybody living at York Lodge was living with dementia and people had mobility and sensory challenges.

We found the provider had not taken adequate steps to ensure people’s safety in relation to door alarms on fire exits. Although the home was clean, we found some risks associated with the transfer of soiled laundry through the home had not been considered.

People spoke positively about food and meal times at York Lodge; however on the first day of our inspection we found an issue with staff deployment resulted in one person not being supported in line with their care plan during the lunch time meal. The provider took steps to rectify this issue immediately.

Staff were seen to be caring and treated people with respect and dignity, however the provider had not taken sufficient actions to discuss and record people’s preferences and choices in respect to end of life care.

Although people underwent a comprehensive pre-assessment prior to living at York Lodge the providers pre-assessment related to mental capacity did not capture sufficient detail to inform staff of the types of decisions people may require support with and whether these needs could be met.

The provider had systems in place to monitor and drive improvements in the performance of the service; however we found some shortfalls with care plan auditing which meant not all areas had senior staff oversight.

The delivery of care was based on people’s preferences. Care plans contained sufficient information on people’s likes and dislikes, routines and their choices related to activities and social interaction.

Staff we spoke with understood the principles of consent and therefore respected people’s right to refuse consent. Mental capacity assessments were consistently recorded in line with legal requirements. Deprivation of Liberty Safeguards (DoLS) had been submitted.

There were sufficient number of staff working at York Lodge with the appropriate skills and experience. Robust recruitment checks had taken place prior to staff working at the home.

Staff communicated clearly with people in a caring and supportive manner. There was an open and relaxed atmosphere within the home, where people were encouraged to express their feelings.

People who used the service had complex needs and were not able to tell us about their life at the home. We used a number of different methods to help us understand their experiences. These included looking at records, talking to staff and observing care practices. We also received feedback from the relative of a person who lived at the home.

People told us they liked the home. One person said it was "Very good here".Another person told us "Staff get what you want" and "I am more than looked after". A relative commented "I find it very good".

We found that people received care and support that met their needs. Care plans were detailed and kept up to date. We observed staff supporting people with sensitivity and at an appropriate pace.

People were provided with a suitable diet and any concerns about weight were closely monitored. People told us they liked the food. One person said "The food is very nice".

People were protected from the risk of abuse. Any concerning incidents were recorded and reported to the appropriate authority. Staff were aware of their safeguarding responsibilities.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to store medicines. We found that the medication room was sometimes too warm for safe storage.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Because the people using the service had complex needs they were not all able to tell us their experiences. We spoke to one person at the home and three carers who were visiting. We also spoke with three care staff and the manager.

One person said that they were ‘very pleased’ with York Lodge and that staff were ‘calm and friendly’. A carer of one person at the home said that it was ‘excellent’ and the standard of care was ‘very good’. Another carer said that they were kept informed and encouraged to get involved in the home.

This inspection was a follow up to our visit on December 2012 when we found concerns in relation to care and welfare, respect and involvement and safeguarding. When we returned we found that improvements had been made in all these areas. There were good care practices to support people which ensured that they were treated as individuals. However improvements needed to be made to the storage of medication and the reporting of possible safeguarding incidents.

People using the service were able to tell us that they liked living in the home, but they were not able to communicate their views in more detail due to their dementia. We spent time watching how staff cared for people and seeing whether people seemed to be happy and comfortable and had their needs met. We found that people were treated with kindness and respect by staff and that they appeared comfortable and relaxed with the support they were getting.

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.