About the service: York Lodge Residential Home (York Lodge) 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. York Lodge accommodates up to 22 people in one adapted building and at the time of our inspection the home was fully occupied. The service also provides day care services.

People’s experience of using this service:

At this inspection we found evidence the service did not meet the characteristics of Good in all areas. We have made two recommendations to the service about creating a more dementia-friendly environment and person-centred care. More information is in the full report.

The registered manager had completed audits on the service to help ensure quality of service. However, these did not identify concerns we found during our inspection such as poor record keeping and fire safety concerns.

People’s rights had not always been considered in line with the Mental Capacity Act 2005 and documented to show they had been consulted on all aspects of their care. Fire safety arrangements at the home potentially compromised some people’s safety, dignity and privacy. We have asked the provider to address these concerns with some urgency.

One person’s care plan was not always followed; risks were not consistently monitored to ensure they were kept safe and appropriate action taken in a responsive way.

In the main, medicine administration was managed safely. The recording of thickeners needed to be more consistent and some people’s protocols for ‘as required’ medicines were being updated.

There was sufficient and adequately trained staff to support people safely. Recruitment processes were very robust. This helped to ensure staff were appropriate to work with vulnerable people. The provider had suitable systems in place to protect people from abuse.

Staff had adequate professional support to enable them to support people safely and effectively.

People were supported in a friendly and respectful way. People, relatives and staff got on well and staff were aware of people’s personalities and behaviours. People told us staff supported them in a patient and unhurried manner. People and relatives said that staff were caring.

People knew how to make a complaint. There was an effective complaints process in place. Complaints were thoroughly investigated, and action taken to address the complaint raised.

Care at the end of people’s lives had been considered and recorded in their care plans.

People and relatives told us they were very happy with the care provided. They commented positively about the registered manager, owner and staff

Rating at last inspection:

At the last inspection the service was rated Requires Improvement. The report was published in December 2017.

Why we inspected:

This inspection was planned based on the previous rating. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well Led to at least good. We found the provider had not made sufficient improvements in these areas and we found a further two breaches of the regulation relating to the need for consent and dignity and respect.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected York Lodge Residential Home (known as 'York Lodge' by the people who live there) on 11 December 2017. The inspection was unannounced, so this meant they did not know we were coming. At the last inspection on 31 October and 02 November 2016 we rated the home ‘requires improvement’ overall and no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been identified. This is the fourth time the service has been rated Requires Improvement

York Lodge 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.

At the time of our inspection, 21 people were residing at York Lodge, some of whom were living with dementia. The service also provided day care to for up to ten people on weekdays, during the inspection six people were receiving day care service.

At the time of the inspection the service did not have a registered manager, but there was manager in post who had started the process of registering with the Commission. 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.

During this inspection we checked if the required improvements had been made. We found a number of improvements had been made, however we identified a continued breach in respect of the safety of the home and new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the provider failing to provide information requested by the Care Quality Commission and a breach of the CQC registration regulations for failing to submit Deprivation of Liberty Safeguards (DoLS) statutory notifications.

You can see what action we told the provider to take at the back of the full report.

During our inspection the provider made us aware the fire service had visited the home and found shortfalls in relation to fire safety at the premises. The fire service identified the cellar of the home was a potential fire risk due to the inappropriate storage of combustible items. These shortfalls were previously unknown to the current manager or provider. The provider was proactive at following the advice set by the fire service and immediately removed items from the cellar, added an additional night worker to assist in the event of an emergency and implemented 30 minute safety checks of the building. The provider also told us that they had suspended any new admissions to the home until the fire service is satisfied with the safety of the home.

During this inspection, we found other issues affecting the safety of the environment. The provider did not have a risk assessment in relation to legionella. The provider confirmed they had completed routine sampling of the water systems and were awaiting these results, but this information could not be located at the time of our inspection. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease that can be dangerous, particularly to more vulnerable people such as older adults.

During the inspection we identified areas within the home that required remedial works. Two walls had holes in that required plastering and painting. We found one radiator cover had started to come away, which exposed a small area of the radiator. A room within the home stored a bed pan machine; this room required a lockable door to minimise the risk of people who may be confused incorrectly using the machine. These areas were discussed with the provider who was eager to make the necessary improvements to ensure the safety of the home was not compromised. The provider has

We inspected York Lodge Residential Home (known as 'York Lodge' by the people who live there) on 31 October and 2 November 2016. The inspection was unannounced, so this meant they did not know we were coming. At the last two inspections in October 2015 and June 2016 we rated the home as inadequate overall and placed it in special measures.

We took enforcement action after the last inspection. This included serving two notices of proposals (NoP), one to cancel the registration of the service and the second to cancel the registration of the registered manager. The provider put forward representations to the Commission (CQC) in respect of the NoP to cancel the registration of the service. No representation had been received in respect of the NoP to cancel the manager’s registration; therefore a notice of decision (NoD) was served to the current registered manager on the 4 November 2016 to cancel his registration as manager at York Lodge.

We took enforcement action after the last inspection. At this inspection we checked to see if improvements had been made in all the areas we identified. At this inspection we found there had been improvements which were sufficient for the service to be rated as requires improvement overall and good in caring and responsive, with no inadequate domains. This meant the service could come out of special measures.

York Lodge is a family owned residential care home in the Urmston area of Trafford. It has been operating since 1986. The home is registered to provide care and support to a maximum of 22 older people. Accommodation is provided over three floors which can be accessed by stairs or a lift. The home has a conservatory and garden area which people can access.

At the time of our inspection, 22 people were residing at York Lodge, some of whom were living with dementia. The service also provided day care to for up to ten people on weekdays.

The service did not have a registered manager since the NoD had been served. 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 we found some records relating to medicines were confusing, as it was not possible to tell how often medicines had been administered. At this inspection we found improvements had been made, medicines were ordered, stored, administered and disposed of safely.

At the last inspection we noted two downstairs radiators still had no covers and were too hot to touch and an extension lead presented a trip hazard on a stair landing. At this inspection we found these hazards had been rectified, however, during the inspection we found a new hazard with the kitchen gate being left open by staff on three occasions. This was a potential risk factor for people living with dementia entering the kitchen unsupervised.

At the last inspection we found people at risk of pressure ulcers still did not have individualised care plans, although we noted none of the people at York Lodge had pressure ulcers at that time. At this inspection we found the service had reviewed people’s pressure ulcers care plans, ensuring detailed risk assessments were now available to guide staff.

At the time of our last inspection the service could not evidence which training courses staff had attended, which they needed to attend or if any were overdue. At this inspection a newly appointed administrator was responsible for the training and provided new training dates that confirmed staff will soon complete key training. New care workers were signed up to the Care Certificate and all staff received regular supervision and an annual appraisal.

At the last inspection paper-based risk assessments and care plans had not improved and were not fit for purpose. At this ins

We inspected York Lodge Residential Home (known as ‘York Lodge’ by the people who live there) on 13 and 14 June 2016. The inspection was unannounced, so this meant they did not know we were coming. At the last inspection in October 2015 we rated the home as inadequate overall and placed it in special measures. We also took enforcement action by serving warning notices. This inspection was to see whether improvements had been made.

York Lodge is a family owned residential care home in the Urmston area of Trafford. It has been operating since 1986. The home is registered to provide care and support to a maximum of 22 older people. Accommodation is provided over three floors which can be accessed by stairs or a lift. The home has a conservatory and garden area which people can access.

At the time of our inspection, 22 people were resident at York Lodge, some of whom were living with dementia. The service also provided day care to between two and six people per day on weekdays.

The service 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 took enforcement action after the last inspection. At this inspection we checked to see if improvements had been made in all the areas we identified. We found that whilst some aspects had been addressed either fully or partially, others had not and remained outstanding. We made the decision to keep York Lodge in special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found medicines prescribed to be taken by people when they felt they needed them, for example pain relief, were being administered on a regular basis by staff. Some medicine records were confusing as it was not possible to tell how often they had been administered.

The majority of safety hazards we identified at the last inspection in October 2015 had been remedied, however, we noted two downstairs radiators still had no covers and were too hot to touch and an extension lead presented a trip hazard on a stair landing. Other risk assessments and health and safety checks were up to date.

At the last inspection in October 2015 we noted people assessed as being at high risk of pressure ulcers had no care plans for this. At this inspection we found people at risk of pressure ulcers still did not have individualised care plans, although we noted none of the people at York Lodge had pressure ulcers.

We observed two care staff assisting a person to mobilise in a manner that was highly unsafe.

At the last inspection in October 2015 we found the home had not carried out any assessments for people thought to lack mental capacity to make decisions. At this inspection, apart from capacity assessments for people’s ability to consent to living at York Lodge, no other assessments of people’s capacity had been undertaken.

At the time of our inspection the service could not evidence which training courses staff had attended, which they needed to attend or if any were overdue. New care workers were signed up to the Care Certificate and all staff received regular supervision and an annual appraisal.

Paper-based risk assessments and care plans had not improved since the last inspection in October 2015 and were still not fit for purpose. People whose records had been transferred to the new electronic system were better, but we still found gaps and omissions. Care workers told us they did not read people’s care plans often.

The home still had a structured approach to bathing. People told us they had a bath once a week and some said this was not enough. The home could not evidence when people had last be

Overall, we found people were happy living at York Lodge and made positive comments about the service and their care. Comments included; “I can’t grumble I suppose. The care is good” and “The staff are good, I am treated well. I’m happy enough here it’s nice” and “It’s alright here. You get good food and plenty of attention from the staff” and “It’s not like home but I like it. The staff are nice, I have no complaints”.

We spoke with visiting relatives throughout the day. Comments included; “My ‘x’ is happy and settled living here. The staff help ‘x’ with personal care, washing and dressing. People’s needs are met here I’m sure of that. I visit each day and ‘x’ is always well turned out. I visit most days and there are always bits and pieces of activities taking place. It’s easy going here. Very family orientated”.

We undertook a tour of the building to ensure the premises were suitable to meet the needs of people who used the service and we found they were fit for purpose.

We looked at six staff personnel files to ensure staff had been recruited safely. We found some shortfalls including a lack of references from previous employers in some files we looked at, and a lack of staff supervision records.

We looked at how the quality of service provision was monitored. This was done with the use of surveys, staff/resident meetings and the learning from accidents and incidents at the home.

We spoke with one person who uses the service and the relatives of two people who use the service. They told us that the staff were friendly, helpful and always listened to them.

The people we spoke with told us they were happy at the home. They told us they had a choice of meals and staff would prepare alternative meals if they did not like what was on offer. Two people told us they are regularly involved in the review of care plans.

People told us that they had no concerns about the care they receive. They told us that if they had any concerns or complaints, they would speak to the Manager.

We inspected York Lodge on 21 and 22 October 2015 and the first day of the inspection was unannounced. Our last inspection took place on 14 July 2014. At that time we found the service met the standards we inspected against.

York Lodge is a privately owned residential care home in the Urmston area of Trafford and has been operating since 1986. The home is registered to provide care to a maximum of 22 older people and accommodation is provided over three floors. The home provides care and support to older people, some of whom live with dementia. There were 22 people living at York Lodge on the day of our inspection.

In the last two years York Lodge had also started to provide a day care service to between two and six people per day on weekdays.

The service 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspecting again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate in any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Medication administration records were recorded correctly but the service did not have instructions for ‘as required’ medications and body maps for topical creams and lotions were not completed properly.

We found that risks assessments were not always done or, when risks had been identified, care plans to mitigate the risks were not put in place. The care plans we saw were generic and lacked detail; the Local Authority had previously suggested improvements but these had not been made.

Although most of the home was clean and tidy and the people using the service and their relatives told us the home was clean, we found areas that were not clean.

Potential safety hazards were identified as we walked around the building. The registered manager was aware of some of them but had not put measures in place to reduce the risks to the people using the service.

Mental capacity assessments and best interest decisions were not recorded for the people using the service who were known to lack mental capacity. People and their relatives (when appropriate) had not been involved in developing their care plans.

The roles and responsibilities of the registered manager, the care manager and the cook who managed the home were not clearly understood by the people, their relatives, staff and visiting healthcare professionals.

Proper audits and checks on the quality and safety of the service were not in place. People and their relatives were not asked for their views about the service.

We saw examples of poor and inaccurate record-keeping during our inspection. Night time hourly checks were either completed wrongly or falsely and food and fluid balance charts were not kept properly. None of the people or their relatives said they’d ever made a complaint but the registered manager couldn’t find the complaints file during the inspection for us to check.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

There were enough staff to meet people’s needs but they were not always effectively deployed. We observed that staff time was often focused on supporting people attending the home for day care and not caring for the people who lived at York Lodge. We recommended that a dependency tool was used to calculate staffing levels.

We recommended that the service investigates and implements good practice in modern dementia care and improves the signage and aids to navigation in the building.

People and their relatives told us that the staff were caring. On the day of our visit people looked well cared for. Most staff spoke respectfully to people who used the service although we did see two incidences where people were spoken about in a demeaning way when they were present.

Staff had regular supervision and an annual appraisal with the care manager. Records of meetings were detailed; however they focused on adherence to policy and procedures and the care worker’s role and responsibilities.

We saw that the people using York Lodge for day care had more opportunities to take part in activities that those with complex needs who lived at the home.

People liked the food that was offered at the home, it was served generously and we saw that it was homemade from good quality ingredients; however, people were not given a choice before meals.

People told us they felt safe at the home. Staff could explain the different forms of abuse people may be vulnerable to and said they would report any concerns to one of the managers.

People and their relatives told us they thought staff were well trained. Staff told us they received regular training and could ask for more if they wanted it; records showed us that staff had received training. The induction programme was thorough and well documented.

We saw that Deprivation of Liberty Safeguards applications had been made for the people that needed them.

We saw people had access to a range of healthcare services, including GPs, district nurses and chiropodists which meant that people’s holistic health care needs were met.

Staff demonstrated they knew people’s individual personal histories, their preferences, likes and dislikes.

The service had provided end of life care to people and had received positive feedback from families whose relatives had been cared for at the home at the end of their lives.

The registered manager, the care manager and the cook were visible and involved in the care of the people using the service and could describe their needs and preferences.