York Lodge

York Lodge is located in Crowborough and provides accommodation and personal care for up to 22 older people. The home also provides respite (short -term) care for people. The home is set out over three floors with a basement for the laundry facility. There is lift access between the ground floor and upper levels. At the time of our inspection there were 22 people living at the home. Everybody living at York Lodge was living with dementia and some people had mobility and sensory challenges.

People’s experience of using this service and what we found

Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, there were areas of peoples’ documentation that needed to be improved to ensure staff had the necessary up to date information to provide consistent, safe care. Whilst care plans identified a care need, there was a lack of clear guidance and changes to care needs were not clearly defined. Staff were able to discuss best interest decisions and who was involved, however these and the rationale for the decision was not always documented. This meant that agency staff and new staff would not have the relevant information to support care decisions. This included the use of sensor mats and covert medicine.

People received safe care and support from staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I feel safe here.” A visitor told us, “Staff are very vigilant about peoples’ safety, good security.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with the use of walking aids and specialised cutlery for eating. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were regularly reviewed following falls or changes in a person's health condition. Safe recruitment practices had been followed before staff started working at the service.

Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “It’s really lovely here, everyone works as a team to make sure we support people in the safest and best way. We got lots of training to do this.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One visitor said, “Very kind and polite staff, the atmosphere is good, I feel welcomed every time I visit.” People were relaxed, comfortable and happy in the company of staff. People’s independence was considered important by all staff and their privacy and dignity was promoted.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.

There was a stable staff team who were knowledgeable about the people they supported and had built

trusting and meaningful relationships with them. Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with family and members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as method sign language, pictures and objects of reference, to gain their views.

People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. End of life care was delivered empathetically and with respect and dignity.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve and had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.

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

Rating at last inspection and update:

The last rating for this service was Good (published 20 May 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 were able to give feedback and have choice in what they ate and drank. One person told us, "The food is very good, no complaints.” Special dietary requirements were met, and people's weight was monitored, with action taken when required. Health care was accessible for people and appointments were made for regular check-ups as needed.

There was a positive, welcoming and friendly atmosphere within the home. People’s right to privacy and dignity was respected and staff had built positive relationships with people.

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 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.