Castleford Lodge

Castleford Lodge provides accommodation for up to 60 older people who require nursing or personal care, some of whom may be living with dementia. At the time of our inspection there were 44 people using the service. The care home accommodates people across two floors, the ground floor specialises in dementia care with nursing, and the second floor provides residential and nursing care.

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

This was a targeted inspection that considered how people’s medicines were managed. Based on our inspection we found the provider had systems and protocols in place to ensure people received their medicines as prescribed.

Staff were suitably trained, and assessments were carried out to ensure staff were competent to administer medicines. We saw staff administering medicines in line with national guidelines.

We observed staff interacting with people and found they were kind and considerate in their approach.

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

Rating at last inspection

The last rating for this service was good (published 17 May 2022.)

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of medicines. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

We undertook this targeted inspection in response to a specific concern regarding the management of medicines. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castleford Lodge on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental health needs. The accommodation is arranged over two floors with units specialising in dementia care and nursing on the ground floor and residential and nursing care on the second floor. There were 48 people living at the home on the day of our inspection.

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

Systems in place to monitor the service were not always effective. Audits in place had not always identified the concerns we found on inspection. Although concerns raised were swiftly addressed, systems and approaches required improvement. The provider had identified this and was implementing a new auditing system from 1 May 2022. However, this needed embedding in to practice.

We observed staff interacting with people and found they were kind and friendly. The home had three activity co-ordinators who were available throughout the week. However, there were some areas where person centred care required improvements. This included making sure personal items, such as hairbrushes and toiletries were named and improving some aspects of people’s mealtime experience. The registered manager had commenced action to improve the mealtime experience and new menus were due to commence in May 2022.

We carried out a tour of the home and found some areas required cleaning. Other areas needed some maintenance work to ensure they could be cleaned effectively. The registered manager took immediate action to address these issues.

The provider had a tool which was used to identify the number of staff required each day, based on the needs of the people using the service. We found there were enough staff available to meet people’s needs in a timely way. The provider had a safe recruitment procedure to ensure suitable staff were employed.

Accidents and incidents were recorded and analysed to identify any trends or patterns. This helped to mitigate future risks and ensured lessons were learnt. Risks associated with people's care had been identified and plans were in place to mitigate risks.

Staff were knowledgeable about safeguarding and confirmed they had received training in this subject. They knew what actions to take if they suspected abuse.

The manager had been in post since January 2022, prior to this the home had several interim managers. Staff we spoke with said the new manager had begun to take action to address issues and shortfalls within the home.

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

Rating at last inspection

The last rating for this service was good, with requires improvement in the responsive key question (published June 2018).

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Castleford Lodge on our website at www.cqc.org.uk

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.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental health needs. The accommodation is arranged over two floors with units specialising in dementia care and nursing on the ground floor and residential and nursing care on the second floor. There were 44 people living at the home on the day of our inspection.

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

People told us they were well cared for and we saw further evidence that this was the case during the inspection. We observed staff approaching people in a caring and respectful manner. Staff demonstrated they knew people’s individual needs and preferences well.

We found the provider had effective systems in place to safeguard people from the risks associated with abuse. There was effective management of risk and staff were recruited, trained and deployed to ensure people’s needs were met. People were protected from the risk and spread of infection and people’s medicines were managed safely.

There was a range of activities available for people to participate in. Staff were enthusiastic and people told us they felt there was enough activities. People had been supported to stay in touch with those important to them throughout the pandemic.

There were effective systems of governance, monitoring and review in place, with good evidence of provider oversight to ensure the service was working to the provider’s expected standards. There was evidence that feedback from people and their relatives had been sought and acted upon in positive ways. There was an emphasis on improving the service, and ensuring it was person centred. There was evidence of staff working in partnership with other agencies. This helped deliver individualised care and supported people’s access to other healthcare and social care services.

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

Rating at last inspection

The last rating for this service was good, with requires improvement in the responsive key question (published June 2018).

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Castleford Lodge on our website at www.cqc.org.uk.

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.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental health illnesses. There were 44 people living at the home on the day of our inspection. The accommodation is arranged over two floors with the dementia nursing unit on the ground floor and the nursing and residential unit on the second floor. There is a passenger lift operating between both floors.

There was a registered manager at the service at the time of our inspection. 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 saw the provider had improved systems for the purpose of assessing and monitoring the quality of the service. This showed through audits that this was an effective system. We saw accident and incidents were recorded and analysed to look for any trends. However, further improvements were needed to ensure where actions were completed these were recorded appropriately.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes. People told us they were cared for. There was mixed views in relation to the staffing levels some people and relatives felt there was not enough staffing. At the time of inspection through observations and documentation we felt there were enough staff to support people’s needs.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). The service was meeting the requirements of the Mental Capacity Act 2005 (MCA). We felt staff had confidence in using the MCA to make best interest decisions for people who lacked the capacity to make decisions in relation to their care.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering, storage and disposal of medicines. We discussed with the registered manager about the importance of using body maps to support where topical creams were to be applied.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

People told us the food at the home was good and they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

We saw the home had a range of activities in place for people to participate in. Staff were enthusiastic and people’s relatives told us they felt there was enough activities. This meant people’s social needs were being met. However we did speak to the registered manager in relation to the level of noise in the dementia area. We saw some people enjoyed the music but others stood up and started walking away. The registered manager said they would look into this and discuss at the next staff meeting.

We looked at four staff personnel files and saw the recruitment process in place ensured that staff were suitable and safe to work in the home. Staff we spoke with told us they received supervision and had annual appraisals carried out by the registered manager. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended.

We found that staff had training throughout their induction and also received annual refresher training in areas such as moving and handling, Mental Capacity Act 2005, DoLS, safeguarding, health and safety, fire safety, challenging behaviour, first aid and infection control. The home had an action plan in place to ensure that staff were booked in for the relevant training when required. This meant people living at the home could be assured that staff caring for them had up to date skills they required for their role.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental health illnesses. There were 31 people living at the home on the days of our inspection. The accommodation is arranged over two floors with the dementia nursing unit on the ground floor and the nursing and residential unit on the second floor. There is a passenger lift operating between the two floors.

There was no registered manager at the service at the time of our inspection. 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 our previous inspection we found people were not protected from harm by other people living at Castleford Lodge as staff were not always available to observe and respond to incidents. At this inspection we found staffing levels had increased which meant staff were more visible and responsive to people at the home. In addition, measures had been put in place to ensure there were more objects around the dementia friendly area to provide occupation for people such as prams, a wheel barrow, dolls and sensory items.

At our last inspection we found moving and handling risk assessments and care plans were not completed adequately and we saw poor moving and handling practice during our inspection. At this inspection we saw improvements had been made in this area and we saw no poor moving and handling practice during this inspection. Systems to ensure assistive equipment was in good working order had improved and we saw a wheelchair with missing footrests had been removed from use and placed in the manager’s office until the plates could be located.

At our last inspection we found areas of the home were not always thoroughly clean to ensure the risk of infection was minimised. At this inspection we found liquid soap and personal protective equipment were in place to ensure good practice was followed and the registered provider had implemented systems to ensure areas were cleaned thoroughly.

We found decision specific mental capacity assessments had been carried out for people living in the dementia unit which were compliant with the Mental Capacity Act 2005 and there had been an improvement on the nursing unit. Staff would be receiving further training to fully embed the principles of the Act. Deprivation of Liberty Safeguards had been appropriately applied for and authorisations were in place or awaiting authorisation by the relevant body. The registered provider had obtained confirmation of Lasting Power of Attorney’s for health and welfare decisions to ensure consent obtained from family members was lawful. Recorded consent in people’s care files had improved to evidence they had consented to care and treatment.

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

People’s weights had been consistently recorded to ensure those at risk of weight loss were adequately monitored and there had been an increase in people’s weights since our last inspection, assisted by the access to snacks during the day and the fortification of meals in addition to staff recording who had eaten.

We observed staff were kind and caring when they were supporting people with care. They treated people with dignity and respect.

Although record keeping had improved at the service further improvements were required to ensure accurate care plans, evaluations and monitoring. The registered provider was changing the system of recording to an electronic system with hand held records. The daily monitoring of care interventions showed an improvement to the paper based system as staff could input information as soon as care was provided.

There had been a lack of leadership at the home and audits had been completed poorly at our last inspection. Leadership had improved and the registered provider had regular input into the service to measure improvements and was effectively assessing and monitoring the quality of the service provided to people and as a result improvements were on-going. Systems and processes were more robust to ensure the service was working towards full compliance with the regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We identified a breach of Regulation 17 (good governance) at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Castleford Lodge provides accommodation and nursing care for up to 61 older people, some of whom may be living with dementia and other mental illnesses. There were 43 people living at the home on the days of our inspection. The accommodation is arranged over two floors with the dementia nursing unit on the ground floor and the nursing and residential unit on the second floor. There is a passenger lift operating between the two floors.

There was a registered manager who had been registered since October 2016 but they were absent from the service at the time of our inspection. 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.

People at the service were not protected from harm by other people living at Castleford Lodge. We found staff on the dementia unit were not always observing or responding to incidents between people using the service. This meant there was an under recording of incidents which were not always fully investigated to implement actions to prevent a reoccurrence.

Moving and handling risk assessments and care plans were not completed adequately and we saw poor moving and handling practice during our inspection. Risks around the use of assistive equipment such as wheelchairs, bathing equipment, shower chairs and specialist seating systems were not always recorded to ensure identified risks were reduced to the lowest possible level. There was no robust system in place to ensure faulty equipment was removed from use.

We found areas of the home were not always thoroughly clean to ensure the risk of infection was minimised such as faeces on mattresses, bed rail bumpers and carpets. Not all areas had liquid soap or personal protective equipment to ensure good practice was followed.

We found decision specific capacity assessments had been carried out for people living in the dementia unit which were compliant with the Mental Capacity Act 2005. In contrast, we found capacity assessments on the nursing unit which were not decision specific.

Deprivation of Liberty Safeguards had been appropriately applied for and authorisations were in place or awaiting authorisation by the relevant body. However, we found one person’s conditions attached to their authorisation had not yet been incorporated into their care plan. Staff were not aware who had a Lasting Power of Attorney for health and welfare decisions to ensure consent obtained from family members was lawful. We also found a lack of recorded consent in people’s care files to evidence they had consented to care and treatment.

Not everyone was provided with a meal on the day of our inspection and there was a lack of system in place to ensure people received adequate nutrition and hydration. In addition, people’s weights had not been consistently recorded to ensure those at risk of weight loss were adequately monitored.

We observed some staff were kind and caring when they were supporting people with care. They treated people with dignity and respect. However, we observed some people were ignored by staff and they did not have their care needs met or were left to wait.

Some records contained person centred information detailing people’s preferences and choices. However, other records lacked detail and were incomplete in this area. We found care plans did not always evidence people’s care needs and daily records for several people did not evidence care had been provided such as oral care or foot care.

Not all complaints had been recorded in line with the registered provider’s procedures, which meant there was no opportunity to learn from the experience or for management to recognise there was an issue with care delivery.

We found there had been a lack of leadership at the home. Not every area of care had been audited to determine the quality of the service provided. Where audits had been completed and actions identified, these had not been undertaken. For example, there had been ongoing issues with the management of medicines which had been identified at management audits but improvements had not been sustained. Staff were assessed as competent to manage medicines but still made errors which demonstrated a lack of robustness in the systems used at the home.

The registered provider had failed to effectively assess and monitor the quality of the service provided to people and as a result any improvements that had been made were not sustained. Records relating to people who used the service and staff employed were not accurate enough to withstand scrutiny and systems and processes were not robust enough to ensure full compliance with the regulations.

We found the service was in breach of several regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 inspected 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 for 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