18 December 2020
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014. At this inspection we looked at the safe, effective and well-led domain.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection team consisted of two inspectors.
Service and service type
York Lodge Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was as a health and safety measure due to the coronavirus pandemic.
Inspection activity started on 15 September and ended on 6 October 2020.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections.
We used all this information to plan our inspection.
During the inspection
We spoke with four relatives about their experience of the care provided. We spoke with six members of staff including the provider, registered manager and care assistants. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We contacted other professionals who have supported people at the service. We held a meeting with the provider and local authority to seek assurances around improvements required at the home.
18 December 2020
About the service
York Lodge residential home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. York Lodge accommodates up to 22 people in one adapted building. At the time of the inspection there were 13 people using the service. Of the 13 people, 11 people were using the service on a short term basis as part of the discharge to assess process. This process supports people being discharged from hospital for further assessment about their care needs.
In early 2020 we were informed by the provider that they intended to close the home. Some people living at the home subsequently moved out. Due to the coronavirus pandemic the home remained open to support people being discharged from hospital. The provider has given assurances that there are no plans for the home to close.
People’s experience of using this service and what we found
We found that there were breaches of the regulation.
The home required further modernisation to create a dementia friendly environment for people using the service. The service had not been adapted, in line with best practice guidance, to support people with dementia. Since the inspection the provider has given assurances that they are committed to improving the environment of the home and work has commenced in this area.
Risk assessments were in place to reduce risk to people using the service.
Not all staff had a criminal record check in place before commencing work at the service. This meant the risk to people using the service had not been effectively mitigated.
The registered manager completed weekly audits of the home. The audits did not identify all required updates to the home or ways to create a more dementia friendly environment for people.
Where areas of improvement within the home were identified, the provider had not always acted in a timely manner to drive improvement. Since the inspection the provider has given assurances that they are committed to driving improvement at the home.
We observed kind and respectful exchanges between staff and people using the service.
Staffing levels were good. Staff felt that they had enough time to support people in a person-centred way.
Medicines were administered safely. Improvements had been made to support people with ‘as required’ medication.
The registered manager and wider management team were approachable. People told us that they felt able to raise any concerns.
People were asked for their consent prior to receiving care interventions. People and their relatives were involved in decision making and risk assessments. 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.
Staff worked well with partner agencies to support people being discharged from hospital for further assessment.
We have recommended the provider pays due regard to national best practice to make reasonable adjustments to support people who used the service to find their way easily and independently around the service.
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 requires improvement (published 28 May 2019) and there were four breaches of regulation.
Following the last inspection we took enforcement action including issuing a warning notice relating to the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulation.
The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. Since this inspection we have met with the registered provider and registered manager to seek assurances regarding improvements.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for York Lodge Residential Home on our website at www.cqc.org.uk.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified a continuing breach in relation to good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Following the inspection we met with the provider to discuss the improvements required at the service. We will work alongside the provider and local authority to monitor progress. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.