The service was inspected on 7 and 8 December 2016 and was unannounced. The inspection was prompted in part by notification of an incident following which a service user sustained a serious injury. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the risk of unsafe management of medicines. 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