We undertook an unannounced focused inspection of Red Lodge on 10 and 11 May 2018. This inspection was carried out following anonymous concerns raised with the Care Quality Commission (CQC). These concerns related to staffing levels, medicines management, completion of care records and reviews, and a lack of transparency from the registered provider. The first day of the inspection was unannounced. The manager was aware we would be returning on the second day.

The team inspected the service against three of the five questions we ask about services: is the service safe, is the service responsive and is the service well led. No significant changes were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them.

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

Red 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. Red Lodge is owned by the Joseph Rowntree Housing Trust (JRHT). The home is situated in New Earswick to the north of York city centre. Each person living at the home has their own flat and access to a range of communal areas, which include a restaurant, communal lounge and quiet areas.

Red Lodge is registered to provide care and support for up to 42 older people, some of whom may have a learning disability or autistic spectrum disorder. At the time of our inspection there were 34 people receiving a residential care service and 10 people living in the sheltered accommodation who received a personal care support service.

At the time of our inspection the registered manager was not at work. An interim manager was 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.

In the main the concerns which were raised anonymously with the CQC were not founded. However, we did identify some other areas of concern. At this inspection we found that there were breaches of two of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment and the governance of the service.

Risks to people had not been adequately assessed or mitigated which meant people were at risk of potential harm. One person's bedroom was not as clean as we would expect.

Care planning records did not always accurately reflect people’s changing needs and reviews were not always completed. Quality assurance systems were not consistently effective in identifying and rectifying concerns.

Despite these concerns people told us they received a good standard of care and felt safe. We concluded there were sufficient staff to meet people’s needs and overall medicines were safely managed.

People were provided with good end of life care and staff sought appropriate advice from health care professionals to ensure people were supported comfortably.

Although records related to people’s care were not consistently updated we saw people received a good standard of care from staff who knew them well.

People were confident that concerns they raised would be taken seriously and they were asked about the standard of care they received via a satisfaction survey.

The staff team, interim manager and registered provider were open and transparent throughout the inspection process and were committed to improving the service for people living at Red Lodge.

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

This inspection was carried out on 27 September and 4 October 2017. The inspection was unannounced on the first day and we made arrangements to return for the second day.

Red Lodge is owned by the Joseph Rowntree Housing Trust (JRHT). The home is situated in New Earswick to the north of York city centre. Each person living at the home has their own flat and access to a range of communal areas, which include a restaurant, communal lounge and quiet areas. The home has its own car park and benefits from outside garden and seating areas.

Red Lodge provides a care home service without nursing care and incorporates a domiciliary care service, which assists people residing in the on-site sheltered accommodation. The home is registered to provide care and support for up to 42 older people, some of whom may have a learning disability or autistic spectrum disorder. At the time of our inspection there were 30 people receiving a residential care service and seven people living in the sheltered accommodation who received a personal care support service.

The home had a manager in place and the provider had submitted an application to the Care Quality Commission (CQC), in respect of the manager's registration. A registered manager is a person who has registered with the CQC 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 last inspection in July 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to ensuring the suitability of workers, staff supervisions and risk management. At this inspection we found that improvement had been made in these areas and the provider was no longer in breach of regulation.

There was a robust recruitment procedure in place to ensure that staff employed were suitable to work in a care setting. Records were retained in relation to agency staff used by the provider, including information about the training they had completed.

Staff received an induction, regular supervision and training appropriate to the role in which they were employed. Checks of staff competency were also completed.

Risks in relation to people’s needs were assessed and generally appropriately managed, although we found gaps in one person’s care file in relation to individual risks. The information was updated during our inspection. Accidents and incidents were recorded and analysed in order to prevent reoccurrence. Checks of the premises and equipment were completed to monitor their safety.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff knew how to respond if they had any concerns. People we spoke with told us they felt safe.

There were mixed views about whether there was always sufficient numbers of staff to meet people’s needs promptly. The provider was reviewing the deployment of staffing across the home to enable staff to respond to people in a timelier manner. We will continue to review this at forthcoming inspections.

Systems were in place to ensure people received their medicines safely and the provider was taking action to ensure medicines were stored at the correct temperature.

The provider was meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in decisions about their care and for those people unable to make decisions about their care, these were made in their best interests using an appropriate process.

People were supported to maintain good health and had access to relevant health professionals when needed. People’s nutritional needs were met and information about their dietary requirements was recorded in their care plans.

People and relatives told us that staff were kind and caring. We observed positive a

This inspection was carried out over two days on 14 and 15 July 2016 and the inspection was unannounced.

Red Lodge is owned by the Joseph Rowntree Housing Trust (JRHT). The home is situated in New Earswick to the north of York city centre. Each person living at the home has their own flat, furnished with their own furniture, and access to a range of communal areas, which include a restaurant, communal lounges and quiet areas. The home has its own car parking and benefits from outside garden and seating areas.

Red Lodge provides a care home service without nursing care and incorporates a domiciliary care service, which assists people residing in the on-site sheltered accommodation. The home is registered to provide care and support for up to 42 older people, some of whom have a learning disability or autistic spectrum disorder. At the time of our inspection there were 35 people receiving a service.

The home had a manager in place and the registered provider had submitted an application to the Care Quality Commission (CQC), which was being processed to certify the individual as the registered manager. A registered manager is a person who has registered with the CQC 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 people received care and support that was managed by a wide range of risk assessments for the individual, the home and the environment. However, we found that risk assessments were not always appropriate or person centred and where people’s needs had been reviewed, resulting actions had not always been implemented.

We found that environmental risk assessments and reviews had been completed to help protect people and others from the risk of fire and waterborne diseases but at the time of our inspection, resulting actions were outstanding and remedial actions had not been implemented in a timely manner.

The registered provider showed us a health and safety file that contained reference to a policy and procedure for accident and incident reporting but the document was not available. We found that documented outcomes for and evaluations of accidents had not been completed to identify trends and reduce the risk of re-occurrence.

The registered provider undertook pre-employment checks for care workers they employed. These included checks with the Disclosure and Barring Service (DBS), details of pre-employment references, application forms and right to work in the UK documents. The provider undertook some additional checks when recruiting agency staff. However, these checks were inconsistent and failed to provide information to demonstrate care workers who worked in the service from employment agencies were always suitably trained and of appropriate character to work with vulnerable people.

People and care workers we spoke with voiced their concerns around the number of care workers available during the night shift. We were informed that staffing was reviewed and was adjusted dependent on the number of number of residents, their needs and any planned activities. People had access to a call system and care workers responded to people on an individual basis. We recommended the registered provider undertook a review of the effectiveness of night staffing.

People we spoke with told us they felt safe. Care workers we spoke with had received training in and understood how to recognise signs of abuse and discussed appropriate action they would take if they had concerns. We saw a safeguarding policy and procedure, however, the whistleblowing policy was in the process of being updated and a copy was not available in the file at the time of our inspection. Safeguarding concerns were managed appropriately with guidance sought from the relevant safeguarding authorities.

Safe systems and processes for the management of medic

We carried out an unannounced scheduled inspection of Red Lodge on 20 June 2014. A breach of a legal requirement was found. We made a compliance action for the registered provider to meet relating to the management of medicines.

In September 2014 a follow up visit to the service was carried out and revealed that the registered provider had made sufficient improvements so that the legal requirement was being met. However, we found a second breach of legal requirements in relation to general maintenance of records. Therefore a compliance action was made for record keeping.

In December 2014 when we visited again, we found that the registered provider was still not meeting the legal requirements in relation to records and was not meeting the legal requirements relating to the management of medicines again.

Therefore we took regulatory action in the form of a compliance action regarding regulation 13 and a warning notice regarding regulation 20 of The Health and Social Care Act [Regulated Activities] Regulations 2010.

These regulations have been revised since 1 April 2015 and are now superseded by regulations 12 and 17 of The Health and Social Care Act [Regulated Activities] Regulations 2014.

After the inspections in December 2014 the registered provider wrote to us to say what they would do in order to meet legal requirements in relation to regulations 12: Safe Care and Treatment, and 17: Good Governance.

We undertook this focused inspection in April 2015 to check that the registered provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last scheduled inspection, by selecting the 'all reports' link for Red Lodge on our website at www.cqc.org.uk

At our visit in April 2015 we were informed by the new ‘deputy head of care operations’ that the registered manager was absent from work with no immediate planned return and that the deputy manager was ‘acting up’ as manager. The new ‘deputy head of care operations’ had been appointed since our last visit and was supporting the acting manager to run the service. We were told by the outgoing ‘head of care operations’ that the organisation was looking at the current appointments within the service, with the view to developing the management team.

We looked at the changes made to the systems in operation and documentation held by the service. We found that there were sufficient improvements made with medication systems and recording of medicine administration to judge that they were safe for people that used the service. We found that risk assessments were being used more effectively to ensure risks for people were reduced. We found that general record keeping had improved sufficiently to enable the service to evidence the care and support that was being delivered to people.

We judged that the service still had to embed the changes it had made in care delivery and to introduce further improvements in the overall service people received.

We recommend that the service considers the current guidance on risk assessments for people who self-administer medicines.

We recommend the service continues with improvements in record keeping and introduces patient passports.

This was a follow up inspection undertaken by an inspector and a pharmacist inspector. When we inspected the service in September 2014 we found that records kept by the service were not well maintained. The provider sent us an action plan following the inspection, telling us of the improvements they were making to achieve compliance. This inspection was to check that these improvements had been made.

The inspectors visited the service and the information they collected helped answer one of our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

Medicines were not always managed safely for people and medication records had not been completed correctly. This increased the risk of people not receiving their medications safely and as prescribed.

Care plans overall were not well completed. Some records were inaccurate or incomplete. This increased the risk of people living at the service receiving unsafe, inappropriate care. The lack of robust risk assessments also increased the risk of people's care needs not being well managed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing medication and maintaining accurate records.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable

Is the service responsive?

Not applicable.

Is the service well-led?

Not applicable.

We carried out this inspection to answer one of our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also wanted to check that the provider had taken action to improve one area that we found non-compliant at our last inspection of the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw overall that people were receiving their medications as prescribed. People told us that staff supported them in a kind and sensitive way. Those people we spoke with told us they received their medication at the times they wanted them and they could not recall an occasion when the service had ever run out of their medicines.

We found some written records to help staff provide the right care and support were not in sufficient detail to enable staff to provide this support safely and appropriately. There were no care records relating to ‘as required’ medication nor the administration of creams and ointments. The lack of records for staff to refer to increases the risk of the individual receiving inconsistent, inappropriate or unsafe care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining accurate and up to date records.

Is the service effective?

Not applicable

Is the service caring?

Not applicable

Is the service responsive?

Not applicable

Is the service well-led?

Not applicable

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also wanted to check that the provider had taken action to improve one area that we found non-compliant at our last inspection of the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People living at Red lodge felt safe because their rights and dignity were respected and they were supported to make decisions about how they spent their time.

People’s care needs were assessed before they moved to the home so that the provider was satisfied that staff had the skills and knowledge to support the individual safely and appropriately.

People were protected from the risks of harm because the service assessed that risk and where necessary introduced measures to minimise that risk. We noted though that some improvements in record-keeping would better evidence this.

People were not always protected against the risks of unsafe medication management. We have told the provider to take action to improve this area of care and we will re-visit the service to check these improvements have been made.

Is the service effective?

People were encouraged to express their views about their care and their care records included some information about their preferences and choices. This helped to ensure these views were taken into account when care was planned.

People were involved in decisions and choices about their nutrition and hydration needs, although the records evidencing these discussions could be improved.

People who chose to look after their own medications were assessed and regularly monitored to check they were still willing and able to have this responsibility. This promoted people’s independence and wellbeing.

Staff were supported to undertake training and refresher training so they had the up to date skills and knowledge to support people safely and appropriately.

Is the service caring?

People were supported by kind, friendly and attentive staff. They told us “The staff are wonderful. They let you do things for yourself but are there to help if you need them.” One visitor commented the home was ‘fine’ and ‘super’. They added “We’re pleased our relative has ended up here. Our family has experienced other care services and this is the best.”

We noted that care staff were polite and respectful towards people living there. None of the visitors could recall an occasion when they had observed or seen any staff behaviours or attitudes that caused them concern.

The manager was a visible presence in the home. People told us he regularly talked with them and checked on their welfare. This helped them feel listened to and meant they had the opportunities to speak about how they were feeling, and how the home was being run.

Is the service responsive?

The provider actively sought people’s views about how the service was operating. The provider acted on those views and fed back to people where possible, so people knew they had been listened to.

There were a range of activities and these were provided following discussion with the people living there. This meant they were tailored to the group’s needs, not what the provider thought they would like.

People were regularly reminded about the need to inform the manager or staff if they had a concern or worry, so that these could be properly looked into and addressed.

Is the service well-led?

The provider had a quality assurance system to monitor the quality of the service delivery. This needed to be built on to ensure audits were conducted in a robust and consistent way.

The provider had a clear senior and local management team and staff were aware of their roles and responsibilities and felt valued and listened to. This helped to promote a supportive team that worked together to provide quality care.

People told us that their rights were respected and that they were supported in making choices and decisions regarding their care. All of the people we spoke with confirmed that they were treated with dignity and respect and said that staff were polite and friendly.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. A person we spoke with said "I’m so glad I am here, it’s a nice place.” We saw that people were supported to maintain their independence and observed a warm and friendly rapport between those living and working within this service.

There were policies and procedures in place which helped to protect people from abuse. Issues raised were referred appropriately to the local authority's safeguarding of vulnerable adult's team for further investigation or advice. This helped to protect and safeguard

people.

We saw that there were sufficient staff on duty and staff received training to ensure that they had the skills they needed to be able to look after people safely. A member of staff said "It is a very good organisation to work for; we are kept up to date with our training."

There were quality monitoring systems in place to gain the views and opinions of people regarding the way in which the service was ran. One person told us "We often have meetings where we are asked for our views and opinions."

People we spoke with said that they were treated with dignity and respect and were involved in decisions regarding their care. Comments included "I am treated with dignity, it’s a lovely place” and “My GP visit’s me here and staff help make appointments for me. I go to activities, I enjoy them and it gets you out.”

All of the people we spoke with said that they were well cared for by staff. They told us that there was a restaurant on site which many people used and people said that the food was good. Other comments included "Staff are very good, they are really helpful” and "I get lots of help, the staff visit every day, I couldn't be better looked after.”

People said they felt safe and there were systems in place which helped to protect people. Comments included "I feel safer here than I did in my own bungalow" and "I know if I press my alarm, staff will come and check on me."

Staff were recruited safely with relevant checks being completed to ensure that they were suitable to care for people. People told us "They are often short staffed which means sometimes you can wait” and “They are all very nice girls but they are often really busy.”

People said they felt confident in raising any concerns and said that they felt these were appropriately addressed.

People told us that they were consulted about their care, treatment and the support options which were available to them. They said that their views were sought and were acted upon so they felt they were central to the decisions being made about their care. One person said ‘I can read my care plans and risk assessments and I agreed with what they say’. Another person said ‘l feel that my rights are respected by the staff at the home’.

The people we spoke with told us that they received help and support when they needed it. One person said ‘The staff know how to help me’. Another person said ‘I can choose what I want to do and the staff encourage me to be as independent as possible. The staff assist me with the things I cannot do for myself’.

People told us that they knew how to raise concerns and said they felt any issue raised would be dealt with. One person said ‘I feel protected living here’. Another person said ‘I have not had any concerns to raise at all. I feel safe’.

We were informed by people we spoke with that they felt the home was a nice place for them to live in. One person said ‘It is the first home I have been in and I like it’. Another person said ‘The environment is good it is well looked after. I think it is going to be improved in the future’.

Those people who we spoke with during our visit said that staff had the skills they needed to be able to care for them. People confirmed that they were happy with the service that they received from the staff. One person said ‘They seem to know what they are doing’. Another person said ‘The staff have training to help them look after me’.

People we spoke with told us that the manager and staff asked them everyday if everything was alright for them. One person said ‘We are asked for our opinions which are taken into account’.