Residents told to wait to use the toilet, staff too busy to read care plans and alarm bells sounding continually have all been witnessed at a Leeds care home.
The latest inspection of Wykebeck Court Care Home, on York Road, by the Care Quality Commission (CQC) has found there are not enough staff placing people "at risk of harm".
The Bupa run care home provides nursing and personal care for up to 84 people, some of whom may be living with dementia.
At the time of the inspection in January 2019, 45 people were using the service.
The report, published on April 3, 2019, criticises the home over staffing levels stating that too few staff, and the poor management of them has led to patients being put at risk.
A relative told inspectors their family member had become distressed while waiting 10 minutes for staff to respond to them and that staff were not familiar with their family member's care.
The report said: "Staff did not offer any reassurance or emotional support to a person who appeared visibly distressed."
Inspectors saw employees not following guidance in a person's care plan and were told by staff that they hadn't had time to read them.
The report says staff appeared under pressure and didn't seem to have relationships with patients, who appeared 'withdrawn'.
They said: "Staff appeared very busy and we observed very little meaningful interaction or activity between staff and people.
"People sat for a long period of time in one of the lounges with little or no interaction from staff. People appeared withdrawn.
"One person asked to go to the toilet and was asked to wait for a few minutes for another member of staff to become available."
General management of the service was not good enough according to the CQC who were told by staff that they often went without breaks and found it difficult to care for people.
The report continues: "Some areas of the home were not staffed and staff did not always respond to people who needed care and support and important duties such as pressure ulcer care were not always completed and we found call bells sounded continually."
The CQC were also concerned about resident's privacy and dignity weren't always respected having been told by a member of staff: "I've walked in when people are not covered up during personal care; sometimes the doors are not closed."
In conclusion the CQC said: "The service was not well managed.
"We consistently found there was a difference in understanding in how the management team believed care was being delivered and actual staff practise.
"As a result, people were placed at risk of harm and not having their needs met."
The CQC gives an overall rating based on five criteria, the safety, effectiveness, care, responsiveness and leadership of the service.
Wyebeck Court was rated as "requires improvement" for the first four and "inadequate" in its leadership.
The inspection identified four breaches of the Health and Social Care Act:
In the wake of the report Bupa quickly brought in interim management to offer support and an experienced home manager with 25 years experience has been appointed to join the team in June.
Amy O’Donoghue, Regional Director for Bupa Care Services, said: “Since the inspection we’ve made significant improvements including improved training for staff, and we continue to drive change within the home.
"We’re also introducing a new management team to ensure these changes have long-lasting results.
“As a new-build property, Wykebeck is set up to deliver care in clean and comfortable surroundings.
"As we continue to make improvements, I’m confident we can deliver the high standards that both we and our residents expect.”
Wykebeck Court is one of 10 care homes in Leeds that have been ordered to improve by the CQC in the last six months.
The other nine can be found here.