Royley House Care Home

Royley House care home is a residential care home providing accommodation and personal care for up to 41 people, some of whom are living with dementia. At the time of our inspection there were 13 people living at the home. The home is an adapted building set in its own grounds with accommodation over two floors. Only the ground floor was occupied at the time of this inspection.

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

Medicines were managed safely. Improvements had been made in staff knowledge, understanding and use of the electronic medicines system. The provider carried out recruitment checks to make sure staff were suitable to support and care for vulnerable people. There were enough staff to care for people safely. Staff had received training in safeguarding adults and knew how to recognise and report abuse or neglect. Infection control practices were in place and the home was clean and well maintained.

Relatives spoke positively about the home and told us they would recommend it. Since our last inspection management of the home had stabilised and changes and improvements had been sustained and embedded in practice. Quality assurance systems to monitor the service were in place and used effectively. There were arrangements in place to make sure any accidents, incidents and complaints would be fully investigated, and people and relatives would be involved and informed of the outcome. Relatives we spoke with were happy with the way the service communicated with them, although they commented they had not been asked to complete a satisfaction survey. This is currently being devised and distributed. Staff worked well with other healthcare professionals to ensure people’s health needs were met.

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 10 August 2021). There were breaches of two regulations. At this inspection enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the key questions of Safe 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 improved to good.

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 Royley House 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.

Royley House care home is a residential care home providing personal care for up to 41 people. At the time of our inspection there were 15 people living at the home. The home is an adapted building set in its own grounds with accommodation over two floors. Only the ground floor was currently occupied.

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

We found further improvements were needed in the management of medicines and the governance of the service to ensure changes were embedded and sustained.

People told us they felt safe living at Royley House care home. Staff had received training in safeguarding and knew how to identify and report any concerns. Enough staff were deployed to meet people’s needs and keep them safe. The home had recently been refurbished to a high standard. Equipment was regularly checked and serviced in line with guidance. Good infection control practices were followed.

Improvements had been made in staff training and supervision since our last inspection. Training was up to date and staff now received regular supervision. Assessments were completed prior to people’s admission to the home. This ensured the home was suitable for their needs. 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. People were happy with the choice of food provided and mealtimes were pleasant and sociable. People’s healthcare needs were being met, with referrals made to healthcare professionals when needed.

There had been greater provider oversight at the service since our last inspection, and the employment of a new manager. Some improvements had been made. However, we found continued concerns around the management of medicines and the governance of the service and continued breaches of regulations.

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 (report published 19 February 2021). We found breaches of three regulations. At this inspection enough improvement had not been made and the provider was still in breach of two of the regulations.

Why we inspected

We carried out a focussed inspection of this service on 8 December 2020. Three breaches of legal requirements were found.

We undertook this focussed inspection to follow up on enforcement action we took following our last inspection and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of 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 requires improvement. This is based on the findings at this inspection. This service has been rated requires improvement for the last five consecutive inspections.

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

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.

Enforcement

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 have identified breaches in relation to the management of medicines and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Royley House is a residential care home providing personal care for up to 41 people. At the time of our inspection there were 22 people living at the home. The home is an adapted building set in its own grounds with accommodation over two floors.

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

Managerial oversight of the home had been inconsistent during 2020. This meant improvements needed following our last inspection in 2019 had not been fully implemented or sustained. We found continued breaches of the regulations of the Health and Social Care Act 2008. However, a new manager had recently been appointed and staff and relatives spoke positively about them and the changes they had started to make at the service.

We again found improvements were needed in the management of medicines, in particular with the operation of a newly introduced electronic medicines system.

Staff supervision meetings had not been held regularly throughout the year and some staff had not completed the training necessary for their role.

Recruitment procedures were robust and there were enough staff to care for people safely.

Relatives told us they were happy with the care and support provided by staff. Staff told us they would report any safeguarding concerns and safeguarding training had been completed.

Large areas of the home had recently been refurbished to a high standard. Correct infection control procedures were followed, and the service had taken additional infection control measures to minimise the risk posed by COVID-19.

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 requires improvement (report published November 2019). There were breaches of Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan 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 regulations.

Enforcement

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.

At this inspection we identified breaches in relation to the management of medicines, staff training and supervision and governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Royley House is a residential care home providing accommodation and personal care to 38 people aged 65 and over at the time of the inspection. The service can support up to 41 people. Royley House accommodates people in one adapted building over two floors; each floor has a lounge and dining room.

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

The provider had consistently failed to ensure safe and effective governance of the service. This inspection rating demonstrates a fourth consecutive overall rating of requires improvement.

Audit systems and processes had been established. However, the provider had not ensured they were robust enough to operate effectively to ensure compliance with the regulations.

Mandatory training was not up-to-date for all staff and we found gaps in staff training.

We found concerns regarding the safe management and administration of medicines.

Improvements were needed to the décor and we have made a recommendation to make the home more dementia friendly.

There were good, established working partnerships with other healthcare professionals. People received timely medical assistance where necessary.

Accidents and incidents were managed well, and action was taken to help lower future risks.

Feedback from people and their visitors told us they felt staff were caring and kind. Observations showed us people were treated with dignity and respect.

Care plans were very person-centred and reflected people’s choice and preferences.

People and their families received good end of life care from compassionate and caring staff.

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.

The registered manager was visible around the home. Our observations and feedback received, showed us the manager was approachable and keen to ensure people were happy living at Royley House.

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 (8 October 2018) and we found one breach of regulations. 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 not improvement had been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to the safe management of medicines, staff training and good governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection the service had a registered manager. 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. Staff told us they felt supported by the registered manager and people who lived at the service and relatives spoke highly of her commitment to the service.

At our last inspection in August 2017 we rated the service Requires Improvement overall. We found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not received adequate supervision. At this inspection we found that staff had received regular supervision and the service was therefore not in breach of this regulation. However, we found concerns with the management of medicines and the safety of the fire extinguishers and water temperatures. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The management of medicines was not always safe. Protocols for the administration of ‘when required’ medicines were not in place. The administration of topical medicines was not recorded safely. One person’s eye drops had not been recorded as given for two weeks. We could not be sure they had received this medicine. Some steps were taken during our inspection to rectify these concerns.

The home was clean and well-maintained. Most areas were nicely decorated. However, the corridors were in need of redecoration and the corridor carpets were in a poor condition. There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas and electricity were up-to-date. However, we found that no action had been taken when concerns about the fire extinguishers and water temperatures had been found.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on newly recruited staff to ensure they were suitable to work in a care setting. At the time of our inspection there were sufficient staff to respond to the needs of people.

Risk assessments had been completed to show how people should be supported with everyday risks.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. All staff received regular supervision. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns.

Staff worked closely with health care professionals to ensure people were supported to maintain good health. People were supported to eat a well-balanced diet and were offered a choice of home-cooked meals.

The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent before helping and supporting them.

People who used the service and relatives were complimentary about the home. We observed kind and caring interactions between staff and people who used the service. Staff respected people’s privacy and dignity and promoted their independence.

People's care plans contained detailed information about their preferred routines, likes and dislikes and how they wished to be supported. A range of activities were available for people to take part in.

The service had a formal process for handling complaints and concerns. We saw that complaints had been dealt with appropriately.

There were a range of policies available for staff to refer to for guidance on best practice. There were quality assurance processes in place to monitor the quality of the service and ensure it was maintained and improved. However, they had not picked up the areas of concern we found during our inspection.

Royley House is situated close to the centre of Royton, Oldham. It provides care and support for up to 41 people. At the time of our inspection there were 32 people living at the home. Accommodation is provided over two floors which are accessible by a passenger lift. Each floor has its own lounge and dining room and there is a large garden to the rear of the property. Some of the bedrooms have en-suite facilities.

We last inspected Royley House in October 2016. At that inspection we rated the service ‘Requires Improvement’ overall, with the ‘Well-led’ domain being rated ‘Inadequate’. At that inspection we identified three regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to infection prevention and control, medicines management, staff training and poor governance. We issued warning notices in respect of the three regulatory breaches. Following the inspection the provider sent us an action plan detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found improvements had been made. However, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staff supervision. You can see what action we asked the provider to take at the back of the full version of this report.

The service had a registered manager. 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.

Staff understood safeguarding procedures and what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

Medicines were stored safely and were administered by staff who had received appropriate training and been assessed as competent to safely administer medicines.

The home was clean and free from any unpleasant odours. The dining rooms and some of the bedrooms had recently been redecorated to a high standard and there was an on-going programme of redecoration. Procedures were in place to prevent and control the spread of infection.

Environmental checks of the home, such as for the gas and electricity supply were up-to-date. However, tests of the fire alarm and water temperature had not been carried out as frequently as they should have been. The registered manager has taken steps to rectify this since our inspection.

Staff had undertaken a variety of training to ensure they had the skills and knowledge required for their roles. All new staff received a comprehensive induction.

Staff supervision was not carried out in line with the supervision policy. Some staff had not received any supervision during 2017.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. People we spoke with were happy with the quality of food provided.

Everyone we spoke with was complimentary about the staff and we observed staff to be kind and patient with people they supported. Care plans, which were reviewed regularly, were detailed and reflected the needs of each individual.

An activities coordinator encouraged people to participate in a wide range of activities.

There were a range of policies available for staff to refer to for guidance on best practice. There were quality assurance processes in place to monitor the quality of the service and ensure it was maintained and improved.

We last inspected Royley House in November 2014. At that inspection we found the service was meeting all the regulations we assessed.

Royley House was originally built as a sheltered housing project and is situated close to the centre of Royton, Oldham. In 2000 it was taken over by RochCare Ltd and transformed into a care home for older people, where it provides accommodation for up to 41 people. At the time of our inspection there were 31 people living at the home. Some of the bedrooms were vacant because the owners were undertaking a programme of refurbishment. Accommodation is provided over two floors which are accessible by a passenger lift. Some of the bedrooms have en-suite facilities. Each floor has its own lounge and dining room and there is a large attractive garden to the rear of the property.

The service had a registered manager. 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 identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Infection prevention and control measures were not thorough enough. Posters detailing the correct handwashing procedure were not on display and we observed a carer instil eye drops without first washing their hands. We were unable to find evidence to show us that staff had received recent training in infection prevention and control.

Medicines were not managed safely. An action plan put in place following a recent medicines error had not been implemented in full. We found unsafe practice in relation to the administration of insulin.

Staff had an understanding of safeguarding procedures, how to identify signs of abuse and what action they would take to protect people in their care. However we could not find evidence to show that all staff had received recent training in this area.

The registered manager was unable to provide us with evidence to confirm that staff had received appropriate training in order to be able to carry out their roles effectively. However, staff received regular supervision and those we spoke with told us they found it to be helpful.

The home was clean and generally well-maintained, although there had only been a minimal attempt to make the environment ‘dementia friendly’. We have recommended the provider reviews good practice guidance in relation to developing a dementia friendly environment.

We observed some caring and kind interactions between staff and people who used the service. Activities were available for people to take part in.

People were supported to eat and drink sufficient amounts to meet their needs. People were referred appropriately to a variety of health professionals in order to be supported to maintain good health.

Complaints were recorded, investigated and action was taken in response.

Governance systems to ensure that the quality of service provided was regularly monitored were very limited and issues we identified during our inspection had not been picked up by the few checks that were in place.

The registered manager did not have over sight of the day-to-day running of the home and lacked leadership.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found -

Is the service safe?

Emergency fire procedures were in place at the care home. A personal emergency evacuation plan (PEEP) had been implemented. This meant people who used the service had undergone an individual assessment of their support needs in the event of a fire at Royley House.

We observed staff members using effective infection control procedures. This included wearing protective clothing when supporting people with personal care. The risk of cross infection was further minimised by the use of hand washing liquid, disposable paper towels and hand sanitizer. This helped ensure the health and welfare of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS authorisations had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

Before people were admitted to Royley House care home, they underwent a pre-admission assessment. We saw the person`s individual choices and preferences had been recorded. A care plan involvement form had been signed by the person or a family member. People`s signatures within care plans confirmed their involvement and consent with their identified care needs.

People`s needs were taken into account with the signage and layout of the service which enabled them to move around freely and safely. The care home had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

We spent time in communal areas and observed staff asking people for their consent before providing any care or support. For example, at lunch time, people were asked if they required support eating their meal. We saw one person was supported to finish their meal but gave their consent before the staff member assisted them.

One person we spoke with told us, "I am very happy here. The staff are really nice and patient with me." We asked a family member why they chose Royley House and we were told, "We looked around quite a few other care homes, but once we came here our minds were made up. This was simply the best."

Is the service responsive?

An activities co-ordinator was employed at the care home. We observed several activities taking place. These were recorded in people`s care plans which helped identify what activities were undertaken and enjoyed by different people. People were supported to maintain their involvement within the local community.

We saw a suggestion/complaints box was present in the entrance area. When people were first admitted into the care home, they received a service user handbook, which we saw was present in the reception area and in people`s rooms. This included the procedure for making a complaint.

Is the service well led?

The provider had procedures in place that monitored the quality of service being provided to people who used the service. We saw evidence of monthly environmental and medication audits and accidents and incident analysis. Monthly managers meetings were held which we were told were aimed at improving the quality of service being provided.

General Practitioner and other professional appointments had been recorded within care plans. The registered manager told us, "We have a very good relationship with other agencies. If we ring they come out really quickly."

People living at the home generally spoke positively about the food. Some changes to the menu were suggested, for example, to increase the variety at tea time. One person told us their relative 'seems happy with the food'. Another told us 'the food here is always Ok'.

The accommodation was provided across two floors and a passenger lift was available. On each floor there was a lounge, a dining room, bedrooms, toilets and bathrooms.The d'cor and furnishings were well maintained throughout and the home was free from unpleasant odour.

We spoke with two members of staff. Both were enthusiastic about their work. They spoke positively about the opportunities for further development made available to them, and the support they had received from the provider in pursuing them.

The provider had a complaints procedure in place. We saw that a copy of this was included in a service user guide in the reception area. This was readily accessible to people using the service.