The Care Quality Commission
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Archived: Nydsley Residential Home

Overall: Inadequate read more about inspection ratings

Mill Lane, Pateley Bridge, Harrogate, North Yorkshire, HG3 5BA (01423) 712060

Provided and run by:
Nydsley Residential Home

All Inspections

14 December 2015

During a routine inspection

We last inspected this service on 4 June 2015 where we found continued breaches relating to:

Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014 – Staffing. The provider had failed to protect people against the risk associated with not providing appropriate training, supervision and appraisal for staff working at the home.

Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2014 – Good Governance. The provider failed to protect people against the risks of inappropriate care and treatment by not having systems in place to regularly assess and monitor the quality of the service and to identify, assess and manage risks.

We used our enforcement powers and served warning notices against the provider in respect of Regulations 18 and 17.

We also asked the provider to take action to make improvements to the shortfalls identified. The provider sent us an action plan telling us about the actions to be taken and that the improvements would be completed by 1 November 2015.

This inspection took place on 14 December 2015 and was unannounced. This inspection was carried out to look at the five questions, is the service safe, effective, caring, responsive and well-led and to follow up on whether action had been taken to deal with the breaches. At this inspection we found some improvements had been made but found further breaches in regulations.

Nydsley Residential Home provides personal care and accommodation for up to 14 people. The home is owned by Mr and Mrs Hall. Mrs Hall is the registered manager of this service. 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. Nydsley Residential Home is a large detached property in its own grounds. Accommodation is provided on two floors with a stair lift for people to use to get to the upper floors. There is a small car park for visitors to use.

The feedback we received from relatives of people who used the service was positive. They were very satisfied with the quality of the service their relatives received. This view did not correspond to our findings in a number of areas.

At times during the day there were insufficient staff on duty to ensure people’s safety and welfare. This is a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staffing.

There were general risk assessments in place relating to the safe running of the service and also individual risk assessments for some people who used the service. However, the risk assessments relating to people lacked detail about mitigating against risk and failed to assess the balance between risk and people’s independence. For some people there was no risk assessment completed where risks had been identified. This is a breach of Regulation 12. Safe care and treatment. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People received their medicines at the times they needed them, however, some aspects of the storage, recording and administration of medication placed people at risk. We observed people’s medicines were left unattended and there were insufficient checks recorded where people were prescribed medicines outside of the usual medicines cycle. This is a breach of Regulation 12. Safe care and treatment. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some staff had received training with regard to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. However, where people lacked capacity, the restrictions that staff and the provider had put in place may amount to depriving some people of their liberty but an application under the Mental Capacity Act Deprivation of Liberty Safeguards had not been made as required. This is a breach of Regulation 11 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Need for Consent.

Although we observed staff demonstrating kindness and respect during the inspection, we found derogatory and judgemental language used in people’s care records and were concerned how this reflected on the culture and atmosphere at the service. We observed that, although people did not express any concern, there was little choice offered throughout the day. The culture we observed did not enhance opportunities for people to have their emotional social needs and enjoyment of life addressed. This is a breach of Regulation 10. (Dignity and respect) of the Health and Social Care Act 2008 (regulated activities) Regulations 2014.

Prior to people being admitted to the service a preadmission assessment was completed to ensure the service was able to meet the person’s needs. There was a new care planning format in place and we saw some good detail about people’s needs, their likes and dislikes and their social history. However, these were not sufficiently personalised and were not always being met in practice. Care plans lacked evidence of people being involved in determining how they wished their care and support to be provided. They related more to tasks to be completed rather than how to meet people’s individual needs, and choices and their well-being and enjoyment of life. This is a breach of Regulation 9 (Person centred care) of the Health and Social Care Act 2008 (regulated activities) Regulations 2014.

We found some improvements to auditing and monitoring systems of the service. However, they were not sufficiently detailed to facilitate an analysis of the findings and the development of improvements. The registered manager worked alongside staff and as such worked ‘hands on’. This gave them little time to concentrate on management tasks and keeping up to date with new legislation and good practice. This meant the service failed to have a culture of continuous improvement. This is a (continuing) breach of Regulation 17 (Good Governance) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 from the inspection carried out on 11 November 2014.

The overall rating for this provider is ‘Inadequate’. The means the service has been placed into ‘Special Measures.’ The purpose of special measures is to:

1. Ensure that providers found to be providing inadequate care significantly improve.

2. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

3. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Although staff had received training with regard to safeguarding adults and were able to demonstrate an understanding of the issues, the policies and procedures available did not reflect up to date legislation and guidelines.

The provider had systems in place to ensure new staff were recruited safely, this included carrying out appropriate checks to ensure people had not been barred from working with some groups of people. No new staff had been recruited since the previous inspection.

The service was clean and staff had access to personal protective equipment such as gloves and aprons.

Since the previous inspection a training programme had been put in place and all staff had received updated training. Although we were told the content of training had been discussed in the staff team, more formal systems to monitor competency and understanding of training would be beneficial in ensuring staff could demonstrate appropriate skills and knowledge in relation to the people they cared for.

Although there was no choice of menu people’s food preferences were known and accommodated. People were very positive about the food provided with particular reference to everything being ‘home cooked’. However, identified nutritional risks were not always appropriately managed.

The service is an older, adapted property with a purpose built extension and as such some areas of the home were not as easily accessible as others. We were told by the registered manager that this was considered when people expressed an interest in coming to live at the home. We discussed the increasing number of people living at the home who lived with dementia and the need to improve the environment to make it more dementia friendly, with the use of signage for example.

People’s bedrooms were personalised and visitors to the home were encouraged and welcomed. The provider arranged for entertainers in the home but there was a lack of daily activities provided by the staff team, either for a group of people or for individual interests.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.

4 June 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 11 November 2014 June 2015. Breaches of legal requirements was were found with regard to Regulation 18 (Staffing), of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This is because the provider had failed to support staff working at the home. And Regulation10 (Assessing and monitoring the quality of service provision), of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 17 (Good governance) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 4 June 2015, to check that the provider had followed their plan and to confirm that they now met with the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nydsley Residential Home on our website at www.cqc.org.uk

Nydsley Residential Home provides personal care and accommodation for up to fourteen people in a large detached property in its own grounds. Accommodation is provided on three floors with a stairlift for people to use to get to the upper floors. There is a small car park for visitors to use. The home is in the centre of Patley Bridge with all community amenities being close by. On the day of the inspection there were seven (7) people living at the home.

The home has a registered manager who is also one of the owners and has worked at the home since it opened. 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 found that, other than safeguarding adults training, staff working at the home had not received any further updated mandatory training. The cook had not updated their food hygiene certificate. Some staff had not had updated first aid training which resulted in some occasions when there were no staff on duty with first aid qualifications. This meant the provider remains in breach of Regulation, 18 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

because they failed to ensure staff had up to date mandatory training.

The manager had not put in place a system to demonstrate they were monitoring the quality of the service provided for people. The provider had not taken an opportunity to use publications by the commission which outline how to meet regulations. As a result the provider is still in breach of Regulation 17 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.because no action has been taken to address this matter.

The manager did not provide an action plan as required by the commission but wrote to us explaining how they were meeting the requirements made at the inspection of 11 November 2015. However, our findings indicated the provider had not taken appropriate action to meet the requirements.

You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

11 November 2014

During a routine inspection

This was an unannounced inspection carried out on the 11 November 2014. At the last inspection in September 2013 we found the provider met the regulations we looked at.

Nydsley Residential Home provides personal care and accommodation for up to fourteen people in a large detached property in its own grounds. Accommodation is provided on three floors with a stairlift for people to use to get to the upper floors. There is a small car park for visitors to use. The home is in the centre of Pately Bridge with all community amenities being close by.

The home has a registered manager who is also one of the owners and has worked at the home for a long time. 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 found that there were sufficient and experienced staff on duty each day. We looked at the recruitment processes followed by the home when employing staff. We found them to be robust, which meant that people were kept safe. However staff did not always have the skills to manage people well in some circumstances. This was linked to the lack of the necessary training to ensure they were skilled and qualified to do their job well. Mandatory training for staff was not up to date for all staff working at the home. Staff records showed that some staff had received supervision although not regular whilst other staff had not received any supervision. We did not see any evidence that annual appraisals had been undertaken for staff by the manager

There was a friendly, relaxed atmosphere at the home. People told us they enjoyed living there as it was close to where they had all lived and they had regular visits from their family and friends.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. We saw that regular checks to ensure that safety equipment such as the fire alarm system were in good working order were regularly being carried out by the owner of the home. However we found that regular servicing of fire extinguishers had not been maintained, which meant that people could have been put at potential risk in the event of a fire occurring. Action was taken to address this on the day of inspection.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. However this did not include regular auditing by the home.

Although the home did not have any formal systems in place to monitor the cleanliness of the home, for example there were no cleaning schedules in place, for staff to follow which could help to minimise the risk of infection, however, we did not identify any concerns during our visit, about the cleanliness of the home. We found the home was kept clean and free from the risk of infection and there were no odours in any areas we inspected.

All areas of the environment we saw were well maintained although we identified that some work was needed on the hall floor as the old tiles were lifting and leaving bare floor in some places which made it uneven. This meant that people could be at risk from falling.

People’s physical health was monitored as required. We saw in the care plans we looked at this included the monitoring of people’s health conditions and symptoms, which meant that appropriate referrals to health professionals were made.

No complaints had been received by the home since the last inspection. Notifications had been reported to the Care Quality Commission as required by law.

Staff did not understand how to apply for authorisation to deprive someone of their liberty if they needed to do so. We have asked the provider to make improvements in this area.

We did not see any programmes of activity which were stimulating and meaningful on display or available to people living at the home. People told us that there were occasional activities at the home to stimulate them. Therefore people did not always have access to proper and appropriate activities.

We contacted other agencies such as the local authority commissioners and Healthwatch to ask for their views and to ask if they had any concerns about the home. Feedback from Healthwatch was that no concerns were raised about this service. Commissioners had no concerns around care as people looked well cared for when they visited. Although they did have concerns regarding staff attitudes and practices and a lack of engagement with people living at the home and other care professionals.

25 September 2013

During a routine inspection

We spoke to seven people who lived at the service and five relatives who all expressed satisfaction with the care and support they received.

To ensure the service could meet people's needs a pre admission assessment was completed.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. Staff had the knowledge and experience to meet people's needs. We received comments from people including; 'I am very happy here, I can keep in touch with life in the town because I have lived here all my life.' And, 'The staff are very kind and helpful; I have a lovely room.'

We found people were provided with a choice of suitable and nutritious food and drink. People commented, 'The food's is freshly cooked it's beautiful.' And, 'The food is very good, the cook knows what I like and don't like.'

People who needed it had been provided with suitable equipment which met their needs; this was checked and serviced regularly.

There were sufficient staff available for the number of people currently living at the home. People commented, 'Staff are busy but there are always enough around and I never have to wait long.' And, 'The staff are super.' We did receive one comment that sometimes there could be more staff around, although they commented the manager was always available because they lived on the premises.'

The service had a complaints policy which was provided for people. No formal complaints had been received by the home.

3 December 2012

During a routine inspection

People we spoke with told us they made their own decisions and choices about how to spend their time. We saw that people were treated as individuals and their rights were being protected. We saw people or their representative had signed the care records to say they consented to the care that they had received.

A person living at the home said 'I am happy with the care. The staff try and do what they can for me.' We saw that people had care plans and risk assessments in place. This helped the staff to understand people's needs. People's care records were updated as people's needs changed. This helped to make sure that people's needs were known and could be met.

We saw that there were policies and procedures in place to help to protect people from abuse. Staff received safeguarding training and they were aware of the action they must take if they suspected abuse may be occurring. This helped to protect people.

People we spoke with during our visit confirmed that there was enough staff to support them. One person said 'The staff are all very nice, they are skilled.' Staff we spoke with said they received training which helped them to provide care to people in a safe way.

People's views were sought informally about the quality of the service provided. People we spoke with said they were happy living at the home and with the service they received.

21 February 2011

During an inspection in response to concerns

During our visit we talked to people about the care they received and what it was like living at the home. People told us that they were well looked after and that they were happy with the care they received. People made comments about the home such as 'lovely'. Everyone we spoke to spoke highly about the care workers whom work at the home. People said 'the staff are super, lovely everything is lovely'.

We talked to people about if they were unhappy or what they would do if they had a complaint. People we spoke to told us that they did not have any complaints but were very clear as to what they would do if they had one or they were unhappy. People made comments such as 'I would see the boss you know Liz' another said my family would sort it out for me.' Another person said 'I would speak to Mr or Mrs Hall if I wasn't happy they are always here, but I have no complaints or grumbles, only about the weather'.

We did not talk to people who live at the home about equipment provided by the home as we discussed this with the providers. We also did not talk to people about how the home co-operates with other agencies, such as health care professionals as we spoke to a visiting health professional during our visit.