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Archived: Royd Hill Nursing Home Inadequate

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Inadequate

Updated 31 March 2015

We inspected the home on two days. The first visit was carried out on the 4 February 2015 and the second visit was on 7 February 2015. Both visits were unannounced.

The visit on 4 February 2015 was a routine inspection. However, the visit on 7 February 2015 was carried out to check that action had being taken to address the serious short falls that we had identified on 4 February 2015. We had particular concerns relating to the care practices at Royd Hill Nursing Home, which put people at risk of receiving inappropriate care and treatment, of receiving insufficient fluids and food, receiving inappropriate support around pressure ulcer prevention and unsafe moving and handling techniques.

Such was our concern in relation to these practices that we requested an urgent action plan from the provider to minimise the risks to people at the service. This was requested from the provider on 9 February 2015. The action plan returned by the provider on 10 February 2015 lacked detail, was aspirational and did not provide any means by which the provider would monitor and improve the care being provided. An updated action plan was again requested from the provider on 10 February2015. This also failed to address the concerns we had highlighted.

We previously inspected Royd Hill Nursing Home in August 2013, and we found people were not fully protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening in relation to management of people's personal money. We also found at the inspection in August 2013 that there were not enough qualified, skilled and experienced staff to meet people's needs.

We visited Royd Hill Nursing Home again in December 2013 to check that the necessary improvements had been made. We found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We also reviewed the staffing arrangements and found that the increased staffing levels, which had been agreed on the day of our previous inspection in August 2013, had remained in place. Overall there were enough staff on duty to meet people's needs. However, staff told us that at peak times, usually around the teatime period, they felt under pressure to provide an adequate service especially when the nurse on duty was busy carrying out a medication round and was not available to help with the teatime meal.

Royd Hill is a care home which provides nursing and residential care for older people and for people who have dementia. It is situated in the village of Sutton in Craven; it is near to transport links and local shops. The home is set in private grounds and there is car parking available.

At the time of this inspection, the home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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. The provider had however employed an acting manager, who had been in post since early October 2014. The acting manager has not yet applied to register with CQC.

The acting manager was present during our first visit on 4 February 2015 and the deputy manager assisted with the inspection on 7 February.

On 4 February 2015, we walked around the premises and checked the records relating to cleaning schedules and audits. We found multiple examples of inadequate cleaning and poor standards of maintenance and décor. For example, chairs, walls, door architrave and carpets were stained and marked. There was a strong unpleasant smell of urine, particularly in the communal lounge area and the ground floor corridor. We noted that pull cords in toilets were dirty, some were covered in what looked like faeces and radiators were rusty and stained. We noted that wheelchairs were stained with food waste and spilt drinks and that easy chairs had torn upholstery and stained cushions. We also found that crockery and cutlery cupboards were stained and had chipped delaminated exposed areas, making adequate cleaning difficult. Some curtains and wall coverings were stained with what looked like food and in some cases bodily fluids. The kitchen area, despite being awarded a five star rating by the environmental agency in 2014, was not clean. Freezers, fridges and the floor were dirty. There was food debris found under the sink area and waste bins were overflowing. We contacted the environment agency to discuss our findings. They were due to revisit the service to support the staff to improve their awareness of the importance of infection control and were awaiting a mutually convenient time to do that.

We noted that a significant number of people looked unkempt and dishevelled in terms of their personal appearance. For example, people were seen to have long fingernails with dirt underneath, people’s hair was not groomed, looked greasy and unwashed and men were unshaven. After breakfast and lunch, we noted that some people were supported back to the lounge area and they had food stains on their clothing, hands had food on them and people had dried food around their mouths. Staff did not attend to this detail which compromised peoples overall dignity and respect and was indicative of a service where people were not given basic care, thus placing them at risk of infection and neglecting their welfare and wellbeing.

We found that people were not being provided with adequate fluids to prevent them becoming or being dehydrated and that people’s nutritional needs were not always being met. During the course of the inspection we found that although people had lost significant amounts of weight, little or no action had been taken to address this. We also saw that people, who needed support with their meals and drinks, were not being assisted to eat or drink regularly or in an appropriate way.

This meant that people were not always receiving adequate nutrition, were losing weight and this put them at risk of being undernourished.

During our observations in communal areas, we saw that some people were not regularly moved despite them being at risk of developing pressure ulcers, according to their care records.

The home did not have an effective quality assurance system in place and there was no auditing schedule. We found this put people at risk of potentially unsafe or inappropriate care. This meant people were not benefiting from a service that was continually looking at how it could provide a better service for people.

Staff training was inadequate and staff had not received training in accordance with their roles and responsibilities.

Medicines were appropriately stored and administered.

Inspection areas

Safe

Inadequate

Updated 31 March 2015

The service was not safe.

Some people told us they felt safe living at Royd Hill. However, during our inspection we found that the service was failing to provide consistent and safe care. The inspection team noted that people’s needs were not anticipated or dealt with at the time they occurred.

Staff had not received adequate training and poor care practices were seen during the inspection visit, including staff using illegal lifts when moving people.

We also found the home was dirty and in need of a good clean and there were malodours in some areas of the home. There were inadequate cleaning schedules.

Concerns were highlighted by the fire authority on 3 February 2015, about the lack of a suitable and sufficient risk assessment for the premises, that in the event of danger persons would be unable to evacuate the premises as quickly and as safely as possible and that appropriate procedures and safety drills were not established. There was also a concern about inadequate training for staff.

There had been a significant number of safeguarding referrals to the local authority. The provider was working with the local authority to address matters and this involved attendance at meetings and providing regular updates regarding the running of the service. However, the number of ongoing safeguarding matters was of concern. The safeguarding concerns were regarding weight loss, dehydration, lack of proper recording and poor care practices.

Medicines management was good; medication was appropriately stored and administered as required and according to the prescriber’s instructions.

Safe recruitment practices were followed to ensure that people were suitable to work at this setting.

Effective

Inadequate

Updated 31 March 2015

The service was not effective.

We found that people were not being provided with adequate fluids to prevent them becoming or being dehydrated, that people’s nutritional needs were not always being met. This meant that people were not always receiving adequate nutrition, were losing weight and this put them at risk of being undernourished.

We also found that although people had lost significant amounts of weight, little or no action had been taken to address this. We also saw that people, who needed support with their meals and drinks, were not being assisted to eat or drink regularly or in an appropriate way. This meant that people were not protected from the risk of harm or injury.

During our observations in communal areas, we saw that some people were not regularly moved despite them being at risk of developing pressure ulcers, according to their care records.

There was no adequate training programme for staff; some staff had not received any training since 2013. This meant that staff were not sufficiently trained to deliver appropriate and safe care and treatment to people using the service.

The Mental Capacity Act 2005 (MCA 2005) says that before care and treatment is carried out for someone it must be established whether or not they have capacity to consent to that treatment. If not, any care or treatment decisions must be made in a person’s best interests. Some efforts had been made by staff to work within the principles of the MCA but the record keeping was not always accurate. They had requested capacity assessments and a best interest meeting had been arranged.

Caring

Inadequate

Updated 31 March 2015

The service was not caring.

People we spoke with told us staff were kind and comments about them were positive overall. We observed some staff spoke clearly when communicating with people and care was taken not to overload the person with too much information. This helped staff to build positive relationships with the people they were supporting. Some of the staff we spoke with told us of their commitment to provide a good standard of care.

Staff routines were mainly task focused. However, we noted some positive relationships between staff and those they were supporting.

Some people we met during the visit were dishevelled and attention was not given to people’s fingernails and hair. We saw that men were unshaven and people were seen to have food stains on their clothing or around their mouths after meals.

Staff were reactive rather than proactive when issues arose, and did not always appreciate what contributed to good end of life care. Therefore service users were at risk of not receiving adequate and safe care, particularly when they were vulnerable or being nursed in bed.

Responsive

Inadequate

Updated 31 March 2015

The service was not responsive.

People had not been involved in planning their care. Not all care plans and associated records were up to date and did not reflect the current care needs of some people.

People were given support to make a comment or complaint where they needed assistance. Staff we spoke with knew how to respond to complaints and understood the complaints procedure. We looked at the complaints records; there had not been a formal complaint in the last twelve months.

The environment was in need of improvement particularly around the areas used by people living with dementia. For example, there was little useful signage or use of colour to help people orientate themselves when moving around the home. The home was dirty and there were malodours, some extremely strong, particularly in the large communal lounge and some bedrooms. There was little signage or other aids visible in the service which would benefit people who were living with dementia or had cognitive impairment.

Well-led

Inadequate

Updated 31 March 2015

The service was not well-led.

Paperwork and systems were disorganised and chaotic with files and papers randomly distributed in an ad hoc fashion, making it difficult to locate information quickly. There seemed to be little or no urgency to address matters, which staff acknowledged throughout our visit.

The home did not have an effective quality assurance system in place and there was no audit schedule. This meant people were not benefiting from a service that was continually looking at how it could improve.

There was no clear leadership in the home. The acting manager was unable to provide supervision or address issues as they arose, as the expectation was that the acting manager and the deputy worked on shift to provide care to people who used the service. There was no opportunity to work on a supernumerary basis to reflect and make any positive impact on the practices in the service.

The service had notified the Care Quality Commission, as required by law, about accidents and incidents since their last inspection.