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Archived: Royd Hill Nursing Home Inadequate

The provider of this service changed - see old profile

Reports


Inspection carried out on 4 and 7 February 2015

During a routine inspection

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 carried out on 2 December 2013

During an inspection to make sure that the improvements required had been made

When we inspected the service in August we found people who used the service 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. This was particularly around the management of people’s personal money, which was being managed by the service. We also found at our August inspection that there were not enough qualified, skilled and experienced staff to meet people’s needs.

We re-visited the service to check that the necessary improvements had been made. We did not speak with people about the way their finances were handled on this visit but we did look at the systems in place around the management of personal monies. We found that people were now protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We reviewed the staffing arrangements and found that the increased staffing levels, which had been agreed on the day of our previous inspection, 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.

Inspection carried out on 21 August 2013

During a routine inspection

Prior to this visit we had received information of concern about food provision being poor, the home was short staffed, that personal finances were not managed correctly and that people were not being properly looked after. We reviewed the service and paid particular attention to these areas of concern.

During our visit we spoke with 12 people who lived at the home and six members of staff. People told us that staff were polite and respectful. We saw staff treating people with kindness and involving people in their care. People generally looked well cared for and had their care needs met. One person told us, “They [the care workers] are very good to us and really care.” Other people told us they were happy with the home and the care provided.

Care and treatment was planned and delivered in a way that was intended; to ensure people's safety and welfare

There were not enough qualified, skilled and experienced staff to meet people’s needs. The Area Manager agreed that the staffing levels were not sufficient to fully meet people’s needs in a timely way. A number of people we spoke with felt that staffing levels could be improved and that on occasion they had had to wait for attention to their continence and personal care needs. This was also confirmed by the staff we spoke with.

We saw that people were provided with choices of food and drink throughout the day. The food on the day of our visit was well presented and looked appetising. Staff provided people with assistance where this was needed. Systems were in place to monitor people’s weight and to make sure that action was taken if people started to lose weight.

People were not 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.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

Inspection carried out on 24 January 2013

During an inspection in response to concerns

We visited the home because we had received information that people were not being cared for in a dignified and caring way. We also received information that there were not enough staff in the home and that the premises were not clean or well maintained.

We looked at the care people received and found that they were well cared for and consistently supported with their needs. We observed that people were supported in a dignified and timely way by the staff. We also saw that staff were courteous and positively engaged with individuals.

We looked at the care records and found that assessments and care plans were in place. We saw that they were regularly reviewed to make sure that people’s needs were met.

The information shared with us stated that the home was not clean or well maintained. We toured the home and found that the home had been extensively refurbished. We looked at twelve bedrooms and the communal areas and we saw all these areas were clean and well maintained.

We also reviewed staffing levels at the home. We found that staffing levels were consistent and met the needs of people at the home.

Inspection carried out on 24 July 2012

During a routine inspection

The people we spoke with said that they were able to make choices and decisions in most aspects of their daily lives. This included times to get up, what clothes they wanted to wear and a choice of main menu. Some people felt that some of the menu choices were limited. One individual said “I was offered soup, I don’t like mushroom soup but I wasn’t offered anything else.”

People said that they were well cared for. One of the people we spoke with said “It’s alright here; I am looking forward to the garden party on Saturday. There is plenty going on, singing, dancing and chair exercises.”

People said that they felt safe. One person said “The staff are very kind, they look after me.” Another person said “The staff are good; they are always on the go. The girls help me.”