Archived: Royd Hill Nursing Home

Updated 31 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection over two days, the 4 and 7 February 2015. On 4 February 2015, the inspection team consisted of two inspectors and a specialist advisor (with knowledge of complex care needs, tissue viability and end of life care.) The team were also joined by an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector carried out the second visit on 7 February 2015.

Prior to our inspection we reviewed all of the information we held about the service. We considered information which had been shared with us by the local authority and looked at ten safeguarding alerts that had been made. In addition to this, before the inspection we would usually ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. On this occasion we did not request the PIR. However, this does not affect the inspection process, the information we requested can also be gathered during an inspection visit.

We used the Short Observational Framework for Inspection (SOFI) because there were a number of people living with dementia. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed people in the lounge and dining areas during meals and at rest.

On the 4 February 2015, we spoke with five people who could share their experiences, two visiting relatives and nine members of staff. We tracked five peoples care from when they were admitted and looked at how their present needs were being met. We also spoke with the operations manager and area manager for the service.

We looked at all areas of the home, including people’s bedrooms with their permission. We looked at the kitchen, laundry, bathrooms, toilets and all communal areas. We spent time looking at care records and associated documentation. This included records relating to the management of the service; for example policies and procedures, maintenance records, staff duty rosters and staff recruitment files. We also observed a medication round in the morning, the lunchtime experience and interactions between staff and people living at Royd Hill Nursing Home.

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.