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Inspection on 08/03/10 for Royd Hill Nursing Home

Also see our care home review for Royd Hill Nursing Home for more information

This inspection was carried out on 8th March 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There have been some improvements made at the home. The communal areas of the home are cleaner and a lot of old and unused furniture and equipment has been disposed of. New kitchen equipment has been purchased as well as some kitchen work tops being replaced. Additional staff have also been recruited to work in the kitchen, the cook told us that he was `very pleased with the improvements`. and `it`s good we have got new utensils, a water boiler and crockery. We have been given training in values and respect and also in protecting people if we think they have been abused. I am really please with the changes here, it`s a much better place to work.` We saw more interaction between the staff and the people who live at the home. In the afternoon of the inspection people were enjoying themselves in the lounge having a game of skittles. Another member of staff had taken advantage of the fine weather and was walking in the grounds of the home with a resident. Staff training has continued with staff having refresher training in the protection of vulnerable people, respect and values and confidentiality. We saw that there was a good supply of disposable gloves and aprons for staff to use, all the liquid soap dispensers were full and paper hand towels were available. This minimises the risk of cross contamination and the spread of any infection. We were told by the laundress that the use of communal clothing had been stopped, the manager and care staff confirmed that people now wear there own clothes and underwear. We looked at some staff files and saw that appropriate checks on people`s suitability to work with vulnerable adults at Royd Hill are now being carried out. Four staff files were checked, all had references and a current criminal records bureau check in place. A temporary manager has been recruited to the home, this has had a positive impact on the home. Staff told us `he`s firm but fair`. Another member of staff said ` we have someone to give us direction and take control, it`s what we need to pull things around.` A visitor to the home said `he came and introduced himself to us and told us that if we had any concerns or complaints we had to see him and he would try and help and sort it out. This home feels a lot safer now he is here we feel a bit more confident now things are changing.`

What the care home could do better:

Although it is acknowledge that some improvement has been made at the home, we are still not satisfied that people are being cared for safely. We looked at several people`s care plans, observed the person and asked staff how they cared for the individual. What the staff told us and what we saw recorded in the care plan was a conflict of information. In the absence of a detailed care plan coupled with the lack of permanent staff at the home, people`s care is being compromised due to the lack of accurate recording and continuity of care staff. We observed very poor practice when staff were met with aggression from one person. It appeared that the member of staff`s actions actually inflamed the situation. However on checking the persons care plan there was no instructions for staff to follow on how best to deal with this aggression. Risk assessment and risk management recording is still very poor, and basic risk assessments are still not completed correctly, if at all. We found that referrals to other agencies such as the mental health team or the occupational therapist have not been undertaken. When we asked the manager about this, he said he was unaware of the situation due to the nursing staff not reporting to him. He gave us assurances that if he had known about the issues he would have actioned referrals promptly. We saw in a daily handover sheet a complaint that a service user had raised with a member of staff about some missing clothing. Again this had not been reported to the manager and not recorded in the complaints book, and remained unresolved. The manager once he was made aware of this acted quickly to find the missing clothing. People are being placed at risk of harm because as yet the fire alarm has not been properly checked to make sure it is safe and in good working order. In addition the manager was unable to confirm to us if the homes electrical wiring was safe. We have asked for both of these things to be checked out at our inspection of the service in December 2009 and in January 2010. The hot water and heating system remains problematic in some people`s bedrooms. Currently the home only employs two permanent members of nursing staff. The manager told us that they are currently recruiting for five more trained nurses. The continuity of people`s care is paramount as is the leadership on a shift by competent and skilled nurses. The inspectors saw poor nursing practices taking place, regarding the safe handling of medication and without the intervention of the inspector could potentially have placed people who use the service at risk of harm.

Random inspection report Care homes for older people Name: Address: Royd Hill Nursing Home Royd Hill Nursing Home Sutton Lane Sutton in Craven Keighley West Yorkshire BD20 7AJ zero star poor service 08/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Bridgit Stockton Date: 0 8 0 3 2 0 1 0 Information about the care home Name of care home: Address: Royd Hill Nursing Home Royd Hill Nursing Home Sutton Lane Sutton in Craven Keighley West Yorkshire BD20 7AJ 01535633499 01535636668 roydhill1@googlemail.com www.roydhill.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royd Hill Nursing Homes Ltd care home 46 Number of places (if applicable): Under 65 Over 65 0 0 46 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 46 10 0 The maximum number of service users who can be accommodated is: 46 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE; Mental Disorder, excluding learning disability or dementia - Code MD (maximum places 10) Date of last inspection 0 8 1 2 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home Royd Hill is a care home providing nursing care for up to 46 service users who have general nursing care needs, dementia and mental illness and those who are terminally ill. The original building, which is in stone, circa 1900 was a Mill owners dwelling and an extension was built on about fifteen years ago. The accommodation is on three floors, including the basement and there is a vertical lift to facilitate level transfer to all of them and a stair lift from the ground to first floor is also provided. The home is located in Sutton-in-Craven and is situated in well-laid out private grounds with ample parking facilities for visitors and staff. The fees charged on the 26th February 2009 was from three hundred and ninety two pounds seventy four pence to five hundred and eighteen pounds twenty pence. Care Homes for Older People Page 3 of 14 What we found: We decided to carry out this inspection to satisfy ourselves that peoples care needs were being met and that they were being cared for in a safe, clean and comfortable environment. Two inspectors visited the home. We looked around the home, talked to people who live at the home and the staff who work there.We also talked to some visitors who were at the home during the inspection. We looked at some paperwork associated with peoples care and looked at some health and safety documentation and recording. What the care home does well: There have been some improvements made at the home. The communal areas of the home are cleaner and a lot of old and unused furniture and equipment has been disposed of. New kitchen equipment has been purchased as well as some kitchen work tops being replaced. Additional staff have also been recruited to work in the kitchen, the cook told us that he was very pleased with the improvements. and its good we have got new utensils, a water boiler and crockery. We have been given training in values and respect and also in protecting people if we think they have been abused. I am really please with the changes here, its a much better place to work. We saw more interaction between the staff and the people who live at the home. In the afternoon of the inspection people were enjoying themselves in the lounge having a game of skittles. Another member of staff had taken advantage of the fine weather and was walking in the grounds of the home with a resident. Staff training has continued with staff having refresher training in the protection of vulnerable people, respect and values and confidentiality. We saw that there was a good supply of disposable gloves and aprons for staff to use, all the liquid soap dispensers were full and paper hand towels were available. This minimises the risk of cross contamination and the spread of any infection. We were told by the laundress that the use of communal clothing had been stopped, the manager and care staff confirmed that people now wear there own clothes and underwear. We looked at some staff files and saw that appropriate checks on peoples suitability to work with vulnerable adults at Royd Hill are now being carried out. Four staff files were checked, all had references and a current criminal records bureau check in place. A temporary manager has been recruited to the home, this has had a positive impact on the home. Staff told us hes firm but fair. Another member of staff said we have someone to give us direction and take control, its what we need to pull things around. A visitor to the home said he came and introduced himself to us and told us that if we had any concerns or complaints we had to see him and he would try and help and sort it out. This home feels a lot safer now he is here we feel a bit more confident now things are changing. Care Homes for Older People Page 4 of 14 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Peoples care needs must be properly assessed before they move into the home. This will make sure that the home has enough resources and the correct facilities to be available to meet the persons needs fully. Timescale not met An extended timescale of 28th March 2010 has now been given to meet this requirement 25/01/2010 2 7 14 Care plans must be written in sufficient detail to ensure that the care that is been given is appropriate and can be evaluated for its effectiveness. To ensure people are not put at unnecessary risk of harm. This is now being dealt with under enforcement procedures, using regulation 15 An extended timescale of 28th March 2010 has now been given to meet this requirement 3 7 13 To avoid harm people who live at the home must have 25/01/2010 Care Homes for Older People Page 6 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action in place documented risk assessments and risk management plans To make sure that staff have clear instructions on how to manage an identified risk in order to keep people safe from harm. We are dealing with this under our enforcement procedures. An extended timescale of 28th March 2010 has now been given to meet this requirement 4 9 13 Where people choose to self- 25/01/2010 administer medication risk assessments need to be completed and care plans kept up-to-date to help ensure they receive any help they may need to do so safely. An extended timescale of 28th March 2010 has now been given to meet this requirement 5 9 13 Medication, including external preparations, must be safely administered as instructed and sufficient stocks maintained To enable continuity of treatment. Time scale not met An extended timescale of 28th March 2010 has now been given to meet this requirement Care Homes for Older People Page 7 of 14 25/01/2010 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 6 14 12 People who live at the home 25/01/2010 should be offered a choice over how they wish to spend their days. This must be documented,and routines must be flexible to meet individual preferences. This will give people autonomy and choice and provide a more stimulating fulfilling lifestyle. Time scale not met An extended timescale of 28th March 2010 has now been given to meet this requirement 7 16 22 Any complaints made by 25/01/2010 people who use the service or their representatives must be fully investigated and a written record of the action taken and the outcome of the complaint kept. This will make sure that people can be confident that their complaints will be listened to, taken seriously and acted upon in a timely way. Time scale not met An extended timescale of 28th March 2010 has now been given to meet this requirement 8 19 13 The registered provider must make sure that all parts of the home are safe and kept warm and that hot water is available in peoples bedrooms. Page 8 of 14 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This makes sure that peoples health is not put at risk. This is now being dealt with under enforcement procedures. An extended timescale of 28th March 2010 has now been given to meet this requirement 9 19 13 The carpets identified at the inspection that were worn or damaged need replacing In order that peoples health and safety is maintained. This is now being dealt with under enforcement procedures. Extended time scale of 28th March 2010 has now been given to meet with this requirement 10 26 13 The floor in the laundry 25/01/2010 needs repairing or replacing where large cracks have appeared in the concrete, and the floor covering needs replacing. To reduce the risk to staff tripping when working in the laundry and to make it safe. We are dealing with this under our enforcement procedures. Time scale not met. Extended time scale of 28th March 2010 has now been given to meet with this requirement Care Homes for Older People Page 9 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 11 26 23 There must be an adequate hot water supply to all hot water outlets in the home To enable people to wash and keep hygienically clean. This is now being dealt with under enforcement procedures using regulation 13. An extended timescale of 28th March 2010 has now been given to meet this requirement 12 27 18 Staffing numbers and skill mix of staff must be appropriate to the assessed needs of the service users, the size, layout and purpose of the home, at all times. In order that peoples assessed needs can be met safely. This is now being dealt with under enforcement procedures using regulation 12. An extended timescale of 28th March 2010 has now been given to meet this requirement 13 27 18 The registered person must review the staffing rota to make sure that there are enough staff with the neccesary skills to look after people properly. This makes sure that peoples care needs are met at all times. Page 10 of 14 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is now being dealt with under enforcement procedures using regulation 12. An extended timescale of 28th March 2010 has now been given to meet this requirement 14 30 18 All staff should be 25/01/2010 appropriately trained to help them to maintain the health, safety and well being of people living in the home and themselves. This must include training about the specialist needs of people such as dementia care. To ensure that staff are qualified and competent for the job they are doing. Time scale not met An extended timescale of 28th March 2010 has now been given to meet this requirement 15 38 13 Valid safety certificates must 25/01/2010 be produced to demonstrate that equipment used in the home is safe. This is so people who live and work at the home are kept safe. Time scale not met An extended timescale of 28th March 2010 has now been given to meet this requirement Care Homes for Older People Page 11 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The drugs trolley must be secure at all times and not left open when unattended. To make sure that peoples medication is stored safely and reduce the risk of harm to others. 28/03/2010 2 38 13 Valid certificates need to be 28/03/2010 available for inspection at the home to confirm that the fire alarm is in good working order, and fit for purpose . This will make sure that people are living at the home are kept safe. 3 38 13 An action plan that addresses 28/03/2010 all of the outstanding requirements in this report and the additional requirements made at this inspection must be sent to the Commission. So the commission can assess compliance and the progress in meeting with the requirements and statutory Care Homes for Older People Page 12 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action notices that have been issued. 4 38 13 A valid certificate needs to 28/03/2010 be available for inspection at the home to confirm that the electrical hard wiring at the home is safe. This will make sure that people live in a safe home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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