Archived: Elm Royd Nursing Home

Updated 18 July 2017

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 inspection took place on 5 and 8 June 2017 and was unannounced. On the first day the inspection was carried out by three inspectors, a pharmacist inspector and an expert by experience with experience of services for older people. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the second day three inspectors attended.

Before the inspection we reviewed the information we held about the home. This included looking at information we had received about the service and statutory notifications we had received from the home. We also contacted the local authority commissioning and safeguarding teams and the clinical commissioning group (CCG).

We observed how care and support was provided to people. We spoke with eight people who were living at the home, four relatives, three nurses, twelve care workers, the manager and the area manager.

We looked at ten people’s care records, four staff files, eight medicine administration records and the training matrix as well as records relating to the management of the service. We looked round the building and saw people’s bedrooms and communal areas.

Updated 18 July 2017

This inspection took place on 5 and 8 June 2017 and was unannounced. At the last inspection on 13 and 20 December 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We found six regulatory breaches which related to staffing, nutrition, safe care and treatment, dignity and respect, person-centred care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Prior to this inspection concerns had been raised by the local authority and clinical commissioning group (CCG) regarding the clinical management of the home. These concerns had been discussed with the provider who agreed to a voluntary suspension on admissions to the home and additional nursing staff were provided by the CCG in April 2017 to work alongside the home’s own staff providing clinical support and guidance. On 1 June 2017 the additional nursing staff supplied by the CCG were withdrawn at the request of the provider following the transfer of eight people from Elm Royd to other services. The voluntary suspension on admissions was still in place when we carried out this inspection.

Elm Royd Nursing Home is registered to provide nursing and residential care to up to 50 older people, some of who may be living with dementia. On both days of the inspection there were 29 people living in the home, 28 who required nursing care and one person who required personal care. Accommodation is provided on two floors in single rooms with en-suite facilities. There are communal areas on both floors.

At the time of the inspection the home did not have a registered manager. A manager had registered with the Care Quality Commission in January 2017, however they left their post in April 2017. A manager from one of the provider’s other services was managing the service when we inspected. 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.

Although people we spoke with told us they felt safe we found there were insufficient staff to meet people’s needs and keep them safe. For example, on the second day of the inspection we saw some people did not receive their morning medicines until 12.30pm as there was only one nurse on duty when previously there had been two. The night staff told us they had been told to get more people up to help the day staff and were concerned as this meant people had to be washed and dressed very early in the morning. We saw periods of up to an hour when no staff were present in communal areas.

Risks were not well managed which placed people at risk of injury or harm. For example, we saw one person had a severe choking episode after eating bacon, fried bread and sausage when they were supposed to have a soft diet because of swallowing difficulties. Staff were not aware this person required a soft diet.

Medicines were not safely managed which meant we could not be assured people were receiving their medicines as prescribed.

Safe recruitment processes were in place and new staff received induction, however we found this often took place several weeks after the staff member had started work. Staff received ongoing training however this was not always kept up to date and supervisions had lapsed although the manager told us they had a plan to address this.

We saw current certificates showed the safety of the gas supply, portable appliance testing, electrical wiring and fire systems. However, weekly checks of emergency lighting, door guards and water temperatures had not been completed since 10 May 2017.

Staff were aware of safeguarding procedures and were confident any abuse they reported would be dealt with appropriately.

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met as we found conditions which had been applied to DoLS authorisations had not been complied with.

Most people said they enjoyed the food although we found the meals identified on the menus were not always been served. We found people’s dining experiences differed depending upon whether they were on the ground floor or the first floor. For example on the ground floor people were offered a choice of food and drink which did not happen on the first floor.

Where people’s food and drink intake was being recorded there were no systems in place to review these records to ensure people were receiving sufficient to eat and drink.

People praised the staff and said they were kind and caring. However, we observed practices which showed a lack of respect for people and compromised their privacy and dignity.

There was conflicting information about people’s care needs and care plans did not always reflect accurately the care people required, putting people at risk of receiving inappropriate or unsafe care. People had access to healthcare services.

People told us they knew how to make a complaint and we saw records which showed complaints had been investigated and the complainant had been informed of the outcome.

We found there was a lack of consistent and effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. This was evidenced by the continued breaches we found at this inspection. We identified seven breaches in regulations – staffing, safe care and treatment, dignity and respect, nutrition, person-centred care, consent and good governance. Following the inspection we made safeguarding referrals to the local authority safeguarding team and had discussions with the CCG and local authority commissioners. Due to the seriousness of our concerns the CCG and the local authority took immediate action to provide additional support into the home and worked with the provider to ensure all people accommodated in the home were moved to alternative accommodation by 16 June 2017.

The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.