This inspection took place over two days 21 and 22 October 2014. Day one of the inspection was unannounced. The service was last inspected on 1 October 2013 where it was found to be meeting the requirements of the regulations we inspected at that time.
Water Royd Nursing Home is registered to provide care for up to 62 older people. There are three units; two on the ground floor and the third nursing unit is on the first floor. On the ground floor one of the units is dedicated to supporting people who have a diagnosis of dementia. There were 54 people living at the home at the time of our inspection.
A registered manager was in post. 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.
The quality assurance process within the service was not effective and this has resulted in improvements identified by audits not being implemented in a timely way. People using the service, relatives and staff raised ongoing concerns about the staffing levels at the home. The registered manager informed them that they were adhering to the company policy.
We were informed by staff that they had received training in safeguarding vulnerable people and when questioned staff demonstrated a very good understanding. CQC had been informed by the registered manager of any incidents and allegations of abuse. The registered manager and staff had followed correct procedures by referring allegations to the local authority safeguarding team and had taken action as directed by the local authority.
There was a lack of documentary evidence that relatives and the people who lived at the home had been involved in the planning of care. However the care staff and the deputy manager told us during annual care plan reviews the registered manager or the deputy manager discussed with the family members the care needs of people and updated them. Not all the people and relatives we spoke with said they had been involved in the care planning and reviews.
We spoke with relatives of people receiving palliative care. They told us that they were fully kept informed of the condition of their family members by the nurses at the home and the visiting MacMillan nurses. One family member said, “It is a lovely peaceful place and staff are very caring”.
The provider had an up to date plan to manage an emergency situation in the service such as fire or flood. Staff members we spoke with said, they were aware of the plans and had attended the necessary training to manage such situations.
Medicines were administered by registered nurses on the nursing unit and senior care workers on the residential units. We observed staff checking the medicines against the medication administration records (MAR) before administering medicine. We heard staff asking people whether they had any pain or discomfort and waited until the person replied before moving on to the next person.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict them. The registered manager told us that they had applied to the supervisory body for the deprivation of liberty safeguards for eleven people following the latest court ruling. Staff said they had received training and were expecting further training later this year.
We noted the cook and the kitchen assistants monitoring the food sent back to the kitchen after meals to find out which food was popular and which was not. The cook was very involved in finding out the likes and dislikes of people and also attending the residents and relatives meetings to obtain views about the food served at the home.
We carried out a short observational framework for inspection (SOFI) in the unit where people who had a diagnosis of dementia lived. SOFI is a tool used by CQC inspectors to capture the experiences of people who use services who may not be able to express or have difficulties communicating their experience of care. During our inspection we saw staff interacting with people in an encouraging way and distracting people when they became anxious and maintaining a calm atmosphere and promoted their wellbeing.
A new activities co-ordinator had been appointed two weeks before our inspection and they were settling into their post. On the first day of the inspection we saw people taking part and enjoying singing in the afternoon. However during the day we saw people looking bored and sitting asleep in front of the television or sitting in lounges without any stimulation.
Staff said when they received complaints they tried to resolve them as early as possible. The registered manager had records of the formal complaints they had received and the outcome of the investigations with lessons to be learnt. The manager told us they shared the lessons with the staff at staff meetings.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
You can see what action we told the provider to take at the back of the full version of the report.