Archived: Greenroyd Residential Home

Updated 4 May 2018

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 comprehensive inspection took place on 21 and 23 February 2018. Both inspection dates were unannounced.

Greenroyd Residential Home is a detached property situated in Hest Bank, near Lancaster. The home is registered to care for up to twenty three people who are assessed as requiring residential care. Accommodation is located over three floors. There is a passenger lift and a stair lift for people to use if required. The home has three communal lounges and two dining rooms. All rooms are single occupancy and have an ensuite.

Following the inspection visit carried out in March 2017, the registered provider had been supported by the Local Authority quality and improvement team, and the infection prevention control team to make the required changes. Prior to this inspection visit we spoke with these parties to check whether or not any improvements had been made. We received positive feedback from both teams in regards to the improvements made at the home. In addition, we reviewed information held upon our database in regards to the service. This included notifications submitted by the registered provider relating to incidents, accidents, health and safety and safeguarding concerns which affect the health and wellbeing of people. We also reviewed other feedback upon our database which had been provided to us from relatives of people who lived at the home. We used this information provided to inform our inspection plan.

We looked at information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us plan our inspection visit.

On the first day of the inspection visit, the inspection team consisted of two adult social care inspectors. One adult social care inspector returned alone on the second day to complete the inspection process.

Throughout the inspection visits we gathered information from a number of sources. We spoke with three people who lived at the home and four relatives to seek their views on how the service was managed. We found not all of those who lived at Greenroyd Residential Home were able to communicate fully with us. Therefore, during our inspection, we used a method called Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with the registered manager, the manager, the care manager, three members of staff responsible for providing direct care and the cook. In addition, we spoke with a health care professional who was visiting the home during our inspection visit.

To gather information, we looked at a variety of records. This included care plan files related to five people who lived at the home and medicines administration records for people who lived at the home. We also looked at other information related to the management of the service. This included health and safety certification, auditing schedules, training records, team meeting minutes, policies and procedures, accidents and incidents records and maintenance schedules. We also viewed recruitment files and Disclosure and Barring Service (DBS) certificates relating to two staff members who had been employed since the last inspection visit.

In addition we walked around the building to carry out a visual check. We did this to ensure r

Updated 4 May 2018

This unannounced inspection took place on 21 and 23 February 2018.

Greenroyd Residential Home is a care home in Hest Bank. It is registered to care for up to twenty-three people living with dementia assessed as needing residential care. The home has three floors. There are three lounges and two dining rooms on the ground floor. Access to upper floors is by way of a passenger lift and stair lift to the first floor. All bedrooms are for single occupancy and have en-suite facilities. At the time of the inspection visit sixteen people were receiving care and support at the home.

Greenroyd Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Greenroyd Residential Home was inspected in March 2017and was rated as inadequate. We re-inspected the service in September 2017 to check what improvements had been made and found some but not all improvements had been made. At the inspection visit in September 2017 the registered provider continued to fail to meet all the fundamental standards. Breaches were identified of the Health and Social Care Act (2008) Regulated Activities 2014. These related to person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, premises and equipment, good governance and staffing. The service therefore remained rated as inadequate and in special measures.

We used this inspection visit carried out in February 2018 to check to see if the required improvements had been made.

During this inspection in February 2018, we found some but not all improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

There was a registered manager in place. 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 registered manager was supported at the home by a manager. The manager had responsibilities for the day to day running of the home.

Following the inspection visit carried out in September 2017, the registered provider had worked to improve systems and processes to ensure the fundamental standards were achieved. Although we found improvements had been made, during this inspection visit we identified a breach to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure medicines administration was in line with current guidance. Systems were not in place for ensuring medicines were appropriately and safely administered.

The manager had developed a training plan and had identified external trainers to provide training to staff. However, training had not yet been fully provided to staff to enable them to have all the required skills to complete their role appropriately. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as staff had not been provided with the appropriate skills to carry out their role.

The registered provider had started to make improvements to make the home more dementia friendly but work had not been completed at the time of the inspection. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the premises were not suitably maintained for people who were living with dementia.

Some improvements had been made to improve the quality of paperwork and documentation at the home. Although some improvements had been made we found paperwork was not always accurate and complete. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The manager had reviewed the auditing systems at the home and made improvements to the auditing system. Although some improvements had been made, we found the audits had not been firmly embedded to ensure all concerns were identified. In addition, we found systems to ensure good governance at the home were not always complete. Advice and guidance provided at the last inspection visit and by other professionals had not been acted upon. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as systems to ensure good governance were not established.

Staffing levels had been reviewed and work had begun to review the staff dependency calculator. We saw staff were not rushed and had time to meet people’s needs in a timely manner. Oversight within lounges had improved to promote the safety of people who lived at the home. We have made a recommendation about deployment of staffing.

We looked at how people’s dietary needs were being met by the registered provider. Improvements had been made to ensure staff were suitably deployed at meal times. People were offered choices of meals. We have made a recommendation in regards to providing suitably nutritious meals which promote health and well-being at all times.

Relatives we spoke with told us they had no complaints about the service provided. They said the manager was approachable.

We reviewed how information was provided to people who lived at the home. We found information was not always accessible. We have made a recommendation about this.

At this inspection visit carried out in February 2018, the manager had reviewed safeguarding processes to promote peoples safety and well-being. New systems had been introduced to reduce the risk of people being harmed from abuse.

Systems had been reviewed to ensure risk was suitably managed and risk was lessened. This meant falls risks and risk associated with the usage of bed rails were suitably managed.

The manager had reviewed systems to ensure person centred care was delivered and achieved. This included reviewing people’s care records to ensure they clearly documented people’s needs and preferences. We observed person centred care being delivered throughout the inspection visits. Improvements had been made to ensure required documentation was completed in a timely manner when care and treatment had been delivered.

Improvements had been made to promote infection control processes at the home. The manager had taken on the role of infection prevention champion and had reviewed systems and processes to make sure they were in line with good practice.

People who lived at the home and relatives praised the caring and helpful nature of staff. From observations we saw staff were patient and respectful with people. People’s needs were met in a timely manner.

The manager had reviewed activities for people who lived at the home to ensure activities provided were appropriate for people living with dementia. We observed activities taking place. People responded positively to activities being offered.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Feedback from staff who worked at the home was positive. We observed staff carrying out their duties responsibly and in a caring manner.

End of life care had been discussed with some people and their relatives. Provisions were in place to promote a dignified and pain free death.

Feedback was routinely sought from relatives. We saw relatives had been consulted with through relatives meetings and through formal questionnaires.

This is the first time the service has been rated Requires Improvement. Although this service had improved since the last inspection we still need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

You can see what action we have taken at the back of the full report.