About the service:

• Water Royd Nursing Home is a care home that provides accommodation and personal or nursing care across three separate units for up to 62 people, some of whom are living with dementia. At the time of inspection 58 people lived in the service.

People’s experience of using this service:

• Most people we spoke with told us Water Royd Nursing Home was a friendly and lovely place to reside, that staff were kind and caring and were treated with respect.

• People were supported to take their medicines in a safe way and were safely managed.

• Recruitment processes were robust and thorough checks were completed before staff started working in the home. We saw there were sufficient numbers of staff on duty on make sure people’s care needs were met. Staff had received training and supervision to ensure people received appropriate care.

• The registered manager and staff knew what to do to keep people safe. Individual risks had been assessment and identified as part of the support and care planning process. One care plan was not updated in a timely manner.

• We saw nice interactions between staff and people who used the service. We saw staff respected people’s privacy and dignity.

• People’s nutritional needs were met and the menus we saw offered variety and choice. Records showed people had regular access to healthcare professionals to make sure their health care needs were met.

• A complaints procedure was in place. People and relatives told us they would have no hesitation in raising concerns. All feedback was used to make continuous improvements to the service.

• The home had good management and leadership. The registered manager was visible working with the team, monitoring and supporting staff to ensure people received the care and support they needed.

• More information is in Detailed Findings below.

Rating at last inspection:

• Requires improvement (report published 28 March 2018)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and the provider was no longer in breach of the regulation relating to medicine management. The service had improved and is now rated good overall.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected Water Royd Nursing Home, known to people, their relatives and staff as Water Royd, on 20 February 2018. The inspection was unannounced.

Water Royd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Water Royd accommodates 62 people across three separate units, each of which had separate adapted facilities. One of the units specialises in providing care for people living with dementia. There were 53 people living at the Water Royd, with a further two people being admitted on the day of our inspection.

Water Royd was last inspected in September 2015. At that time we rated the service as Good in all five key questions and therefore, Good overall.

At the time of our inspection the home had a registered manager in place. A registered manager is a person who has registered with 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.

People were not protected against the risks associated with the administration of medicines as this was not always carried in a safe way. Topical creams prescribed for people on one floor were recorded as administered by staff without checking this was the case. One person had not received one of their medicines for five days.

People told us they felt safe living in the home and we saw there were systems and processes in place to protect people from the risk of harm. The management team and staff knew what to do to keep people safe. Individual risks had been assessed and identified as part of the support and care planning process.

People told us they were happy living at Water Royd and we saw respectful interactions between staff and people who used the service. We saw staff respected people’s privacy and dignity and the home had a ‘dignity champion’ who helped ensure staff did this.

We found the home was well maintained, clean and tidy. People’s bedrooms had been personalised and communal areas were comfortable and homely. The decor was dementia friendly with pictures and signage which helped support people living with dementia to navigate their way around the home.

Recruitment processes were robust. We saw there were sufficient numbers of staff on duty to ensure people’s needs were met. Staff had received training and supervision to ensure people received effective care.

People’s care plans contained sufficient person-centred information to guide staff in how to support them. The registered manager was in the process of updating each person’s electronic care plan to included further individual information. The home had a ‘digital champion’ who supported staff members with the electronic care plans and any future developments.

Records showed people had regular access to healthcare professionals to help meet their wider health needs. People’s nutritional needs were met and menus we saw offered variety and choice.

People enjoyed the different activities available and we saw most people engaged with activities in a positive way.

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

A complaints procedure was in place. We saw the complaints process was well-managed and people and their family members told us they would raise any concerns with the registered manager.

The home had good management and leadership. The registered manager was visible working with the team, monitoring and supporting the staff to ensure people received the care and support they needed.

People and their relatives had opportunities to comment on

We carried out this inspection on 28 September 2015 and it was an unannounced inspection. This meant the provider did not know we were going to carry out the inspection. The last full inspection at Water Royd Nursing Home was in October 2014 and we found the home to be non-compliant with the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; 10 - Assessing and monitoring the quality of service provision and 20 - Records. Compliance actions were given for both these regulations. We followed up on these breaches during this inspection and found the service was now compliant in both these areas.

Water Royd Nursing Home is a nursing home registered to provide care for up to 62 older people, some who have a diagnosis of dementia. There is a separate unit in the home dedicated to supporting people who have a diagnosis of dementia. On the day of our inspection, there were 59 people living at the home.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was present on the day of our inspection.

People and their relatives told us they felt the service was safe, effective, caring, responsive and well led. Comments included; “I’m feel safe [at the home]. [Staff] really take care of me”, “[Staff] always ask if it’s ok for them to do something, even something like brushing my hair”, “[All staff] are so kind and caring. You can tell they are passionate about what they do” and “I have no problem with complaining or talking the [registered] manager. [Staff] are all approachable and make you feel at ease.”

People were protected from abuse. The home followed adequate and effective safeguarding procedures. Care records were personalised and contained relevant information to enable staff to provide person-centred care and support. People and their relatives had been involved in care and support planning.

Staff were supported well and received regular supervisions. Where required, staff were given regular training updates. The training matrix was well maintained.

We found good practice in relation to decision making processes at the service, in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Regular quality-monitoring systems were utilised at the service and audits were carried out frequently. Where issues or areas for improvement had been identified as part of the audits, the registered manager had taken (or were taking) action to address and resolve them. Audits were signed off when actions had been addressed and resolved.

Staff, people who lived at the home and their relatives were regularly asked for their thoughts and opinions of the home, and were given opportunities to give suggestions to improve the home.

People were asked for their consent before care or support was provided and staff acted in accordance with people’s wishes.

People told us the care they received met their needs. One person said, “I get taken out. We’re going on a barge trip next week. I like a pint or two, if I can get out. I can have a shower or a bath. Things aren’t perfect and I complain, but it’s kept in pretty good order and they respect us, so I’m satisfied.” Another person told us they had received a medication review and an optical assessment recently.

The environment was clean and people were protected from the risk of infection. One person said, “They keep the place clean and tidy, you can’t go further than that.”

Safe recruitment practices were being followed.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We carried out this inspection to check out the progress made with the compliance actions made at the last inspection in August 2012. Following this inspection in August 2012 the provider gave assurances to us that improvements would be made and that all areas of non compliance identified by us would be addressed.

During this inspection we used formal methods of observation to judge people’s experiences of living in Water Royd.

Throughout the observation we saw all staff treated people with dignity and respect by using a positive, friendly and kind approach. We observed examples of good communication skills by staff that utilised eye contact and touch to engage people who used services.

During this visit some people were able to tell us that overall they were happy living at the home.

Some people living at the home had complex needs and required dementia care and were not able to verbally communicate their views and experiences to us. Due to this we used a formal way to observe people at this inspection to help us understand how their needs were supported. We call this the ‘Short Observational Framework for Inspection (SOFI).

During the observation we saw some examples of good communication skills by some staff that utilised eye contact and touch to engage people who used the service.

We did see some practices by staff though that did not enable people to make choices and some staff did not engage or communicate with people effectively.

People that we could communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People’s comments included "Staff are brilliant," "It's very nice here the staff are great,” “I’m nice and comfortable here and the staff are very good to me.”

We spoke with six relatives who were visiting the home and they confirmed that they were very happy with the care provided. One told us, “The care and the staff here are excellent.” Another relative said "We are absolutely delighted with the care dad receives, he is safe here and the staff are very good.” Other comments from relatives included “A really good home,” “no issues, no complaints,” and “staff are lovely, very good.”

As part of the scheduled inspection some external stakeholders were also contacted so they could contribute information prior to our inspection. Barnsley council contracts team responded and shared information which contributed to the planning of this inspection. They told us that they had not identified any major concerns at the home.

We spoke with healthcare professionals who were visiting Water Royd at the time of our inspection. They said they visited the service on a frequent basis. They said they thought the standard of care at Water Royd was generally “O.K.”

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.