This inspection took place on 24 October and 2 November 2017, and was unannounced.

At our last inspection in October 2016 we found the registered provider was not compliant with Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was no system in place to ensure that staffing levels were adequate to meet the care and support needs of people using the service. At this inspection we found the registered provider had made improvements to ensure the requirements of this regulation were met.

Ghyll Royd Nursing Home is a 76 bedded care home for older people. They provide nursing care and have a unit dedicated to the care of people who are living with dementia. The home is divided into four units; Yew, Rowan and Maple provide general nursing care and Beech for specialist dementia care. Each unit has a designated unit manager. The services lounge, dining room and conservatory are located on the ground floor. There are gardens to the rear of the home and ample parking available.

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.

At this inspection we found additional staff had been employed and a dependency tool was now in use. This enabled the changing needs of people to be regularly assessed and to ensure there were sufficient numbers of staff provided to support them. Improvements had been made to ensure the principles of the Mental Capacity Act (MCA) 2005 were followed and people’s best interests were promoted when they lacked capacity to make informed decisions. 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.

Staff had been safely recruited and safeguarding training was provided to enable them to recognise and report potential abuse. Medicines support arrangements were safe and systems were in place to ensure potential risks to people were managed. Incidents and accidents were monitored with action taken to ensure these were minimised to prevent reoccurrence.

Staff were supported by a programme of training and development to ensure they were able to carry out their roles. People’s privacy and dignity was promoted and their independence was maximised by staff who demonstrated compassion for their needs. People were treated with kindness and consideration and supported to make choices and decisions about their lives. People’s health and nutritional needs were monitored with involvement from health care professionals, when required.

People were provided with a range of wholesome meals and their wellbeing was supported by a range of meaningful activities. People’s complaints were taken seriously and these were listened to and acted on by management.

Governance systems were in place to enable the quality of the service to be effectively monitored, with action taken to enable the service to learn and develop. There was an open and positive culture that welcomed people’s feedback, which helped the service to continually improve. Staff told us they were supported and listened to and had confidence in the manager who would take action when it was needed.

Our inspection took place on 10 August 2016 and was unannounced. At our last inspection in July 2014 we found the provider was meeting all the standards we looked at.

Ghyll Royd Nursing Home is a 76 bedded care home for older people. They provide nursing care and has a unit dedicated to the care of people with dementia. The home is divided into three units; Yew and Rowan provide general nursing care and Beech is the specialist dementia unit. Each unit has a designated unit manager. The lounge, dining room and conservatory are located on the ground floor. There are gardens to the rear of the home and there is ample parking available.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

We saw there was no system in place to ensure staffing levels were matched to the current care and support needs in the service. People who used the service, their relatives and staff all

expressed concerns that staffing levels were not adequate.

Risks associated with people’s care and support were well assessed, and documented in detail to ensure staff worked with people in ways which minimised those risks. The provider ensured staff were knowledgeable about the risks of abuse and had policies, practices and training in place to ensure staff understood their responsibilities under safeguarding.

Appropriate background checks were carried out before new staff began working in the service.

The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. However, we found capacity assessments and best interest decisions were not always recorded in peoples care records.

Medicines were well managed, and where errors in recording had occurred we were able to see documents which showed the registered manager had taken action to prevent the error re-occurring.

Staff received a thorough induction which included checks on their competencies. We saw there was a programme of training in place which included mandatory training and regular refresher courses. A programme of regular supervision meetings and annual appraisals was in place.

We observed the lunchtime service and saw it was relaxed, with people assisted to make choices

in a patient and caring way. People were supported to eat their meal and we saw the staff

members provided this support when needed.

We saw the provider had robust systems in place to ensure any complaints or concerns were recorded and investigated. We saw accidents and incidents were reported. We were able to see what actions had been taken in response to these reports.

We received consistently positive feedback about the registered manager. The audits were detailed and we saw evidence which showed any actions resulting from the audits were acted upon in a timely manner.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

People were treated with respect and dignity by staff. One person said, “I have no concerns, we are treated very well.”

People told us they felt safe. Staff told us they understood safeguarding policies and would report any concerns they had about people's care and treatment.

Staff demonstrated they knew the people they supported and people’s care records reflected it. Care plans were specific to the person and described how they wished to be supported.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Where people required additional support from health professionals referrals had been made and any instructions had been followed.

Is the service caring?

People who used the service were asked about their care and were able to make decisions. They were supported by kind and attentive staff.

People who used the service told us they were happy with the care and support received. Their comments included: “I do like it here, all very nice, staff are lovely” and “I have everything I need here.”

We saw people were happy, relaxed and comfortable with staff in their interaction with them.

Is the service responsive?

People who used the service told us they knew how to complain or raise concerns if they had any.

We saw people who used the service were responded to promptly when they asked for any support or assistance.

People were supported to be involved in activity of their choice within the home.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable. They said they had confidence any issues brought to her attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

The Provider had systems in place to assess the quality and safety of the service provided.

We spoke with four people who used the service and four people who were visiting relatives or friends who used the service. Everyone we spoke with said they were happy with the care and support provided at Ghyll Royd and said they felt safe. One person said they were “well cared for”. A relative said it was “very comforting” to know their relative was safe and well cared for. People said the staff were “very good” and were always around. One person said the staff seemed to be busy but were available when they needed help. People who visited the service told us they had never seen or heard anything to cause them concern about the way staff treated people. One person singled out the activities organisers for a special mention; they felt they did a very good job of providing a range of different activities for people. People told us they would not hesitate to speak to the manager if they had any concerns and were confident their concerns would be dealt with.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found people’s medicines were managed safely.

We found the required checks were done before new staff started work and there were enough staff to meet people’s needs and keep them safe.

We found people’s records were dealt with appropriately.

We carried out our unannounced inspection in the late evening in response to concerns raised with us about medication handling in general and at that time of day.

At the time of our visit most people were in bed or getting ready for bed so we did not obtain the direct views of people who live in the home.

We found some areas of good practice but we found a number of concerns about the safe administration of medicines and the records kept about medicines.

Before people received any care or treatment they were routinely asked for their consent. Members of staff told us that they always explained all procedures and treatments. The care plans we looked at contained evidence of people’s views and experiences that were taken into account in the way the service was provided. One person told us, “They always ask me things.” Another person said, “I can make my own decisions each day.”

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out how each person should be supported to ensure that their needs were met. One person told us, “I can’t see I could go elsewhere and do any better, general standards are good.” Another person said, “They understand what I need and when I need it, it’s not bad, care is good.”

We observed that people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us that they had no concerns with the cleanliness of the home.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work. This included carrying out a Criminal Records Bureau check and obtaining references.

There was an effective complaints system in place. Complaints people made were responded to appropriately.

During the visit we spoke with people using the service:

People who use the service told us they were very happy with the care and support provided by staff and that staff were kind, considerate and caring and always respected their right to privacy and dignity.

“Great place to be”

“All staff are helpful”

“All staff know my likes and dislikes.”

“Feels staff listen to any concerns and deal with straight away.”

“Something to do everyday.”

“I like the PAT dog.”

“Staff always knock.”

“Excellent home would not want to go anywhere else.”

“Staff have helped me regain my independence.”

“Breakfast is excellent.”