Royley House is a 'care home'. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Royley House is situated close to the centre of Royton, Oldham. It provides care and support for up to 41 people. At the time of our inspection there were 36 people living at the home. Accommodation is provided over two floors which are accessible by a passenger lift. Each floor has its own lounge and dining room and there is a large garden to the rear of the property. Some of the bedrooms have en-suite facilities.

At the time of our inspection the service had a registered manager. 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. Staff told us they felt supported by the registered manager and people who lived at the service and relatives spoke highly of her commitment to the service.

At our last inspection in August 2017 we rated the service Requires Improvement overall. We found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not received adequate supervision. At this inspection we found that staff had received regular supervision and the service was therefore not in breach of this regulation. However, we found concerns with the management of medicines and the safety of the fire extinguishers and water temperatures. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The management of medicines was not always safe. Protocols for the administration of ‘when required’ medicines were not in place. The administration of topical medicines was not recorded safely. One person’s eye drops had not been recorded as given for two weeks. We could not be sure they had received this medicine. Some steps were taken during our inspection to rectify these concerns.

The home was clean and well-maintained. Most areas were nicely decorated. However, the corridors were in need of redecoration and the corridor carpets were in a poor condition. There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas and electricity were up-to-date. However, we found that no action had been taken when concerns about the fire extinguishers and water temperatures had been found.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on newly recruited staff to ensure they were suitable to work in a care setting. At the time of our inspection there were sufficient staff to respond to the needs of people.

Risk assessments had been completed to show how people should be supported with everyday risks.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. All staff received regular supervision. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns.

Staff worked closely with health care professionals to ensure people were supported to maintain good health. People were supported to eat a well-balanced diet and were offered a choice of home-cooked meals.

The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent before helping and supporting them.

People who used the service and relatives were complimentary about the home. We observed kind and caring interactions between s

This inspection took place on 1 and 2 August 2017. Our visit on 1 August 2017 was unannounced.

Royley House is situated close to the centre of Royton, Oldham. It provides care and support for up to 41 people. At the time of our inspection there were 32 people living at the home. Accommodation is provided over two floors which are accessible by a passenger lift. Each floor has its own lounge and dining room and there is a large garden to the rear of the property. Some of the bedrooms have en-suite facilities.

We last inspected Royley House in October 2016. At that inspection we rated the service ‘Requires Improvement’ overall, with the ‘Well-led’ domain being rated ‘Inadequate’. At that inspection we identified three regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to infection prevention and control, medicines management, staff training and poor governance. We issued warning notices in respect of the three regulatory breaches. Following the inspection the provider sent us an action plan detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found improvements had been made. However, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staff supervision. You can see what action we asked the provider to take at the back of the full version of this report.

The service had a registered manager. 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.

Staff understood safeguarding procedures and what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

Medicines were stored safely and were administered by staff who had received appropriate training and been assessed as competent to safely administer medicines.

The home was clean and free from any unpleasant odours. The dining rooms and some of the bedrooms had recently been redecorated to a high standard and there was an on-going programme of redecoration. Procedures were in place to prevent and control the spread of infection.

Environmental checks of the home, such as for the gas and electricity supply were up-to-date. However, tests of the fire alarm and water temperature had not been carried out as frequently as they should have been. The registered manager has taken steps to rectify this since our inspection.

Staff had undertaken a variety of training to ensure they had the skills and knowledge required for their roles. All new staff received a comprehensive induction.

Staff supervision was not carried out in line with the supervision policy. Some staff had not received any supervision during 2017.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. People we spoke with were happy with the quality of food provided.

Everyone we spoke with was complimentary about the staff and we observed staff to be kind and patient with people they supported. Care plans, which were reviewed regularly, were detailed and reflected the needs of each individual.

An activities coordinator encouraged people to

This inspection took place on 11 and 13 October 2016. Our visit on 11 October was unannounced.

We last inspected Royley House in November 2014. At that inspection we found the service was meeting all the regulations we assessed.

Royley House was originally built as a sheltered housing project and is situated close to the centre of Royton, Oldham. In 2000 it was taken over by RochCare Ltd and transformed into a care home for older people, where it provides accommodation for up to 41 people. At the time of our inspection there were 31 people living at the home. Some of the bedrooms were vacant because the owners were undertaking a programme of refurbishment. Accommodation is provided over two floors which are accessible by a passenger lift. Some of the bedrooms have en-suite facilities. Each floor has its own lounge and dining room and there is a large attractive garden to the rear of the property.

The service had a registered manager. 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.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Infection prevention and control measures were not thorough enough. Posters detailing the correct handwashing procedure were not on display and we observed a carer instil eye drops without first washing their hands. We were unable to find evidence to show us that staff had received recent training in infection prevention and control.

Medicines were not managed safely. An action plan put in place following a recent medicines error had not been implemented in full. We found unsafe practice in relation to the administration of insulin.

Staff had an understanding of safeguarding procedures, how to identify signs of abuse and what action they would take to protect people in their care. However we could not find evidence to show that all staff had received recent training in this area.

The registered manager was unable to provide us with evidence to confirm that staff had received appropriate training in order to be able to carry out their roles effectively. However, staff received regular supervision and those we spoke with told us they found it to be helpful.

The home was clean and generally well-maintained, although there had only been a minimal attempt to make the environment ‘dementia friendly’. We have recommended the provider reviews good practice guidance in relation to developing a dementia friendly environment.

We observed some caring and kind interactions between staff and people who used the service. Activities were available for people to take part in.

People were supported to eat and drink sufficient amounts to meet their needs. People were referred appropriately to a variety of health professionals in order to be supported to maintain good health.

Complaints were recorded, investigated and action was taken in response.

Governance systems to ensure that the quality of service provided was regularly monitored were very limited and issues we identified during our inspection had not been picked up by the few checks that were in place.

The registered manager did not have over sight of the day-to-day running of the home and lacked leadership.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found -

Is the service safe?

Emergency fire procedures were in place at the care home. A personal emergency evacuation plan (PEEP) had been implemented. This meant people who used the service had undergone an individual assessment of their support needs in the event of a fire at Royley House.

We observed staff members using effective infection control procedures. This included wearing protective clothing when supporting people with personal care. The risk of cross infection was further minimised by the use of hand washing liquid, disposable paper towels and hand sanitizer. This helped ensure the health and welfare of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS authorisations had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

Before people were admitted to Royley House care home, they underwent a pre-admission assessment. We saw the person`s individual choices and preferences had been recorded. A care plan involvement form had been signed by the person or a family member. People`s signatures within care plans confirmed their involvement and consent with their identified care needs.

People`s needs were taken into account with the signage and layout of the service which enabled them to move around freely and safely. The care home had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

We spent time in communal areas and observed staff asking people for their consent before providing any care or support. For example, at lunch time, people were asked if they required support eating their meal. We saw one person was supported to finish their meal but gave their consent before the staff member assisted them.

One person we spoke with told us, "I am very happy here. The staff are really nice and patient with me." We asked a family member why they chose Royley House and we were told, "We looked around quite a few other care homes, but once we came here our minds were made up. This was simply the best."

Is the service responsive?

An activities co-ordinator was employed at the care home. We observed several activities taking place. These were recorded in people`s care plans which helped identify what activities were undertaken and enjoyed by different people. People were supported to maintain their involvement within the local community.

We saw a suggestion/complaints box was present in the entrance area. When people were first admitted into the care home, they received a service user handbook, which we saw was present in the reception area and in people`s rooms. This included the procedure for making a complaint.

Is the service well led?

The provider had procedures in place that monitored the quality of service being provided to people who used the service. We saw evidence of monthly environmental and medication audits and accidents and incident analysis. Monthly managers meetings were held which we were told were aimed at improving the quality of service being provided.

General Practitioner and other professional appointments had been recorded within care plans. The registered manager told us, "We have a very good relationship with other agencies. If we ring they come out really quickly."

One person living at the home said “I’m happy with my lot. I have a good rapport with the staff. I’ve no complaints. I’ve got all I need”. Another told us “I’m well looked after”. One visiting relative said “The care is excellent” and staff encouraged their relative “to be independent, just as I would wish”.

People living at the home generally spoke positively about the food. Some changes to the menu were suggested, for example, to increase the variety at tea time. One person told us their relative “seems happy with the food”. Another told us “the food here is always Ok”.

The accommodation was provided across two floors and a passenger lift was available. On each floor there was a lounge, a dining room, bedrooms, toilets and bathrooms.The décor and furnishings were well maintained throughout and the home was free from unpleasant odour.

We spoke with two members of staff. Both were enthusiastic about their work. They spoke positively about the opportunities for further development made available to them, and the support they had received from the provider in pursuing them.

The provider had a complaints procedure in place. We saw that a copy of this was included in a service user guide in the reception area. This was readily accessible to people using the service.

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether all the people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an expert by experience who has personal experience of using or caring for someone who uses this type of service.

People told us that their views and preferences were sought when they moved in and that they could say if they wanted a change or were not happy with the service provided. People also told us that their wishes were respected in terms of personal care.

Most people told us that they liked the food although one person said the meals "aren't absolutely wonderful".

People who were using the service, who we asked, said they felt safe living at Royley House. One person said "I feel very safe here" and one relative said they had "no worries at all".

People told us that there were sufficient staff available to answer calls for assistance in a timely way. One person living at the home expressed some regret that staff did not have more time for a chat. However, most people we asked, thought there were sufficient staff for the most part. One person said "staff have enough time for me". Other comments included "people are around if we need them" and "some of the carers come and have a chat".

One person who used the service, commented "you know, I'm right glad I'm in here".

We spoke to a number of people who used the service and some relatives of people who used the service. Overall people told us they were happy with the service provided at Royley House. People told us they were happy with the accommodation and that they could stay in their own rooms if they wished or use any of the communal facilities.

People told us they felt safe with the staff and, although they had not needed to, they believed they could complain and that any complaint would be listened to. People told us there seemed to be enough staff on duty and they responded in a timely manner if help was needed. People who used the service told us that they felt involved in the way in which their care needs were met. One person told us that staff ask, "what can we do to help you that we are not doing at present?” Another person told us that staff were "joking and friendly". Another cited "the friendliness of staff" as one of the best things about the home and something which helped them "to carry on". One person said to us "I know I call it sometimes, but I do know different. The manager is very good and will listen."

People who used the service told us that they had enough food and that there was always an alternative to the main menu option.

People told us they were happy with the way in which medical support was obtained if necessary and that they believed they were supported to take any medicine that had been prescribed.