Royal Care Home

The Royal Care Home is a residential care home providing personal care to up to 27 people. The service provides support to people who may be living with dementia. At the time of our inspection there were 23 people using the service.

People’s experience of using this service and what we found

The service was not always safe. Not all staff had completed the necessary training to keep people safe. We found care records were not always accurate. Where risks to people were identified recorded documentation to lessen the risk was, at times, conflicting. We found concerns with the cleanliness and maintenance of the environment.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The governance and quality checks in the home did not consistently promote the delivery of safe care and treatment. The registered provider had not established good governance in line with best practice and to ensure compliance with regulation.

We found people were not involved in care planning, we have made a recommendation around this.

The service was caring. One person told us, “[The staff] are all very kind.” We observed positive interactions between residents and staff and people were comfortable in the company of staff. The staff knew people well. People told us they were treated with dignity and respect. One person said, “That was something that worried me beforehand, showers, and things like that, but the staff are very good; their approach is very good, and I feel absolutely fine with [personal care] now.”

People told us they felt safe, comments included, “It feels safe here and I feel very safe in my room.” And “I feel very safe because the staff keep a constant check on us and there’s a routine they follow so we know what’s going on.”

There was a positive staff culture at the service and staff were happy in their roles. People, relatives, and staff were complimentary about the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 April 2021). At this inspection the rating has remained requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 February 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, caring and well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment and good governance at this inspection. We have made a recommendation around involving people in their own care and treatment.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service had dedicated staff to ensure people were admitted safely and continued to be supported in the service in accordance with national guidance. Staff supported people and their relatives to understand the policies and procedures surrounding protection against COVID 19, the isolation processes and how the service could help keep people safe.

Social media systems such as mobile phones and computer systems were used to facilitate contact between people and their relatives. One person said, “They make sure we contact our relatives and keep in touch.”

During our visit we observed the staff using Personal Protective Equipment, (PPE) safely. The registered manager told us sufficient stocks of PPE were available and we confirmed this on the visit. A staff member said, “We are not short of PPE, we have plenty of supplies.”

The service participated in the regular COVID-19 testing programme for both staff and who lived at The Royal. There were no staff employed who had not been vaccinated as now required.

The home was clean and hygienic. Cleaning schedules were in place and PPE stations placed around the home. Additional cleaning protocols were in place to ensure all areas of the building were regularly sanitised.

The Royal Care Home is a residential care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 27 people who may be living with dementia.

The care home is a two storey building with a stair lift to the first floor. There are two lounges and a dining room for people to enjoy.

People’s experience of using this service and what we found

People’s care records were not always accurate and contain the most recent information about them. Audit systems had not identified areas of improvement required. People were not consistently supported by staff who received adequate leadership.

Areas of the home required cleaning and additional equipment to minimise the risk and spread of infection. We have made a recommendation about the management of infection prevention and control.

People were supported by staff who had been recruited safely to help ensure they were able to support people who may be vulnerable. People were helped by sufficient numbers of staff who knew them well.

Risk assessments were carried out in order to identify risks to people and staff knew the action to take to minimise risk.

Staff knew how to report concerns and told us they would act to protect people if they were at risk of harm. People received their medicines safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 July 2019).

Why we inspected

We received concerns in relation to the management of medicines, moving and handling, leadership and staffing. As a result, we carried out a focussed inspection to review the key questions of safe and well-led only. We have found evidence that the provider needs to make improvements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The registered manager and provider responded swiftly to our concerns and took action to minimise risk and improve the service.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to record keeping and good governance at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern.

Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice

¿ The registered manager had ensured staff could access comprehensive and informative training in various aspects of infection control. Staff confirmed they felt confident in the training and this helped them deliver care based on best practice.

¿ The environment had been arranged to minimise the risk of infection and was clean and clutter free.

¿ Information was gathered from visitors to help minimise the risk and spread of infection.

¿ Risk assessments were carried out to minimise the risk and spread of infection.

¿ Processes to minimise the risk of infection were carried out by staff. For example, temperature checks, safe waste disposal and increased cleaning of the home took place.

¿ Covid 19 policies and risk assessments were available and known by staff.

¿ Checks and audits were carried out on the cleanliness of the home and action taken if this was needed.

¿ Adequate handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support best practice.

¿ Staff supported people to use electronic tablets and telephones to maintain contact with loved ones.

¿ People were supported to access health professional advice and care records were updated to reflect the advice.

¿ The service was taking part in the whole home testing process. People at the home were supported to decide if they wanted to participate. If people were unable to make this decision for themselves, best interest discussions were held with relatives and documented.

¿ Appropriate signage was displayed throughout the home to promote best practice.

The Royal Care Home provides accommodation for persons who require nursing or personal care. All the accommodation is located on the ground and first floor of the building and a stair lift is available for people located on the first floor. At the time of our inspection visit there were 24 people who lived at the home.

The care home accommodates 27 older people including people living with dementia in one adapted building.

People’s experience of using this service and what we found

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. People told us they felt safe when supported by staff with their care.

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.

People’s care and support had been planned in partnership with them. People felt consulted and listened to about how their care would be delivered. Care plans were organised and had identified the care and support people required.

People’s communication needs had been assessed and where support was required these had been met. This included providing documentation in large print and various communication aids to support people with daily decision making.

People told us they felt consulted and listened to about the service they received. The provider used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek people’s views about the service provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 31 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

This is the Royal care homes first inspection since the new providers registration with the Care Quality Commission (CQC) on 18 December 2015.

The Royal Care home provides personal care and accommodation for up to 27 older people. The home is situated in St Anne's, in a location close to the town centre with a shopping area, local community facilities and resources and public transport. All the accommodation is located on the ground and first floor of the building and a stair lift is available for people located on the first floor. At the time of our inspection visit there were 24 people who lived at the home.

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.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with four people who lived at the home. We also spoke with two people visiting their relatives. People told us they were happy and well cared for and felt safe living at the home. Comments received included, “The staff are very good and look after me really well. I like a grumble but I cannot grumble about them. I am happy here.” And, “I think this is a very good home and cannot fault the manager and her staff who are all wonderful. I am happy with the care and know [relative] is safe.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

We saw people who lived at the home were clean and well dressed. They looked relaxed and comfortable in the care of staff supporting them. One person visiting the home said, “I really cannot fault the care of [relative]. They look really well and are always clean and well-dressed when I visit.”

People who lived at the home and their visitors told us they enjoyed a variety of activities which were organised for their entertainment. One person visiting the home said, “There was so much going on at Christmas it was wonderful to see everyone enjoying themselves.”

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at the recruitment of two recently appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about support needs of people in their care.

We saw the service had an induction training and development programme in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

We found sufficient staffing levels were in place to provide support people required. This included staff supporting people to hospital appointments. We saw staff members could undertake tasks supporting people without feeling rushed.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems. A visiting healthcare professional told us they had no concerns about the care provided by the service.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found equipment used by staff to support people had been maintained and serviced to ensure it was safe for use.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.