The Royal

Updated 5 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The Royal is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Royal is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post. However, the registered manager held an area manager role and the provider had recently appointed to the registered manager post. The new home manager had been in post approximately one week prior to our inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service and six relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager, new manager, and care workers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at a variety of records relating to the management of the service. After our inspection we continued to seek clarification from the provider to validate evidence found.

Updated 5 August 2022

About the service

The Royal is a residential care home providing personal and nursing care for up to 57 people. At the time of our inspection, there were 49 people using the service. Some people using the service were living with dementia.

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

Systems in place to ensure people received their medicines as prescribed were not always effective.

People were not always protected from the risk and spread on infection. For example, some areas of the home required a deep clean and some seating was heavily stained and unclean.

The provider had systems in place to monitor the quality of the service. This process had not always identified issues we found on inspection. Where issues had been noted as a result of internal audits, actions to rectify them had not been completed in a timely way.

The provider had systems in place to safeguard people from the risk of abuse. Staff we spoke with confirmed they had received training in safeguarding and knew what action to take if they suspected abuse.

Risks associated with people’s care had been identified and plans were in place to ensure they were managed safely. The manager had a system in place to monitor incidents and completed an analysis to identify trends and patterns and mitigate future incidents.

The provider had a system in place to ensure staff were recruited safely and received an induction. We observed staff interacting with people and found there were sufficient staff available to meet people’s needs in a timely way.

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 9 June 2018).

Why we inspected

We received concerns in relation to staffing, frequent falls and changes in the management team. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘The Royal’ 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 have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up

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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.