All inspections: The Royal Care Home - Care Quality Commission

The inspection took place on 1 and 2 July 2015 and was unannounced. Our last scheduled inspection at this service took place in August 2014 when we found four breaches in legal requirements. These were regarding staff not being deployed effectively, care records lacking sufficient detail, which led to people’s needs not being met. We also found the recruitment process was not robust, people’s dignity was not always preserved, there were gaps in essential staff training and staff support sessions were not taking place. The provider sent us an action plan detailing what improvements they intended to make and by when.

At our inspection on 1 and 2 July 2015 we found the provider had followed their action plan and legal requirements had been met. However, the provider was still in the process of embedding the improvements made into practice.

The Royal Care Home is situated in Rossington on the outskirts of Doncaster. The service is registered to provide both nursing and personal care for up to 57 people in the categories of older people and people living with dementia. At the time of the inspection there were 39 people living at the home.

The service had 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 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 spoke with staff who had a clear understanding of safeguarding adults and what action they would take if they suspected abuse. Staff we spoke with were confident the registered manager would act appropriately to safeguard people from abuse. Posters were displayed around the service with contacts for the local council safeguarding team.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. However, the home had experienced difficulties in recruiting nurses so was using agency nurses to cover shortfalls. This meant people were not being consistently supported by senior staff who knew them and records were not always reviewed and updated in a timely manner. People who used and visited the service, as well as the staff we spoke with, felt that overall there were sufficient staff available to meet people’s needs.

People were supported to have their assessed needs, preferences and choices met by staff who had the necessary skills and knowledge. Staff we spoke with told us they received appropriate training which made them confident to do their job. However, we found staff support sessions had not taken place on a regular basis.

We found the service to be meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had some knowledge of this and said they would speak to the registered manager for further advice.

People were supported to eat and drink sufficient to maintain a balanced diet. However, menus were not clearly displayed or in a format people could understand, and staff felt there were times when people did not have much to choose from. We observed lunch on the first day of our inspection and found it to lack organisation. This led to people waiting some time before their meal was served.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support. The care records we checked showed they had received support from healthcare professionals when required.

People who used the service were supported to maintain friendships and we saw care plans contained information about their family and friends and those who were important to them.

People’s needs had been assessed before they moved into the home and the relatives we spoke with told us they had been involved in formulating care plans. We found three of the four care records we checked reflected people’s needs, preferences and risks associated with their care in detail. However, the fourth plan we looked at contained an out of date care plan that had not been updated to reflect changes in their needs. We found this had not had any adverse impact on the person and was addressed by the registered manager on the following day.

Records showed that the majority of care plans and risk assessments had been reviewed on a regular basis, but the electronic system showed that several had not been evaluated in the timescales indicated.

Dedicated activities co-ordinators were employed to provide regular activities and stimulation. We saw there was a varied activities programme available which people could choose to participate in.

We saw the complaints policy was easily available to people using and visiting the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. When concerns had been raised we saw the correct procedure had been used to record, investigate and resolve issues.

Staff were clear about their roles and responsibilities, but senior staff were not always ensuring that care workers were working effectively to meet the needs of the people being supported. For example, we saw mealtimes were disorganised which meant some people were sitting in the dining room for up to 30 minutes without receiving a meal or a drink.

The provider had a system in place to enable people to share their opinion of the service provided and the general facilities at the home. However, information obtained through surveys had not always been summarised to highlight what had worked and what needed improvement. We also saw that outcomes had not been shared with people using and visiting the service.

Audits had been used to check if company policies had been followed and the premise was safe and well maintained. Where improvements were needed the provider had put action plans in place to address and issues. However, shortfalls had not always been identified and where they had timescales had not always been met. This meant the system was not effective in improving the quality of the service provided. We also noted that most policies had not been reviewed since 2012 when they were introduced. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The Royal Care Home is situated in Rossington on the outskirts of Doncaster. The service provides both nursing and personal care for up to 57 older people and those living with dementia.

The service had 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 to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We saw there were systems in place to protect people from the risk of harm. We observed some staff responded well to people and understood their individual needs, however we saw some staff were not as caring and supportive.

We found that people were supported by sufficient numbers of qualified, skilled and experienced staff. However, we saw there were occasions where people were left for periods of time without staff intervention. We saw a training matrix which reflected that some training had not been completed and individual staff supervision sessions were not taking taking place regularly.

Suitable arrangements were in place to support people to maintain a healthy intake of food and drink but views about the quality of food were mixed. Staff were aware of people’s nutritional needs and ensured these were met effectively.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Support plans contained a good level of information which explained how to meet the person’s needs. People told us that they had been involved in developing their support plan and felt they contributed on an ongoing basis.

We observed staff supporting people with whom they had developed good relationships and could recognise their needs. Some staff were very respectful and ensured privacy and dignity was maintained. However, some staff had not developed relationships with people and we observed incidents where dignity was not maintained.

Everyone we spoke with said they felt comfortable raising concerns but some did not receive follow up or feedback after they had raised concerns.

The provider had a system to monitor and assess the quality of service provision. This included giving people the chance to have their say and an opportunity for the provider to improve.

We found a number of 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.

We were unable to speak with people who used the service due to their complex needs. However, we gathered evidence by observing people who used the service, we also spoke with their relatives and looked at records. We found the environment to be calm and people were engaging in different tasks. Staff were providing care in a kind and respectful way. Relatives we spoke with told us the standard of care was good. One relative said "I can't fault it, my husband is well looked after and has put on weight since coming here." Another relative said "My wife has been here for three years and requires full care and support.The staff treat both of us well."

People experienced care, treatment and support that met their needs and protected their rights. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We found the home was clean and free from odours. There was a refurbishment programme in place to improve the d'cor of the home.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider took account of complaints and comments to improve the service.

We carried out an unannounced inspection in response to concerns about the high number of safeguarding alerts relating to physical altercations between people who used the service. We were unable to speak with people who used the service due to their complex needs. However, we carried out observations of how staff interacted with people, spoke with staff and looked at records.

We found care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. Information in people's records did not give staff sufficient guidance on what triggers led to people's behaviours, how these were being monitored and what action was taken during and after each incident. We found charts were not always being completed when people's behaviours changed.

People's needs were not assessed and care and treatment was not planned and delivered in line with their individual care plan. We found the frequency of monitoring people's behaviours did not correspond to what was identified in people's risk assessment. This did not ensure care was being delivered to minimise the risk or meet people's individual needs.

We spend time observing how staff interacted with people who used the service. We saw groups of people were sat in lounge areas for most of the day or were wandering around the corridors. We found there was a lack of staff presence in these areas to provide people with a stimulating environment or meaningful activities.

We gathered evidence by observing people who were unable to speak with us. We also spoke with four relatives. We found staff offered support, explanations and reassurance to people who used the service. Relatives spoke positively about the standards of care being provided. One relative said: "The care is excellent. My mum is always nicely dressed and clean." Another relative told us: "I have no concerns. Staff are respectful and polite and do their best for people."

We found people experienced care, treatment and support that met their needs or protected their rights. People's care and treatment was being planned and delivered in line with their individual care plans. Assessments had been regularly evaluated and action taken where required.

People were protected from the risk of infection because appropriate guidance had been followed. Relatives we spoke with confirmed staff wore gloves and washed their hands when providing care.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Evidence showed there were enough qualified, skilled and experienced staff to meet people's needs. Staff said they worked well as a team providing a good standard of care to people who used the service.

There was an effective complaints system available. Relatives we spoke with confirmed they could raise concerns with the manager or staff and these would be acted on.

As part of our inspection we spoke with four people who used the service. They spoke positively about the care and support they received. One person told us: "I like the staff, it's a fun place." Another person told us: "I'm looked after well, I like it here."

We spoke with relatives of two people who used the service. Both expressed their satisfaction with the standards of care at the home. One relative told us: "My relative has been here for two years, the care is fantastic. All his needs are met by staff. The manager acts on any concerns I have quickly. I don't often have any concerns." Another relative told us: "I am happy with the care. My relative enjoys it here, it's a nice place."

As part of our inspection we spoke with people who use the service. They spoke positively about the care and support they received. One person told us: "Staff are good, they look after you." Another person said: "Good here, I am given choices and staff are respectful."

We spoke with relatives who expressed their satisfaction with the standards of care at the home. They told us staff were very good and they were kept informed of any changes. Some of the comments we received included: "I always see staff responding quickly to people's calls and needs" and "Very friendly staff, I ask for things to be done and they do it. Things seem to work well."

During our inspection we also used a method of observation called the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who are unable to communicate verbally in a meaningful way. We observed five people who use the service for a period of 40 minutes and recorded their experiences at regular intervals. This included people's mood, how they interacted with staff, other people who use the service and the environment.

As part of our inspection we spoke with people who use the service. They spoke positively about the care and support they received. One person told us, "It's alright here." Another person said: "They are looking after me alright."

During the visit we spoke with relatives who expressed their satisfaction with the standards of care at the home. They told us the staff were very good and they were kept informed of any changes. Some of the comments we received included: "The care is very good, the nurses and carers are helpful and caring, I have no problems at all", "My husband has been here for 18 months and I have no regrets, I've never had grounds to complain" and "My mum's been here for three years, the staff have been fantastic, they work with her to get the right choices."

We received some mixed comments about staffing levels at the home. Some of the relatives we spoke with felt there were enough staff to meet people's needs. However, others told us sometimes there was a shortage of staff. One relative said: "They (the home) could do with more staff. If anyone is sick they can't replace them, they run on short staff. Staff have to phone somebody to see if a colleague can come in for them."

People who use the service and relatives told us that people were respected and involved as much as possible. A person told us that their family had chosen their room. Relatives told us they appreciated being notified of, and involved in, activities and events.

People using the service told us how they appreciated living in the home. This was mainly confirmed by relatives we spoke with. One relative told us, 'I like it!' Another relative said, 'I think it is a lovely place.' A relative spoke to us about his parent's care, 'The care my mother gets is ideal ' round the clock. Since my mother's been in here her quality of life has improved.'

The relative of a person using the service told us he attended care review meetings every six months, after his relative had fallen more than once. He had access to his relative's care plan. He told us, 'They send me a letter informing me of a carer's meeting. I can't fault the place.'

People told us they felt safe in the home and relatives confirmed this.

A relative told us that there was a smell in the home. However, another relative said,

'It's always clean, and they seem to be on top of the smells.'

People using the service and relatives told us how much they appreciated the staff. A person told us, 'The staff are very good. I can't grumble.' Another person told us, 'I get on well with the staff.'

Some relatives were aware of meetings at the home, but others were not.

Archived: The Royal Care Home

All Inspections

1 and 2 July 2015

During a routine inspection

5 and 11 August 2014

During a routine inspection

26 June 2013

During a routine inspection

10 May 2013

During an inspection in response to concerns

12 February 2013

During a routine inspection

8 August 2012

During an inspection looking at part of the service

9 May 2012

During an inspection looking at part of the service

24 February 2012

During an inspection looking at part of the service

27 October 2011

During a routine inspection