The Royal

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.

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, mental health, younger people and people living with dementia. At the time of the inspection 41 people were living at the home.

At the last inspection in May 2016 the service was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘The Royal’ on our website at www.cqc.org.uk.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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 and associated Regulations about how the service is run.

People who used the service and the visitors we spoke with told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed. People told us they felt safe living in the home. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified any potential risks to people and care plans were in place to help ensure people’s safety.

Medicines were stored appropriately, although the audit procedures could be improved. There was enough skilled and experienced staff on duty to meet people’s needs.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. New staff had received an induction into how the home operated and their job role, at the beginning of their employment. They had access to a varied training programme that met the needs of the people using the service.

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 were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The people we spoke with said they were happy with the meals provided and we saw they were involved in choosing what they wanted to eat. On the day we visited the dining rooms were relaxed and people who used the service were given time to eat their meal leisurely.

People’s needs had been assessed before they went to stay at the home and we found they, and their relatives, had been involved in the planning their care. The care files we checked reflected people’s needs and preferences, so staff had clear guidance on how to care for them.

People had access to a programme of activities and entertainment, as well as trips out into the community. People’s relatives told us people enjoyed the activities they took part in.

The people we spoke with said they had no complaints and they would feel comfortable speaking to staff if they had any concerns. We saw when concerns had been raised they had been investigated and resolved in a timely manner. There were effective systems in place to monitor and improve the quality of the service provided.

Further information is in the detailed findings below

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, mental health, younger people and people living with dementia. At the time of the inspection 33 people were living at the home.

The service did not have a registered manager in post at the time of our inspection. However, a manager had been appointed and had been in post for approximately six months. They were in the process of registering with the Commission. 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 and associated Regulations about how the service is run.

People who used the service, and the visitors we spoke with, told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed. One relative told us, “The new manager is excellent. The home has turned around.” Another relative described the home as, “The best it’s been.”

People told us they felt safe living and working at the home. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified any potential risks to people and we found care plans were in place to ensure people’s safety.

Medicines were stored appropriately and procedures were in place to ensure they were administered safely.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, care records did not always clearly record decisions made in people’s best interest.

There was enough skilled and experienced staff on duty to meet people’s needs, but some relatives felt additional staff would be beneficial at key times, such in the morning and at lunchtime.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. New staff had received an induction into how the home operated and their job role, at the beginning of their employment. They had access to a varied training programme that met the needs of the people using the service.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The people we spoke with said they were happy with the meals provided and we saw they were involved in choosing what they wanted to eat. On the day we visited the dining rooms were relaxed and people who used the service were given time to eat their meal leisurely.

People’s needs had been assessed before they went to stay at the home and we found they, and/or their relatives, had been involved in the planning their care. The care files we checked reflected people’s needs and preferences, so staff had clear guidance on how to care for them.

People had access to a programme of activities which provided regular in-house stimulation, as well as trips out into the community. Relatives told us people enjoyed the activities they took part in.

We saw the complaints policy was available to people using and visiting the service. The people we spoke with said they had no complaints, but said they would feel comfortable speaking to staff if they had any concerns. We saw when concerns had been raised they had been investigated and resolved in a timely manner.

There were effective systems in place to monitor and improve the quality of the service provided.