We carried out a review of the data available to us about Royal Leamington Spa Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Royal Leamington Spa Nursing Home, you can give feedback on this service.
Royal Leamington Spa Nursing Home is a care home with nursing that provides accommodation and personal care for up to 43 older and younger people living with dementia and physical disabilities. At the time of our visit, 38 people lived at the home.
People’s experience of using this service:
• People felt safe and were protected from avoidable harm. Staff understood how to keep people safe and how to report any concerns they may have.
• Staff knew about the risks associated with people’s care and understood how to minimise risks to them. Further information was available in care plans for staff to refer to.
• Staff supported people to take their medicines as prescribed.
• Staff understood how to prevent the spread of infection.
• People received care from a consistent team of staff who understood their needs.
• Staff were recruited safely and processes checked the background of potential new staff.
• People’s needs were assessed to ensure they could be met by the service.
• Staff received the training and guidance they needed to complete their role well. The registered manager encouraged staff to expand their knowledge through specialised training.
• People made their own decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.
• People were offered choices. For example, in the meals and drinks they were offered.
• Staff respected people’s rights to privacy and dignity.
• People received information about the service in a way that was appropriate to their needs.
• People were involved in planning their care.
• Care plans contained the information and guidance staff needed to support people.
• The service used innovative ways to achieve meaningful outcomes for people
• Systems were in place to manage and respond to any complaints or concerns raised.
• The registered manager had robust systems and processes to monitor quality within the home.
• The registered manager understood their regulatory responsibilities and shared information with stakeholders in a timely way.
Rating at last inspection: At the last inspection the service was rated as good overall with one area of requires improvement within the responsive domain (The last report was published on 14 October 2016).
At this inspection we found improvements had been made and the service is now rated good in all areas.
Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Royal Leamington Spa Nursing Home is an older style property, divided into two houses and over three floors. The home consists of two buildings identified as houses '14' and '16'. The houses are connected by a corridor known as 'the link'. The home is registered to provide nursing or personal care for up to 46 older people. At the time of our inspection there were 39 people living in the home.
This service was last inspected on 23 April 2015 and we found two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. People were not always treated with dignity and respect and systems and processes were not established by the registered provider and operated effectively to assess, monitor and improve the quality, welfare and safety of the service. At this inspection we looked to see if the provider had responded to make the required improvements in the standard of care to meet the regulations. We found they had made improvements and they were no longer in breach of the regulations.
A registered manager was in post. 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. The registered manager had been in post since June 2016.
There were enough staff to keep people safe. Staff mostly understood people and were responsive to their care and support needs. However, new staff and agency staff did not always know people’s needs which sometimes led to inconsistency of care and sometimes people had to wait for staff to respond to requests for assistance.
Safe and effective recruitment practices were followed to ensure that all staff were of good character and suitable for the roles they performed. Staff understood safeguarding procedures and knew what action to take if they believed people were at risk of abuse. Staff received training, supervision and support to meet people's needs effectively.
Where potential risks to people's health, well-being or safety had been identified, these were assessed and reviewed to take account of people's changing needs. People's care plans included risk management plans and control measures to reduce the identified risk. The provider had plans to ensure people were kept safe in the event of an emergency.
Medicines were managed safely and people received the medicines they required in the correct dosage at the correct time in accordance with their prescriptions.
The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Decisions were made in people's 'best interests' where they lacked the capacity to make decisions for themselves.
People were supported to eat and drink enough for their needs and to maintain a balanced diet. Staff had regular contact with visiting healthcare professionals to ensure people were able to access specialist advice and treatment when required.
Staff demonstrated an easy rapport in their interactions with people. Staff spoke with people in a kind tone of voice and used effective communication skills such as establishing eye contact with people before speaking with them. People were treated with dignity and respect and supported to be as independent as they wished. The registered manager regularly worked alongside staff to assure themselves that people received care and support from a staff team who were considerate and respectful in their interactions with people.
Care plans were written in an individual and person centred way and gave clear information about what people liked and did not like, and how they preferred their support to be provided. Staff were kept informed about people’s health and wellbeing through handover meetings between shifts.
The provider had a complaints process and procedure that was accessible, but some relatives could not be sure informal concerns had been listened to or acted upon.
Staff felt supported by the management team and described the registered manager as 'open' and 'approachable'. The registered manager had made changes in response to staff feedback which had a positive impact on staff practice in the home.
There were effective quality assurance systems that monitored people's care. Where issues had been identified these were followed up and recorded when completed to improve the quality of care people received.
This inspection took place on 23 April 2015 and was unannounced.
Royal Leamington Spa Nursing Home is an older style property, divided into two houses and over three floors. The home consists of two buildings identified as houses ‘14’ and ‘16’. People living in house 14 were considered by care staff to have higher level care needs.
The home is registered to provide nursing or personal care for up to 46 older people. At the time of our inspection there were 38 people living at the home.
A registered manager was not in post as they had left the service in May 2013. 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. A new manager had been appointed and they planned to complete the process for registration.
Most people at Royal Leamington Spa Nursing Home had high level nursing needs. Many of them were cared for in bed and required two carers to support them. People told us they felt safe living at the home and their care needs were met, but they often had to wait for long periods for staff to assist them with their care.
Some people told us staff were respectful and kind towards them, however others said at times staff could be abrupt in their approach. They told us staff were not always caring and on occasions people’s dignity was not respected.
Care plans contained some relevant information for staff to help them provide the care and treatment people required. However, we found these contained primarily medical information and little information about people’s histories, preferences and interests. Risk assessments were minimal in their detail and did not identify risks clearly, and ways to reduce these or prevent them. This did not protect people from the risks associated with their high care needs.
Checks were carried out prior to staff starting work at the home to ensure their suitability for employment. A period of induction then enabled them to understand systems within the home and people’s individual needs. We saw staff had training in areas considered essential to meet people’s needs safely and consistently. Staff were encouraged to continue to develop their skills in health and social care by managers.
People told us they liked the food and we saw there were a variety of food and snacks available which people could access when they were hungry. However at times drinks were not always accessible. People with special dietary needs were catered for, and relatives could come and eat a meal with their family member if they wished to do so.
Most people we spoke with were positive about the management and the running of the home. We saw systems were in place to make sure the environment was safe for people that lived there. Records of complaints were not up to date so we were unable to see how they had been managed and whether people were satisfied with the outcome. Some people told us they did not feel their concerns had been addressed.
Medicines were stored securely and systems ensured people received their medicine as prescribed. People’s health and social care needs were reviewed regularly with appropriate referrals made to other professionals.
Written consent forms had been completed for some areas of care, but we saw that often relatives had signed these on behalf of their family members. Many of these people had capacity to make their own decisions, so these were not being completed appropriately and within legal guidelines.
Staff responsible for assessing people’s needs, understood the Mental Capacity Act, and we saw that when there were concerns about people’s capacity, some assessments had been completed to determine people’s ability to make certain decisions. Where people were assessed as lacking capacity, decisions were made in their ‘best interests’.
The provider was not meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection, no applications had been made under DoLS for people’s freedoms and liberties to be restricted. The manager had not contacted the local authority in line with recent changes to DoLS to ensure people’s liberties were not being restricted.
People were given choice about how they wanted to spend their day and were able to retain some independence in their everyday lives. Family and friends were able to visit without restrictions and staff encouraged relatives to maintain a role in the lives of their family members.
Some people told us they were supported to be involved in pursing their own hobbies and interests. Activities were available for people living in the home and one to one activities were provided for people who were cared for in bed. Some people felt more activities could be provided to meet their social needs.
You can see what action we told the provider to take at the back of the full version of the report.
During our visit we saw people enjoyed a variety of activities. Some people had a manicure with the activities coordinator. Several people joined in a 'sing along' in the lounge in the afternoon, with live music. We observed people having their lunch in the lounge. We saw that people were appropriately supported by staff and enjoyed their meal.
We saw that people's care was planned according to their needs. We found that staff understood people's needs and followed people's care plans when they supported them.
We found that people or their relatives had agreed to the care and treatment they received.
We looked at the cleanliness of the home and found that everywhere was clean and tidy. Staff we spoke with explained what steps they took to minimise the risk of infection within the home.
We found that there was a procedure in place for recording and resolving any complaints about the service.
One person who lived in the home told us, 'I think the staff are lovely, they are very respectful'. Another person told us, 'I give the home ten out of ten.'
During our last inspection of this service in March 2012 we made three compliance actions due to concerns around the delivery of care to people, management of medicines and maintaining care records. During our inspection, we found that improvements had been made in all three of these areas.
On the day of our visit we saw some people were being supported to look at books, by the activity organiser. Other people were playing dominoes and card games. In the afternoon, some people were listening to live accordion music in the lounge. We saw that people were singing and tapping their feet and were enjoying the event.
People living in the home and the relatives we spoke with were complimentary of the care and support being provided. They told us: "The care is fantastic.' 'I have always been very happy with the care. 'The staff are amazing.'
We found that there had been some improvements made but further actions were needed to achieve full compliance. The provider informed us prior to our visit that the manager had recently left. We found that this may have had an impact on some of the improvements being implemented effectively. The provider advised a new manager was in the process of being appointed.
During our visit we spoke with four people living in the home and two visitors. All those spoken with were complimentary of the care and support being provided. They told us: 'They are marvellous, they really are.' 'Very friendly.' 'Really nice people.'
Staff were knowledgeable of people's needs and we observed that staff were friendly and supportive in their approach towards people.
We saw that most people living in the home were being cared for in bed due to their ill health. We spoke with five people and visitors. They told us: 'I am quite happy'. 'They look after me fine'. 'They are a nice lot, they have loads of patience and are so pleasant, you could not want for better'. 'They are looking after X very well, I am pleased with the care X receives'.
We asked one person who was in bed if staff regularly came in to check they were alright. They stated: 'There is a little bit of that'.
People told us that staff were respectful towards them. Comments included: 'Staff will help with anything I want but it's nice to do things yourself'. 'They are nice, I could not ask for anything better, they listen to you and are quite nice'.
People were happy with the food being provided. They told us: 'It's marvellous, excellent you get a choice of three or four things'. 'Very good'. 'Quite acceptable'. 'Very good can't complain'.
People knew how to raise any concerns if they needed to, comments included: 'I would talk to the lady in charge but I have never had cause to'. 'I have never had to make a complaint or raise any major concerns'.
We saw from a survey carried out by the home that people were 'very satisfied' or 'quite satisfied' with the service. The manager was in the process of collating all responses to incorporate into a report on outcomes.