Background to this inspection
Updated
25 June 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
This inspection was carried out over two days. Three inspectors were present on each day.
Royal Manor 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. Royal Manor 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.
Notice of inspection
This inspection was unannounced on day one and arrangements were made with the provider after day one, to return and review additional documents.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We received feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service. We spoke with seven people who used the service. We spoke with the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke to six members of staff including nurses, senior care staff and care staff.
We reviewed a range of records. This included relevant parts of 15 people's care records and multiple medicines records. We looked at three staff files in relation to recruitment and staff supervision. We checked the pin numbers of all nurses to check their registration was up to date and any conditions were being followed. A variety of records relating to the management of the service, including staff training records and audits were reviewed.
Updated
25 June 2022
About the service
Royal Manor Nursing provides accommodation, nursing and personal care for up to 31 older people, some of whom were living with dementia. There were 28 people living at the service at the time of the inspection..
People’s experience of using this service and what we found
Based on our review of the Safe and Well Led key questions the quality assurance monitoring systems in place were not effective in maintaining and improving the quality of care provided to people. Staff received safeguarding training; however, their understating of safeguarding procedures was not comprehensive.
Risk in relation to people receiving support had been assessed but risk management plans lacked detail. There was limited evidence that the nurses employed had received clinical training updates. We found the provider’s oversight of clinical training for most nursing staff was not in place. Incidents and accidents were not always clearly recorded and audited. There was no analysis to enable the manager to look for patterns and trends.
People received their medicines as prescribed, but we identified that improvements were needed regarding the storage of some medicines. This had been addressed by day two of the inspection.
Sufficient staff were deployed, and appropriate recruitment checks were carried out to ensure they were suitable to support people who used the service. Overall, staff were caring in their approach and people told us they liked the staff. However, we observed the language used to describe people’s needs was not always respectful or professional.
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 good (published 20 August 2021).
Why we inspected
We received concerns in relation to infection control, people’s nursing needs and provider oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 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.
At the start of the inspection the provider was in the process of selling the service. A new provider is now in place and has confirmed they will work with us and other stakeholders to make the required improvements needed.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Manor on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service. We will work with the local authority and new provider to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.