Royal Garden Hotel

Updated 7 December 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced, comprehensive inspection which took place on 24 May and 1 June 2018. On the first day of our inspection, the registered manager was on annual leave, so we met with her on her return. The inspection team consisted of an inspector 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.

Prior to the inspection we reviewed the information we held about the home. This included information from other agencies and statutory notifications sent to us by the registered manager about events that had occurred at the service. A notification is information about important events which the provider is required to tell us about by law. We used all this information to decide which areas to focus on during our inspection. Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection we spoke with ten people who lived at the home, two relatives, the provider, registered manager, deputy manager, chef, two senior care staff and a care assistant. We spent time observing the care and support that people received and also observed a member of staff administering medicines to people.

We reviewed a range of records about people’s care and how the home was managed. These included care records for five people and medicines records. We looked at staff training, support and employment records, audits, minutes of meetings, menus, policies and procedures, complaints and other records relating to the management of the home.

Updated 7 December 2018

The inspection took place on 24 May and 1 June 2018 and was unannounced.

The last inspection took place in January 2017 and we found a breach of regulation in relation to staffing. Staff did not receive regular supervision meetings or an annual appraisal to support them to carry out their duties. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to make improvements. At this inspection, we found that some improvements had been made and that this regulation was met.

Royal Garden Hotel is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Royal Garden Hotel is registered to provide accommodation and care for up to 36 older people. At the time of our inspection, 31 people were living at the home, which included two people who were in hospital. Accommodation is provided over four floors, serviced by a lift and stairs. There are five ‘flatlets’ and bedrooms all have en-suite facilities. Communal areas include a lounge situated on the top floor and a dining room on the ground floor.

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.

Systems were in place to monitor and measure the quality of care provided and the service overall, but these were not completely effective. They had not identified the issues we found at inspection.

The registered manager had scheduled supervision meetings and an annual appraisal for each staff member during 2018. Whilst supervisions had not been formally recorded, staff felt supported by the management. Informal meetings in the form of supervisions did take place, for example, at handover meetings. Staff meetings took place but were not formally recorded.

At the time of our inspection, out of 31 people accommodated at the home, seven people did not have a detailed care plan in place and their risks had not been identified or assessed, although some information was recorded about them prior to their admission. The registered manager took prompt action. Care plans and associated risk assessments were completed by the second day of our inspection following discussion with the management team.

People living at the home were assumed to have capacity. The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been met.

People told us they felt safe living at the home and the majority of staff had completed or updated safeguarding training. Apart from some care plans which had not been completed as needed, in the main, risk assessments in relation to people’s care and support needs had been drawn up and risks were managed safely. Risk assessments relating to premises and servicing of equipment had been completed. Staffing levels were sufficient to meet people’s needs and checks were made on new staff who were recruited safely. The home was clean and smelled fresh. Medicines were managed safely.

People felt staff were competent and effective in their roles. Special diets were catered for and the majority of people were complimentary about the food on offer and the menu choices. People had access to a range of healthcare professionals and services. Rooms were personalised in line with people’s choices and were decorated to a high standard.

People were looked after by kind and caring staff and positive relationships had been developed between people and staff. People did not always have a clear picture about what their care plan was and many people relied on their relatives or appointed representatives to make decisions on their behalf. People were treated with dignity and respect.

Care plans were kept electronically and provided detailed information and guidance to staff about people’s care and support needs. Some activities were organised for people in the home, however, there were no restrictions on people and they were free to go out of the home if they wished. Outings were organised and people were encouraged to participate in activities at the home. Complaints were managed in line with the provider’s policy.

Staff felt supported in their roles and by the management team, including the provider. People were asked for their comments about the home through residents’ meetings and informal, twice-yearly surveys. The majority of people felt they would go to the provider [owner] if they had any issues and felt confident these would be addressed.

At the last inspection, we rated this service as ‘Requires Improvement’ in 'Effective' and awarded a rating of ‘Good’ in the other key questions and overall. At this inspection, the key question of 'Well Led' has been rated as ‘Requires Improvement’, with other key questions rated as 'Good'. The overall rating is 'Good'.