Royal Garden Hotel

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'.

Royal Garden Hotel is registered to provide accommodation and care for up to 36 people; everyone living at the home has low dependency needs. The home is situated close to the seafront in Bognor Regis, with access to local amenities. At the time of our inspection, 28 people were living at the home, including two people who were on short breaks. Accommodation is provided over four floors and is accessible by a lift. There are three self-contained apartments at the home, two of which are occupied by couples. Communal areas within the main home include a large dining room on the ground floor and a large lounge on the third floor. All rooms are en-suite, some with shower facilities and some with toilets and washbasins. There is a small garden accessible to people at the side of the home.

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.

Good management and leadership was not evident in all aspects of the service. There was no system in place to ensure that staff received regular supervision and no evidence to confirm that some staff had received supervision at all in 2016. Annual appraisals were not completed. The registered manager was unaware of the updated regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which meant they were not conversant with the current legislation. We have made a recommendation relating to this. People were involved in developing the service through meetings and they were asked for their feedback about the home. Staff felt supported by management. A range of audits was in place to measure and monitor the care delivery and home overall.

Medicines were generally managed safely, although we observed some medicines were left unattended on top of the medicines trolley whilst the staff member administered medicines elsewhere. The registered manager had also observed this oversight and later discussed this with the staff member in question. People told us they felt safe living at the home and staff had been trained to recognise the signs of potential abuse, knowing what action to take if they suspected abuse had taken place. Risks to people were identified, assessed and managed appropriately. Guidance to staff on how to support people safely was contained within people’s care plans. There were sufficient numbers of staff available and new staff were recruited safely. The home was clean and hygienic and people commented that their rooms were cleaned to a good standard.

Staff had been trained in a range of areas and new staff studied for the Care Certificate, a nationally recognised qualification. Staff understood their responsibilities under the legislation relating to mental capacity. No-one living at the home had their freedom restricted. People were supported to have sufficient to eat and drink and were encouraged in a healthy lifestyle. They had access to a range of healthcare professionals and services. People were encouraged to personalise their rooms and to bring items of importance to them when they came to live at the home.

Staff were warm, kind and caring with people and positive relationships had been developed. People and their relatives spoke positively about the staff and management. People were encouraged to be involved in all aspects of their care and they were treated with dignity and respect by staff.

Care plans were kept electronically and provided detailed, comprehensive information about people and their care needs. Care plans were reviewed monthly and staff kept up to date about any changes within the plans, so that people’s current care needs were met. Some activities were organised for people at the home, but the majority of people were independent and pursued their own interests and hobbies. No complaints had been received within the last year. The provider had a complaints policy in place.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

At the time of our visit there were 27 people living there and we spoke with eleven of them. We spoke with the managing director, manager, visitors, a district nurse, and staff. We found that people using the service had a great level of independence and were receiving a good level of care and support from the provider. People we spoke with told us: 'the service is excellent', 'the owner is very helpful and kind', 'the manager and staff are good', 'food is very good, fresh and plentiful', 'I can do my own thing as I want'.

We read through six personal care files. We found that people needs were thoroughly assessed before admission and people were involved in their care planning. There were risk assessments in place and they were reviewed regularly. We found that people were receiving care appropriate to their needs in a safe and comfortable environment.

We found that people were offered wholesome, fresh and a variety of food and drinks to meet their dietary needs. We noted that there was a safe system in place for the handling of medicines. People confirmed that there was a good complement of staff to support them. The complaint procedure was available and people felt confident that their concern would be addressed appropriately.

We were told by people who use the service 'this is a hotel not a care home'.

We spoke with two members of staff who were on duty. They informed us that they had received training that provided them with the necessary skills to deliver the care and support to people that was required. They also said that they felt well supported by the managers in their work.

The atmosphere throughout the visit was calm and friendly. People were observed to have a good relationship with the staff. People told us that they liked living at the home and that the service met their needs. One person said that, 'If I didn't like it I wouldn't be here'.

People said that they did not have any complaints about the service and that if they did they would speak to staff.