Royal Garden Hotel

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The registered manager reviewed incidents, accidents including medicines errors and near misses to improve practice. Learning was shared with staff, and refresher training was provided where required to promote safe care and reduce the risk of recurrence. Additional checks were established to minimise inaccuracies, for example, a peer check was introduced to check medicine records had been completed appropriately between shifts.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People's care needs were assessed, and information was shared with relevant professionals when needed. Care plan summaries were made available to incoming health and care services should a person require a hospital admission or where they may move to a different home. The registered manager told us of good working relationships with local care and nursing homes which they recommended should the Royal Garden Hotel no longer be able to meet a person’s needs. When people moved into the service they were provided with a welcome pack which contained all the information they required, including room service details.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, the provider did not always share concerns appropriately. We identified an allegation that had been investigated internally but had not been referred to the local authority in line with the provider’s safeguarding policy. We discussed this with the registered manager who acknowledged the matter should have been escalated. We saw other examples where the registered manager had raised concerns with the local authority.

Staff understood their responsibility to recognise and respond to potential abuse. A staff member told us, “I would intervene if I saw anything and report to the manager. I would go to safeguarding if I was concerned. I would ring them up; whistleblowing doesn’t worry me. At the end of the day the residents are the ones that matter.” People and their relatives were supported to raise concerns. We observed people were comfortable with staff. A relative commented, “Absolutely [person] is safe. Right from the start staff have been really kind with them. They can’t do enough for [person].”
 

The provider mostly worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People were involved in managing risks associated with their care and support. Individual risk assessments addressed areas such as mobility, health conditions and support needs. Risks associated with health needs were considered and mitigated. However, interim care plans and risk assessments did not always align with existing records, and some documentation contained wording that could be open to interpretation. Although interim records were not always aligned to established care plans, staff knew people well and described how they supported them. Some people’s personal emergency evacuation plans required review to ensure they reflected current abilities and needs; the registered manager told us they would update them immediately.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We observed the service was well maintained and suitable for the needs of people living there. Fire risk assessments and environmental checks were completed regularly, any areas requiring repair were attended to promptly. People were able to use the building freely; risk assessments were conducted to highlight and mitigate risks. For example, where some people lived in flats within the service, assessments were carried out to ensure their safety. Other people had assessments in place to promote safety where they had a balcony.

The provider made sure there were enough skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Processes for staff recruitment required strengthening to document discussions at interview and reasons for gaps in employment histories. People received care and support from staff who had completed an induction, ongoing training and competency assessments relevant to their roles. Staff told us they felt the training was supportive and frequent, a staff member told us, “Training is a bit of both, face to face and e-learning, I do all the training.” A relative said, “They are well trained. I have witnessed staff being trained in the home. I have seen a training session going on when they had a speaker in to talk to staff and I have witnessed new staff being trained on the job. They shadow an experienced member of staff until they are confident with the job they have to carry out.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff followed processes to prevent and control the risk of infection. The environment was clean and systems were in place to support effective infection prevention and control practices. Staff appropriately wore personal protective equipment which were disposed of responsibly. Housekeeping and laundry staff worked hard to ensure people’s bedrooms were maintained to their standards. A person said, “I like my room, it's got all of my bits in it and it's very clean. The girls do my cleaning and I'm happy with how they do it. They do all my laundry too; nothing gets lost and they iron it.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People received their medicines safely and as prescribed. Medicines were stored, administered and monitored by competent staff. People were encouraged to retain independence with their medicines where appropriate, staff supported them at their preferred level which ranged from full administration to minimal help when ordering medicines. We observed people received their medicines in a person-centred way. Some staff were trained to provide additional oversight of medicines and had made changes to systems to promote safe medicine management. Risks in relation to medicines were assessed, for example, assessments were conducted for people who used paraffin based emollient creams.