Archived: Royal Bay Residential Home

Royal Bay residential home is a care home registered to provide residential care for up to 42 people. There were 33 people living at the service at the time of the inspection. People who lived at the home included people who lived with complex needs including disabilities and long-term conditions such as dementia, sensory loss, Parkinson’s disease, diabetes and Chronic Obstructive Pulmonary Disease [COPD]. COPD is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and non-reversible asthma. We were told that two people were receiving end of life care.

People’s experience of using this service:

Some people did not always receive safe care or treatment at the home. People were at continued risk of serious harm and injuries.

Some people did not always receive access to healthcare services in a timely way which meant they were left with significant injuries, pain and serious deteriorating health conditions with avoidable delays to receiving appropriate intervention and treatment. Staff were not suitably skilled or knowledgeable and did not recognise serious deterioration in people's health. This placed people at significant risk of harm, injury and deterioration in their health conditions without timely urgent care or treatment from appropriate professionals. Serious incidents and concerns were not always recognised, investigated or reported under safeguarding guidelines by the management or the provider, so the relevant agencies were not aware and could not take action.

Lessons were not learnt from serious incidents and practices were not changed to mitigate risks of further harm to people. Following the last inspection, the provider sent us an action plan to tell us how they would ensure people were safeguarded from the risk of falls. At this inspection people continued not to be safeguarded from the risks of falls and serious injury. Staff did not follow moving and handling best practice techniques which placed people at risk of harm.

Medicines were not always managed safely which placed people at risk of harm. Staff were not always skilled or suitably trained to understand the effects of the medicines given to people. Staff did not use systems to help them identify when people may be in pain if they could not tell staff this, as some people were living with dementia.' We could not be assured that there were sufficient numbers of suitably skilled staff to give people their medicines when they needed it and when it was prescribed.

The risk posed by some people’s medical conditions were not always managed effectively, such a diabetes. Some people were at significant risk of dehydration. One person was admitted to hospital due to signs of being unwell and on admittance was diagnosed as being severely dehydrated.

Where some people had been assessed as significantly underweight this was not managed safely to reduce further unexplained weight loss.

There was not always sufficient competent staff with the right skills and knowledge to support peoples complex needs safely and with dignity and respect.

Call bell records showed and people told us that not all calls for assistance had been responded to by staff. The manager confirmed that the some calls for a person had been ‘reset’ without staff attending to them at the time, this had left a person feeling ‘frightened’.

There was a negative culture which meant that staff were afraid to challenge practices and a lack of managerial and provider oversight where opportunities to identify themes from incidents were missed to help prevent possible further injury.

Candour was not culturally evident throughout the staffing, management and provider levels. The manager told us, “I'm not going to lie and cover up anymore.”

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the home did not support this practice.

There were systemic failings across the home that meant people did not always receive safe care or treatment. As a result, we asked the provider to take urgent action to make people safe. We made urgent safeguarding referrals to the local authority and to the police regarding the serious concerns we had about people’s immediate safety.

Rating at last inspection:

At our last inspection on 27 February 2018 [Published 29 June 2018] we rated the service as ‘Requires improvement.’ At this focused inspection the service was rated as ‘Inadequate.’

Why we inspected:

This focused inspection was undertaken due to information of risk and concern about serious injury and recurrent reports of people falling at the home that had not been reported to us. We had identified and been told by health and social care professionals of concerns about the management and leadership of the home.

Enforcement:

We have taken urgent action to safeguard people from the risk of harm. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

A registered manager was not 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 and associated Regulations about how the service is run. The service was run day to day by a manager who had not yet submitted an application to register with the CQC.

People’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, safe procedures for the administration of the medication were not routinely being followed, which placed people at potential risk of receiving their medicines incorrectly.

Risks associated with people’s safety were not always identified and managed appropriately. Staff did not routinely take appropriate action following accidents and incidents to ensure people’s safety.

People’s care and treatment was not delivered in a way that supported their independence, ensured their dignity and treated them with respect at all times.

There were some arrangements in place to meet people’s social and recreational needs. However, activities were not routinely organised in line with people’s personal preferences.

We saw that information had not always been updated in people’s care plans to guide staff on how to deliver care and did not always reflect the level of care people were receiving. Furthermore, some people’s assessed plans of care were not being followed.

The provider undertook some quality assurance audits to ensure a good level of quality was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met individual need. People were not actively involved in developing the service. Other than the complaints process, there were no formal systems of feedback available for people, their friends or relatives to comment on the service and suggest areas that could be improved.

Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

People were cared for in a clean, hygienic environment and infection control protocols were followed, and their individual needs met by the adaptation of the premises. People were being supported to make decisions in their best interests. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s ability to evacuate the building in the event of a fire had been considered and where required each person had an individual personal emergency evacuation plan (PEEP).

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and managing behaviour that may challenge others. Staff had received supervision meetings with their manager.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Royal Bay Residential Home provides care and accommodation for up to 42 older people and there were 35 people living at the home when we inspected who were all aged over 65 years. The home is situated close to Bognor Regis town centre and beach.

All bedrooms were single and each had an en suite toilet with a wash basin. Some of the bedrooms were large enough so they could be used as double if a couple requested this. There is a passenger lift so people can access the bedrooms on the first and second floors.

The service had a registered manager. 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.

At the previous inspection of 16 December 2014 we identified that not all care staff knew how to appropriately support people who displayed behaviours which may be challenging to others. We made a requirement for this to be addressed and the provider sent us an action plan outlining how staff were to be trained in this. At this inspection we found staff were trained in supporting people who had behaviour needs and responded appropriately to people who were living with dementia.

At this inspection we observed people who needed assistance with mobility needs were not always safely supported and supervised by staff. One person was lifted in an unsafe way and staff did not apply a safety brake to wheelchairs when lifting people into them. Care plans did not always have the correct details about supporting people when helping them to transfer safely.

People’s privacy was not always upheld. Each bedroom door had a window with a blind over it for privacy. In several cases these were damaged and did not afford privacy. In one case the blind was partially open in the day time and a person was in a state of undress and was visible to anyone walking along the corridor. Following the inspection the provider confirmed that action was taken to remove the blinds and to cover the windows in the doors in order to given people privacy. People told us staff knocked on their bedroom door before entering but we observed two staff entered someone’s room without knocking or asking for permission to enter.

Providers are required to notify the Commission of certain events such as the deaths of people at the home. The provider had not notified the Commission of eight people who had died at the home.

There was a variation in the standard and state of décor. Bedrooms were well maintained. Some communal areas were in need of attention. Carpets in halls and landings were not always secure and were held together with tape in many areas. This increased the risks of possible tripping as flooring was not always secure. Carpets had been replaced in some hallways. Following the inspection the provider confirmed there was plan with dates to replace the damaged carpets.

There were sufficient numbers of staff to meet people’s needs and staff recruitment procedures ensured adequate checks were made on staff before they started work

Medicines were safely handled and administered.

Staff training was well organised and there was a system of staff supervision and appraisal.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

There was a choice of food and people were supported to eat and drink. The meals were of a good standard.

Arrangements were made for people to receive health care and health care professionals said the staff worked well with them to ensure people received appropriate care and treatment.

People said the staff treated them well and with respect. Staff were observed talking to people respectfully and calmly. Staff demonstrated values of compassion and of treating people in the same way they would treat a family member.

People said they were consulted about their care but this was not always evident in people’s care plans. People’s care needs were assessed and each person had a care plan which included details about how staff should support people. A range of activities was provided including trips out from the home.

The complaints procedure was provided to people.

The provider had a quality assurance system for monitoring the quality, safety and welfare of people which included obtaining the views of people and professionals.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We gathered evidence by watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable when they approached staff and asked for assistance.

Everyone told us that they were happy with the care and support they received. One person told us, "I am happy here, the staff are so nice. I think I am very lucky living here". Another person said, 'I like it here, there is such a nice atmosphere. I spend most of my time in the lounge because it's very pleasant, and there is always something going on'.

All of the people that we spoke with told us that they felt that the home was clean. One person said, "They come into my room every day and vacuum and dust around, they clean my toilet every day too, you can't ask for a better service than that."

All of the people that we spoke with told us that staff asked their permission before they entered their room, and before they assisted them with personal care. People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the home and that they would be listened to if they raised any concerns.

We found that people had planned care that met with their needs. We also found that people's consent had been obtained prior to treatment where appropriate.

We found that the home had followed safe recruitment processes.

One person said, "The staff are all very kind here, I only have to ask and I have anything I want".

Another person said, "The food is lovely, and plenty of it; And I only have to ring my buzzer and the staff come running. Who could ask for more than that ?".

On the day we visited we saw that the home had a calm and friendly environment. We saw that people were comfortable asking staff for assistance, and saw that staff interacted with people in a friendly and polite manner. We found that the home had robust auditing systems in place to ensure that people received good care and service.