Archived: Royal Care Home

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 requires improvement. At this assessment the rating has remained requires improvement. This meant people were not always safe and protected from avoidable harm.

The service was in breach of legal regulation in relation to the good governance of the service, risk management, safe environments, staff supervision, recruitment, infection control and medicines.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive culture around their learning culture. They were not always proactive at promptly resolving issues and driving improvement from concerns raised. Lessons were not always learnt to continually identify and embed good practice.

Although staff knew how to report concerns and we were able to review examples of lessons learned following staff meetings, this did not always drive improvement. We also found an example where an incident form was blank in relation to details of the incident and this had not been picked up during an audit.

People’s relatives seemed to suggest there was an open dialogue of communication with the manager and staff. Feedback from partners indicated the provider works with them, and takes appropriate action when things go wrong.

The service 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 felt the staff team work well together to ensure they received the care and support they needed. One relative told us, “(Person using the service) came here, as a result of the council refusing to fund her last home, she has settled in and likes it here. They asked questions of her relatives about her past and health issues.”

Staff spoke about information being shared at handover and by seniors. Professionals felt the service made referrals in a timely way, though in some instances referrals were not appropriate. Handover sheets were in place to support sharing of information with staff coming onto shift. We were able to see some examples where appropriate referrals had been made when people had fallen.

Although people told us they felt safe, the service did not always ensure peoples safety when visitors were on site. They did not always appropriately assess people’s mental capacity, though staff knowledge around safeguarding was good.

Although there was a signing in book, we found that families were in the building and had not signed in. This means we could not be assured the home had an accurate record of any visitors to protect both people and their loved ones. This also means the service was not acting in line with their visitors policy. We reviewed records relating to peoples mental capacity assessments which were mostly appropriate.

Staff were knowledgeable about safeguarding. One staff member said, “I know how to raise safeguarding online, staff know how to safeguard but tend to come to us.” Staff had completed safeguarding training. Staff were able to confidently explain about mental capacity. One staff member said they should “Always assume someone has capacity, always make sure they are involved and can make decisions where they can.” A Mental Capacity and Deprivation of Liberty Policy and procedure was in place.

People told us they felt safe. The service had a safeguarding policy in place which detailed necessary information. People’s capacity had been assessed and necessary Deprivation of Liberty Safeguards (DoLS) applications were in place to deprive people of their liberty. The manager confirmed people had access to advocates if they needed this support and we reviewed evidence of their involvement.

The service did not work well to understand and manage risks. They did not always work to ensure risks were recorded appropriately or that risk assessments were robust.

Necessary risks assessments were not always as detailed as they should have been or were not accurate. For example, one person’s call bell risk assessment said they were unable to use their call bell and their mental capacity assessment stated they are to be checked every 2 hours, but this is not covered in their risk assessment. For one person who was cared for in bed, their falls risk assessment says they are not cared for in bed. One persons falls risk assessment did not detail how to mitigate risk. The registered manager told us they would work to improve care plan records.

We were able to see examples of various environmental risk assessments that were in place, though some of these needed risk controls detailing. For example, the drinks station risk assessment did not detail what controls were in place. The registered manager updated this risk assessment once we had raised this.

We found peoples personal emergency evacuation plans (PEEPs) records were in place, though they were not always up to date. The PEEP folder contained a record for 1 person who had passed away, whilst 1 person on respite did not have a PEEP in place, meaning that in the event of fire, people may not be safely evacuated. The registered manager updated these records during the inspection.

People and their relatives felt risks were being managed. One relative told us “He has no risk of choking, his only risk is falling, and he hasn’t fallen as they are taking good care of him.” Staff spoke about how they manage various risks and support people with their healthcare needs.

The service did not always detect and control potential risks in the care environment. They did not make sure that equipment and facilities supported the delivery of safe care.

Fire safety was not always being effectively managed. Fire extinguisher certificates had just expired, following us identifying this concern, the registered manager scheduled the necessary checks before the end of our inspection. Emergency lighting had not been recently inspected. The fire risk assessment hadn’t been reviewed in line with recommendations. The registered manager was working to resolve this following our identification of these issues.

One staff member said of the environment, “maintenance is an issue, things are not kept on top of.” We found one person’s mobility aid was being stored in another person’s bedroom, following this issue being raised on day 1, the registered manager confirmed on day 3 that she was now looking to have this removed. We also found that people’s mobility aids were not identifiable to people. The registered manager ensured these were all labelled by the end of the inspection.

One professional told us “There were instances, where the residents were using walking aids of other residents.” The environment was not always safe, and significant improvements were required in this area. For example, flooring was not always even, some areas of the home required deep cleaning, there were some broken radiator covers, a boiler with hot pipes was not in a locked cupboard which posed a risk of scolding and wardrobes were not always secured to the wall. The registered manager was working to drive improvements in this area and some improvements had been made by day 3 of the inspection.

Necessary safety certificates were in place to support safe environments in areas including gas safety, electricity and equipment that is used to move people, however other areas such as legionella risk assessments reviews had not been completed. Following identifying this issue, the registered manager was working to drive improvement in this area, by scheduling necessary checks.

The registered manager was working to make improvements to make the home more dementia friendly by ensuring peoples doors were recognisable/personalised. They told us some of their plans for the environment, they said, "I would like to improve the environment and to establish a dementia garden at the back to make sure all service users can go out safely and spend time outside." Further improvements such as adding contrasting toilet seats could further benefit some of the people living at the service. People and their relatives felt their loved one was in a safe environment. One relative said, “I do think she is safe.”

Although staffing levels appeared to be appropriate, the service did not always make sure staff received effective support and supervision. They did ensure safe recruitment practices were followed.

Staff supervisions and appraisals were not happening in line with policy. The registered manager told us they had been focussing on other areas requiring more urgent attention, but that they were looking to ensure better compliance in this area going forward. Staff feedback on the consistency of supervisions was varied. Safe recruitment practices were not followed. For example, there were gaps in people’s employment that had not been addressed and incomplete recruitment records in place. Some staff did not have the necessary checks in place before they started work.

Although there appeared to be enough staff to support people, the service did not have a dependency tool to calculate staffing based on people’s needs. The manager told us they were looking to implement this. One staff member told us, “We could do with more staff.”

Records indicated that staff training was up to date. People felt there was enough staff, one person said, “Yes (there are enough staff), I think so, we have agency staff all the time, especially in the last three or four weeks.” Staff told us they completed an induction when they started. Agency staff was regularly being used to help ensure staffing levels were consistent.

The service did not appropriately manage the risk of infection.

Staff comments about the cleanliness of the home was not always positive, their comments included, “Cleaning needs improvement.” And “My main issue is the cleaning. We have 3 domestic staff, but I think the home could be cleaned more deeply.” The home was not always clean and tidy. Some areas required a deep clean. On our return on day 3 we noticed a marked improvement in cleanliness, but there was still some way to go.

Safe infection prevention control practices were not always being followed. Mops were left in communal bathrooms. Un labelled toiletries and hairbrushes were in bathrooms meaning these could be used communally. These communal items/toiletries were mostly removed by day 3 of the inspection. People’s clothes were not always labelled with their name, meaning we could not be assured peoples own clothes were always returned to them. Cleaning records were not always being completed meaning we could not be assured that regular cleaning was taking place.

Generally, relatives felt the home was clean, though some improvements could be made. One relative said, “I think it is clean, I think there are things that could be maintained.” Appropriate PPE was in place.

The service did not make sure that medicines and treatments were safely managed.

Medicines and topical applications such as creams were not always safely managed. Bottles of liquid medication were not always dated when opened, meaning we could not always be confident medicines were always in date. A cupboard containing various creams, blood sugar monitoring equipment records and medical equipment was not locked on day 1 of our visit. This was locked immediately once the registered manager was aware.

Medicines for return were not always being safely stored in line with guidance. Controlled drugs were not always safely managed as they were not always stored in an appropriate lockable cabinet. The registered manager told us a further cabinet was on order and by day 3 these drugs were securely stored. Some peoples topical administration records did not clearly indicate where creams were to be applied. One person had not been offered administration of creams in line with prescriber’s guidelines.

Topical applications did not form part of the medicines audit, meaning there was limited oversight relating to this. Fridge temperatures were not being accurately recorded meaning we could not be assured the medicines were safely being stored that were required to be kept in a fridge. The registered manager told us how they would improve this going forward.

People generally had the correct amount of medication in place and people’s relatives said they felt their loved ones received their medication. One relative said, “I know she is getting her medication at the home, which is reassuring.”