Archived: The Royal Care Home

Updated 17 August 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

The inspection took place on the 1 and 2 July 2015 and was unannounced on the first day. The inspection team consisted of two adult social care inspectors 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. Their area of expertise included older people and caring for people living with dementia.

Before our inspection, we reviewed all the information we held about the home. We asked the provider to complete a provider information return [PIR] which helped us to prepare for the inspection. This is a document that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make.

We spoke with the local authority, healthcare professionals connected to the home and Healthwatch Rotherham, to gain further information about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We spent time observing care throughout the service. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

At the time of our inspection there were 39 people using the service. We spoke with six people who used the service and five relatives, as well as two agency nurses, eight care workers, two activities co-ordinators and ancillary staff. We also spoke with the registered manager, the interim manager and the nominated individual for the company.

We looked at the care records for four people using the service as well as records relating to the management of the home. This included staff rotas, meeting minutes, medication records, staff recruitment and training files. We also reviewed quality and monitoring checks carried out by the home’s management team.

Updated 17 August 2015

The inspection took place on 1 and 2 July 2015 and was unannounced. Our last scheduled inspection at this service took place in August 2014 when we found four breaches in legal requirements. These were regarding staff not being deployed effectively, care records lacking sufficient detail, which led to people’s needs not being met. We also found the recruitment process was not robust, people’s dignity was not always preserved, there were gaps in essential staff training and staff support sessions were not taking place. The provider sent us an action plan detailing what improvements they intended to make and by when.

At our inspection on 1 and 2 July 2015 we found the provider had followed their action plan and legal requirements had been met. However, the provider was still in the process of embedding the improvements made into practice.

The Royal Care Home is situated in Rossington on the outskirts of Doncaster. The service is registered to provide both nursing and personal care for up to 57 people in the categories of older people and people living with dementia. At the time of the inspection there were 39 people living at the home.

The service had a registered manager in post at the time of our inspection. 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.

We spoke with staff who had a clear understanding of safeguarding adults and what action they would take if they suspected abuse. Staff we spoke with were confident the registered manager would act appropriately to safeguard people from abuse. Posters were displayed around the service with contacts for the local council safeguarding team.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. However, the home had experienced difficulties in recruiting nurses so was using agency nurses to cover shortfalls. This meant people were not being consistently supported by senior staff who knew them and records were not always reviewed and updated in a timely manner. People who used and visited the service, as well as the staff we spoke with, felt that overall there were sufficient staff available to meet people’s needs.

People were supported to have their assessed needs, preferences and choices met by staff who had the necessary skills and knowledge. Staff we spoke with told us they received appropriate training which made them confident to do their job. However, we found staff support sessions had not taken place on a regular basis.

We found the service to be meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had some knowledge of this and said they would speak to the registered manager for further advice.

People were supported to eat and drink sufficient to maintain a balanced diet. However, menus were not clearly displayed or in a format people could understand, and staff felt there were times when people did not have much to choose from. We observed lunch on the first day of our inspection and found it to lack organisation. This led to people waiting some time before their meal was served.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support. The care records we checked showed they had received support from healthcare professionals when required.

People who used the service were supported to maintain friendships and we saw care plans contained information about their family and friends and those who were important to them.

People’s needs had been assessed before they moved into the home and the relatives we spoke with told us they had been involved in formulating care plans. We found three of the four care records we checked reflected people’s needs, preferences and risks associated with their care in detail. However, the fourth plan we looked at contained an out of date care plan that had not been updated to reflect changes in their needs. We found this had not had any adverse impact on the person and was addressed by the registered manager on the following day.

Records showed that the majority of care plans and risk assessments had been reviewed on a regular basis, but the electronic system showed that several had not been evaluated in the timescales indicated.

Dedicated activities co-ordinators were employed to provide regular activities and stimulation. We saw there was a varied activities programme available which people could choose to participate in.

We saw the complaints policy was easily available to people using and visiting the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. When concerns had been raised we saw the correct procedure had been used to record, investigate and resolve issues.

Staff were clear about their roles and responsibilities, but senior staff were not always ensuring that care workers were working effectively to meet the needs of the people being supported. For example, we saw mealtimes were disorganised which meant some people were sitting in the dining room for up to 30 minutes without receiving a meal or a drink.

The provider had a system in place to enable people to share their opinion of the service provided and the general facilities at the home. However, information obtained through surveys had not always been summarised to highlight what had worked and what needed improvement. We also saw that outcomes had not been shared with people using and visiting the service.

Audits had been used to check if company policies had been followed and the premise was safe and well maintained. Where improvements were needed the provider had put action plans in place to address and issues. However, shortfalls had not always been identified and where they had timescales had not always been met. This meant the system was not effective in improving the quality of the service provided. We also noted that most policies had not been reviewed since 2012 when they were introduced. This was a breach 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.