Royal Leamington Spa Nursing Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

This service scored 70 (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 always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

People told us staff were kind, respectful and treated them with dignity. Comments included, "They are all lovely. They are very kind to me,” “They treat me well, they don’t do anything I am not happy with, I would tell them,” and “Very kind, they treat everyone with respect.”

Staff spoke positively about their caring roles and demonstrated genuine compassion. One staff member told us,“I like caring for people, I like their life stories. I like to make someone’s day, put a smile on their face.” Another staff member said, “Respect and dignity is very important.”

During the inspection, we observed staff interacting with people in a kind and considerate manner, both in communal areas and in people’s own rooms. People appeared comfortable with staff and responded well to them. Where people showed signs of anxiety, staff offered gentle reassurance and supported them at their own pace.

However, in some people’s care plans we found terminology about people’s individual characteristics needed to be considered to promote their dignity.

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff appeared to know people well and spoke confidently about what mattered to them. One person told us how a staff member put bird seed out each day so they could watch the squirrels from their bed, saying, “Nothing is too much trouble for her.” Another person described how staff had rearranged their room to suit their personal preferences. Weobserved 1 person who was unable to communicate verbally. Staff had put on music linked to the person’s cultural background, and this appeared to help them feel calm and settled. This showed staff understood and responded to people’s individual identities.

Some people required support to eat due to their physical disability or their risk of choking. There were enough staff available to provide this support patiently and respectfully, ensuring people were not rushed and their dignity was maintained. Wherepeople wished to attend church outside the home, this was supported, and religious celebrations were recognised and marked within the service. Theseexamples demonstrated that staff valued people as individuals and made efforts to tailor care in ways that were meaningful to them.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Some practices in the home did not demonstrate people had choice and control over their day-to-day support. On the first day of our inspection, we saw lunch was delivered to people on trays from the main kitchen. People in the lounge remained seated there and did not use the dining room. Most people stayed in their rooms or in bed, and their meals were taken to them. Everyone received their main meal and dessert at the same time, even when the dessert was hot. This meant desserts could become cold before people finished their main meal. When we asked 1 member of staff why this happened, they told us, “That’s just how we do it,”and could not explain whether this reflected people’s preferences for where they ate their meals or how they were served. Despite this, mealtime observation forms completed by activity staff consistently recorded that there was “sufficient time between courses.” The registered manager agreed to review how meals were served, following our feedback.

There were activity staff on duty each day, and a monthly programme of activities was displayed on a whiteboard on the ground floor. However, most people spent their time in their bedrooms and did not have access to this information, meaning they were not always able to make informed choices about whether they wished to join in.

Activity staff told us they visited people in their rooms to offer activities, but we did not see this happening during our visit. Activity staff were also responsible for helping to serve breakfast and lunch, as well as running 2 group activities each day in the lounge. It was unclear whether they had enough time to provide meaningful engagement to the many people who remained in their rooms. We saw several people without stimulation or anything to occupy them. When we asked 1 member of the care team whether there was enough going on for people, they said, “I wouldn’t say enough. There’s always activity going on in the lounge every day. I wouldn’t say they get out enough, there isn’t enough staff to do that."

Activities in the lounge included quizzes, exercise sessions, music and colouring. We were told of entertainers that had visited the home previously such as singers and a saxophonist. The provider had purchased a VR headset, which gave people beneficial sensory experiences. The deputy manager told us some people enjoyed gardening and had been involved in filling hanging baskets for outside.

One person also told us how their choices around practising their religion were supported. They said, “I go to church every Sunday morning, staff get me up and ready, I go in a taxi and come back in a taxi. We set up a bible class here every Friday for people who can’t get to church. We had a Christmas and Easter service here, and everyone joined in, even staff." Thisshowed that when people expressed clear preferences, staff made efforts to respect and facilitate them. It was positive to see that where 1 person chose to smoke, this choice was respected. Their care plan included guidance to ensure they could do so safely and with appropriate support.

Visitors were welcomed into the home. One relative told us how the provider had arranged a space for them to celebrate a family birthday, and other relatives said they could visit at any time and felt welcomed.

The provider listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

People we spoke to told us staff were responsive. They said they came when they needed them and were reactive to their current situation. Several people gave us examples of when staff had reacted quickly, when their health deteriorated. One person said, “See those 2 nurses, they are amazing.” They explained to us how they presented as unwell and how the nurses responded and sought immediate help. This person said, “It makes you feel confident they know what to do.” Another person told us of when staff were quick to diagnose a concern. They commented, “They looked at my leg and said, ‘it’s cellulitis’ and immediately called an ambulance. They knew before I did, I didn’t know there was anything wrong with me.”

Relatives also told us staff were quick to notice a change in people’s condition. One relative told us, “They (Name), can deteriorate very rapidly. They check on them regularly, and if there is any sign, they respond straight away.”

Throughout our inspection we observed call bells being responded to promptly, however, in some cases, we saw call bells placed out of people’s reach, meaning it was unclear how they would alert staff if they needed urgent help. This created a risk that people might not be able to get assistance quickly in an emergency. The registered manager later explained that some people were unable to use a call bell, or it would not be safe for them to do so. Additionally, we saw staff failing to respond when 1 person was repeatedly asking to go to the toilet. When we investigated this with leaders in the home, we were told it was not safe for the person to sit on a toilet, however this was not recorded in their mobility care plan or their continence care plan.

We asked the provider to ensure all records were updated so they clearly reflected people’s individual circumstances, how they requested assistance and what additional checks were in place when people could not independently request support.

The provider cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff told us they received regular supervisions and felt the training was sufficient to give them the skills and knowledge to provide safe care. Staff felt there was opportunity for development in their careers, and we saw additional leadership roles had been created such as senior carers, head carer and care manager.

Some care staff had been promoted to senior roles and received extra training, including in medicines management. The deputy manager explained senior care staff were also invited to attend some courses usually aimed at nursing staff, such as training on the safe use of syringe drivers for people receiving end‑of‑life care. Although senior care staff would not be responsible for operating syringe drivers, attending this training helped build their understanding so they could recognise concerns early and support nurses in maintaining safe practice.

These opportunities helped staff feel valued, supported and able to grow in their roles.