Royal Leamington Spa Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Leaders undertook pre assessments of people’s health, well-being, care and support and communication needs prior to them moving into the service. One person told us “(Registered manager) visited me at the hospital and found out all about me. He saw something in me and said I'd fit in well here.” Another person said, “The manager and deputy came out to see me and explained how they would be able to support me with all of my health issues.”

Assessments were holistic as staff obtained information about people’s history, interests and hobbies as well as information about their health and clinical needs.

Relatives said they had not seen their loved one’s care plans, however, they felt confident any concerns, or changes in needs, were communicated to them regularly, in person or by telephone.

The provider did not always plan and deliver people’s care and treatment in line with evidence based guidance or what was important to them.

Care and treatment were not always delivered in line with evidence‑based guidance or people’s assessed needs. For example, there was an inconsistent approach to managing people’s nutritional risks. One person required a pureed diet, and this was clearly recorded in their care plan. However, nutrition records showed that at times, they had been given soft meals instead. It was unclear whether the records were inaccurate or whether the person had not been offered the correct texture of food, creating a risk to their safety.

Another person was at high risk of aspiration and their care plan stated they must remain sitting upright for 1 hour after their meal. Repositioning records did not show this was happening consistently, placing the person at avoidable risk.

Most people were given drinks in beakers with lids. Staff could not explain why this was the case or whether this had been assessed as appropriate. The use of lidded beakers is not widely recommended as it can increase the risk of aspiration unless there is a clear clinical need. Without documented assessments, it was unclear whether this practice was safe or evidence‑based.

Despite these concerns around nutrition and drinking, people were positive about the food provided. They told us they received enough to eat and enjoyed the meals. One person said, “Very good, lovely menu, freshly cooked food every day, great menu for the people here I feel.” Another person told us, “There are 2 choices. If I ask for an alternative, there really isn’t a problem. They let me have what I want if they can. I have plenty of drinks through the day, they get me fresh oranges too.” All people told us the chef catered for their preferences or individual’s choices and examples included vegetarianism and 1 person whose favourite snack was an onion sandwich.

However, the inconsistencies between assessed needs and daily practice meant people were not always receiving care and treatment that reflected current best practice or their individual risks.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked effectively with other services to support positive outcomes for people. The GP, or a representative from the practice, visited weekly and carried out ‘ward rounds’, which helped ensure people’s health needs were reviewed regularly and any concerns were addressed promptly.

People told us staff worked well together and delivered care through a coordinated approach. One person said,“They work well as a team, all the different groups make a good team, they get on well with each other.” Another person told us, “Everyone you speak to, even the chef, they are very good and nothing is too much trouble.”

Staff also described good communication across teams. They told us daily handovers provided the information they needed about people’s needs and any changes in their condition. All staff were able to show us how to access care information on the electronic system. These examples showed that staff communicated effectively and worked collaboratively to meet people’s needs.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff did not always have the information needed to provide effective care. One person had recently developed a pressure sore on their toes. Although staff had created a wound record, their skin integrity care plan and wound care plan only contained instructions for managing an existing moisture lesion elsewhere on their body. These plans had been signed off as reviewed but did not include the new wound. This meant staff did not have up‑to‑date guidance on the actions required to prevent further deterioration and promote healing.

Another person had experienced significant weight loss, but their records did not provide a clear, evidence‑based explanation for it. The nutritional risk assessment stated the weight loss was intended, yet there was no supporting information in the care plan to confirm this or outline any related risks. On the day of our inspection, this person was reviewed by a healthcare professional, and we were informed the person had been prescribed medication to increase their appetite. This created a contradiction between the assessment and the clinical action taken. Because the care plan lacked accurate assessment, identified risks, and guidance, staff did not have the information needed to support the person to maintain a nutritious diet or monitor their wellbeing effectively.

Care plans and risk assessments were not consistently updated when people’s needs changed. This meant staff did not always have reliable information to prevent further deterioration and support people to enjoy the best health possible.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Records did not always accurately reflect the care people needed, which made it difficult to assess how effectively care and treatment were being monitored. For people who required their food and fluid intake to be tracked, staff’s recording was inconsistent. For example, 1 person who required a pureed diet was recorded over the course of a week as having received soft, regular and pureed meals. Descriptions of meals and portion sizes were unclear, meaning that if external healthcare professionals needed to review the person’s nutritional intake, the records would not provide an accurate or meaningful picture of what they had eaten and drunk.

Monitoring of equipment used to support people’s health was also inconsistent. Several people required pressure‑relieving mattresses, but there was no effective process to ensure these were set correctly to the person’s weight or checked to confirm they were working properly. Although we found no direct harm to people, two people told us their mattresses were uncomfortable. We have further reported on this in the safe section of this report.

These concerns showed that monitoring systems were not always robust or effective in identifying emerging risks, ensuring accurate records or supporting improved outcomes for people.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We saw staff offering people day to day choice such as where to go, what to do and what they wanted to eat. Staff recorded people’s capacity to consent and if people lacked capacity, a mental capacity assessment was completed. However, we found the documentation to support people’s choices and capacity varied. In some cases, there was limited evidence of the actions taken to ensure people had the best chance of understanding the decision to be made. The deputy manager recognised this was an area for improvement and assured us more information would be recorded as part of the decision-making process. Our observations confirmed people’s consent was sought, before any support was provided.