We carried out a review of the data available to us about The Royal Star & Garter Homes - Surbiton on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Royal Star & Garter Homes - Surbiton, you can give feedback on this service.
The Royal Star & Garter Homes - Surbiton is a residential care home providing personal and nursing care to up to 63 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection there were 49 people using the service. The service has three units in one purpose-built building in Surbiton.
People’s experience of using this service and what we found
People continued to receive safe care. Systems in place ensured risks were regularly reviewed and staff had clear guidance on how to respond to those risks. Staff received on-going safeguarding training and were aware of the provider’s safeguarding policy. People continued to receive support from adequate numbers of staff to keep them safe. Medicines procedures in place were in line with government guidelines.
People and staff confirmed the service was well-led. Management systems in place ensured the registered manager had clear oversight of the service and where issues were identified, action was taken to address these in a timely manner. The registered manager developed a service that was person centred and sought people’s views to drive improvements. Records showed people benefitted from a service that actively sought partnership working.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 5 November 2020).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice:
Alternative arrangements were being put in place to help people maintain social contact with their family members and friends. A designated room had been partitioned in half using a floor to ceiling transparent screen which allowed people living in the care home and their visitors to enter and leave separately whilst seeing each other safely. Visitors entered this room from the outside grounds which meant they did not have to walk through the care home. The service also used video calls, Facebook portals and other more traditional methods such as letter writing to help people keep in touch with their family and friends.
The service implemented isolation and zoning in line with good practice. Each floor was treated as a bubble with their own communal spaces and dining rooms. Where people were in isolation, a discreet yellow butterfly symbol was used to indicate this and barrier nursing procedures were effectively implemented. A responsible clinician oversaw and audited practice around areas such as the correct use of personal protective equipment (PPE), handwashing and cleanliness.
Staff and people at the home were engaged in the ‘whole-home’ testing programme. People living in the home were routinely tested for Covid-19 every four weeks and staff were tested weekly. Staff also had access to antibody testing. People using the service had received the flu vaccination and staff were being encouraged to follow suit.
The home was clean and well-maintained. The provider had introduced additional domestic staff and cleaning schedules since the beginning of the Covid-19 pandemic. For example, dedicated staff cleaned touch points such as door handles, hand rails and light switches hourly. Disposable cleaning materials were used to prevent any risk of cross infection.
Activities continued for people using the service including themed meals, scenic drives and entertainers performing for them from the garden. The staff team were also being supported effectively with a strong focus on their wellbeing. Staff received PPE packs, gift vouchers and occasional food treats such as takeaway pizza. The homes minibuses were also being used to provide a shuttle service for staff to and from the home.
Further information is in the detailed findings below.
The Royal Star & Garter provides accommodation for up to 63 people on three floors of the building. At the time of inspection there were 60 people living at the home. The units on the ground and second floors, Richmond and Sandgate support people who require nursing care. The middle unit, Lister cared for people living with dementia.
This inspection was carried out on 21 and 29 November 2017. The first day of the inspection was unannounced and we let the service know that we were coming on the second day.
At the last inspection, the service was rated Good, with Outstanding in effective. At this inspection we found the service remained Good, with Outstanding in caring.
At the time of the inspection the service had a registered manager. A registered manager is a person who has registered with the CQC 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.
Safeguarding concerns were not always reported to a local authority to ensure that any risks to people were monitored and actions taken to protect people as necessary. We have made a recommendation about this.
Risk management plans addressed the support people required to minimise risks to their wellbeing, however information was not available on the severity and likelihood on some of the risks to people. There were safe staff recruitment processes in place which ensured that staff were suitably employed at the service. Staffing numbers were monitored and increased where required. Staff worked on different floors to have an up to date knowledge about people’s care needs. Medicines were appropriately administered to people and stored according to the service’s requirements. We found the home clean and hygienic. Staff were knowledgeable in safeguarding people from harm and abuse.
People used electric wheelchairs to move around the home freely. Staff were knowledgeable and had training to support people with their individual care needs. Robust induction and ongoing support was provided for staff to ensure they carried out their duties as necessary. People told us their nutritional needs were met and they had access to food at any time they wanted it. The environment was adapted to meet needs of people living with dementia. The premises were designed to accommodate people’s socialising needs. Staff worked together with the physiotherapists to support people mobilising. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We found that the mental capacity assessments for bedrails were not recorded initially, but the service supported this practice and carried out the assessments immediately.
People, their relatives and volunteers told us about the exceptional care provided by the staff team at the service. People said they felt this was their home and they received support that was aimed at their individual care needs. Staff used different communication methods to ensure that people were engaging and expressing their views. Staff were caring and attended to people’s personal care with respect. People’s independence was promoted and assisted by the staff team as necessary. People had support to enhance their religious beliefs.
There were technical issues around the call bell systems at the service. People complained that the call bells were not answered promptly. We have made a recommendation about this.
People’s care records were detailed and available for staff to use as necessary. Staff responded to people’s changing needs promptly where required. People were involved in planning their care. People had a choice and the support they required to take part in their preferred activities. The service had volunteers attending regularly to spend time with people socialising. People felt able to speak up about the concerns they had and were supported when they raised their concerns. Complaints received were suitably recorded and monitored to ensure it was dealt with as necessary. People had discussions with staff and made choices about their end of life care.
There was a clear management structure in place that shared responsibilities at the service. The management team was approachable and visible to people living in the home. The staff team aimed to deliver high quality services to people. Staff had support to understand their responsibilities so they could ensure good care for people. There was a culture of open communication embedded in the service and staff felt listened to. Systems were in place for staff to receive and share information which meant that important actions were carried out as necessary. All staff were involved and undertook audits which ensured they took responsibility for the services being delivered to people. The service worked in partnership with the relevant agencies and shared information on a need to know basis.
The inspection took place on 6 and 7 October 2015 and was unannounced. The last inspection of this service was on 6 November 2013. At that inspection we found the service was meeting all the regulations we assessed.
The Royal Star and Garter is a care home providing personal and nursing care for older people some of whom may be living with dementia. It provides accommodation for up to 63 people on three separate units, one on each of the three floors of the building. There were 49 people living at the home at the time of the inspection. The units on the ground and second floors, Richmond and Sandgate were for people with nursing needs. The middle unit, Lister had 26 rooms and catered for people living with dementia.
The service has a registered manager 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 2008 and associated Regulations about how the service is run.
People were extremely positive about the care and support they received at The Royal Star and Garter. We saw staff were knowledgeable about people and understood how to meet their diverse needs. We observed a genuine warmth and affection between staff and people who used the service. Levels of staffing were sufficient to ensure that people received care in an unhurried manner and at a time that they needed it.
Staff had a comprehensive and thorough induction when they started working in the home. Training was on-going and refreshed regularly. There was a lot of in-house expertise for training and in addition, the provider regularly bought in training from external sources. Staff had a shared vision and ethos and were highly motivated to provide the best quality care they could.
The service employed a range of healthcare professionals which meant that some of people’s healthcare needs were assessed and met promptly, and their continuing needs could be monitored. People also had access to community healthcare professionals as and when they needed them. The community healthcare professionals told us the service worked well with them, with a number of professionals, stating ‘the home was the best they came across.’ People’s nutritional needs were assessed and monitored and people received a variety of meals according to their choices and needs. People received their medicines as they had been prescribed to them.
The Royal Star and Garter home was a purpose build care home which opened two years ago. The building had been specially planned to meet the needs of people with dementia and to ensure people could move freely and independently around the home. The home was decorated and furnished to a high standard. The welfare and wellbeing of people was enhanced by the well-planned environment.
People told us they felt safe living at the home. Staff were knowledge about what they needed to do if they suspected anyone was at risk of abuse. People and staff told us they felt they could raise issues with the manager and any concerns would be acted upon.
People were asked their consent before care was provided. If people were not able to give consent, the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to empower and protect people who may not be able to make decisions for themselves and to help ensure their rights are protected.
Care that people received was individualised to meet their needs and provided in a way to take account of their likes and dislikes and their preferences. There was a wide range of social activities people could choose to participate in, within the home or in the community. People were supported by a number of activities co-ordinators and in addition a number of volunteers. Relatives were free to visit whenever they wished to make sure people could continue to maintain contact with their family.
The service had a number of measures in place to monitor the quality of the home. There was a drive towards continuous improvement.
We saw that the building was designed to be accessible and was light, welcoming and clean.
A person we spoke with said "The service you get here is excellent" and "The food is excellent and there is normally a good choice but it has been reduced since we moved from Richmond".
We saw that the staff were supportive and treated people with dignity and respect. People were encouraged to take part in activities but they had a choice if they wanted to be involved or not. One person we spoke with said "The concerts are really good but you do get a choice to be involved". Another person said "You can even suggest activities that they will add to the programme".
Staff said "There is really good training and you get plenty of choice" and "You can always request to go on external training as long as it is applicable to your role".
One person said "When we came here my room was too small but they moved me to a larger room really quickly" and "This place is heaven".