Archived: Royal Manor Nursing Home

About the service

Royal Manor Nursing provides accommodation, nursing and personal care for up to 31 older people, some of whom were living with dementia. There were 28 people living at the service at the time of the inspection..

People’s experience of using this service and what we found

Based on our review of the Safe and Well Led key questions the quality assurance monitoring systems in place were not effective in maintaining and improving the quality of care provided to people. Staff received safeguarding training; however, their understating of safeguarding procedures was not comprehensive.

Risk in relation to people receiving support had been assessed but risk management plans lacked detail. There was limited evidence that the nurses employed had received clinical training updates. We found the provider’s oversight of clinical training for most nursing staff was not in place. Incidents and accidents were not always clearly recorded and audited. There was no analysis to enable the manager to look for patterns and trends.

People received their medicines as prescribed, but we identified that improvements were needed regarding the storage of some medicines. This had been addressed by day two of the inspection.

Sufficient staff were deployed, and appropriate recruitment checks were carried out to ensure they were suitable to support people who used the service. Overall, staff were caring in their approach and people told us they liked the staff. However, we observed the language used to describe people’s needs was not always respectful or professional.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 20 August 2021).

Why we inspected

We received concerns in relation to infection control, people’s nursing needs and provider oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

At the start of the inspection the provider was in the process of selling the service. A new provider is now in place and has confirmed they will work with us and other stakeholders to make the required improvements needed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Manor on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service. We will work with the local authority and new provider to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Royal Manor Nursing Home provides accommodation, nursing and personal care for up to 31 older people, some of whom are living with dementia. There were 29 people living at the service at the time of the inspection.

We found the following examples of good practice.

COVID-19 screening was done before people entered the home and personal protective equipment (PPE) was provided.

The home had recently had an outbreak of COVID – 19 and had closed to non-essential visitors. People were supported to contact their relatives and friends through video calls and telephone calls during this time. Care givers were able to visit, in line with Government guidelines.

At the time of the inspection the home had reopened to visitors. Government guidelines were followed to enable people to spend time with their loved ones in a safe way.

Staff and people living in the service accessed regular testing for COVID-19, so that action could be taken swiftly if anyone developed symptoms or had a positive test result.

The infection prevention and control policy was up to date.

Measures were in place to keep people and staff safe. People and staff had risk assessments in place to identify their individual risks associated with COVID-19.

About the service

Royal Manor Nursing provides accommodation, nursing and personal care for up to 31 older people, some of whom are living with dementia. There were 30 people living at the service at the time of the inspection. The service had various communal areas and a garden space for people to relax in.

People’s experience of using this service and what we found

Robust and effective quality assurance monitoring systems were not always in place to maintain and improve the quality of care provided to people.

The service had systems in place to obtain people’s view about the care they received. Care provided was centred around people's needs and preferences.

People and their relatives told us the home was safe. Staff received safeguarding training; however, their understating of safeguarding procedures was not comprehensive.

Risk in relation to people receiving support had been assessed and management plans were in place to minimise the risk. Sufficient staff were deployed, and appropriate recruitment checks were carried out to ensure they were suitable to support people who used the service. People’s medicines were managed safely. Incidents and accidents were clearly recorded, and actions were taken to learn for these and reduce the likelihood of similar events from happening in the future.

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 19 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received about infection control and provider oversight of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Well Led sections of this full report.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ There was a sign outside the home to notify people of current restrictions to visitors during the COVID-19 pandemic to protect people and visitors.

¿ Handover to discuss people’s clinical needs occurred in the large conservatory area, which allowed staff to socially distance. Staff used areas around the home for socially distanced breaks.

¿ The provider was making arrangements ready to restart pre-booked visiting in the garden under a gazebo or using a Perspex screen in the large conservatory area which had garden access.

¿ The service had a visiting policy and procedures were in place to check visitors temperatures and perform a lateral flow test before visiting took place.

¿ Families were using phone calls and video-calls to keep in touch while visiting was restricted.

¿ There were admission procedures in place and people admitted to the service were tested then isolated to prevent the possible spread of infection.

¿ Testing was in place and staff were tested twice a week, people living at the service were tested monthly. People and some staff had received the COVID-19 vaccine.

¿ People’s temperatures were checked twice a day to detect any changes. We recommended that oxygen saturation could also be checked with temperature to detect any deterioration in people’s conditions.

¿ Staff had a room to change into and out of uniforms to prevent cross infection.

¿ The service had trolleys with personal protective equipment (PPE) for personal care and supplies of PPE around the home for staff to access when providing care to minimise the risk of infection.

¿ The service had purchased a sanitising machine to enhance cleaning and this was moved around communal areas. Cleaning was audited and monitored by the management team.

¿ The service had plans in place to isolate people and zone staff into separate teams should there be an outbreak of COVID-19.

¿ Staff were provided with up to date infection control training. The manager performed random spot checks of PPE use to monitor staff compliance and audited infection control procedures.

¿ We observed a chair and a crash mattress that did not meet current infection control standards, the manager took immediate action to remove this equipment from use.

Royal Manor Nursing Home is a care home which provides residential and nursing care to older people including people recovering from physical and mental health issues and some who are living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Royal Manor Nursing Home is registered to provide care for up to 31 people. At the time of our inspection there were 24 people using the service.

The service had a registered manager. 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.

Potential risks people were exposed to had been identified and assessed. Risk assessments provided information and guidance to support staff to carry out their role. However, information in some records was contradictory and could be confusing for staff. Staff were knowledgeable about the needs of people whose behaviours could challenge. Records required further development to ensure staff were provided with clear guidance on interventions and responses to keep people safe.

Staff were able to describe the signs and symptoms of abuse and felt confident to report them. The provider's safeguarding policy required reviewing to provide people and staff with contact details for external agencies to support them to raise concerns outside of the service.

Effective recruitment processes were followed and there were enough staff to meet people's needs. People received their medicines safely and as prescribed.

Systems were in place to ensure the premises were kept clean and hygienic so that people were protected by the prevention and control of infection. We found two items of furniture that presented a risk to the control of infection.

There were arrangements in place for staff to monitor and take action when people experienced accidents or incidents. Further work was required to collect this information and use it to identify trends and patterns in accidents and incidents within the service to improve safety.

People's needs and choices were assessed and their provided in line with their wishes, preference and desired outcomes. People were supported to be involved and make decisions and choices about their care. We made a recommendation about care plans.

Staff were provided with regular opportunities to keep their knowledge and skills up to date. This included essential training and on-going development training. This supported staff to provide effective care based on current best practice.

People were supported to have sufficient to eat and drink in line with their dietary needs. People were supported by staff to use and access a wide variety of other services and health care professionals to maintain their health and well-being. Staff supported people to access health appointments when required to make sure they received continuing healthcare to meet their needs.

Staff demonstrated their understanding of the Mental Capacity Act 2005 (MCA). They gained people's consent before providing care and respected people's right to decline their care.

The provider was in the process of upgrading the décor of the premises to support people using the service.

People had developed positive relationships with staff, who were kind and caring and treated people with respect. Staff understood people's individual needs and preferred means of communicating and this support people to receive and share information about their care. Care was provided in a way that supported people to maintain their independence whilst respecting their right to privacy and dignity.

Care plans provided staff with detailed information and guidance about people's likes, dislikes, preferences and guidance from any professionals involved in their care. People and their relatives were involved in planning all aspects of their care and support, including reviews of their care to ensure their needs were being met. Records were regularly reviewed to ensure care met people's current needs. This helped to enable staff to provide personalised care.

People were supported to pursue hobbies and interests and could choose from a wide range of activities, including group and one-to-one sessions. This helped to reduce the risk of people feeling socially isolated.

People, relatives and staff knew how to raise concerns and make a complaint if they needed to. Complaints had been investigated and action taken to resolve people's concerns. The registered manager used complaints to bring about improvements within the service.

The management and leadership within the service had a clear structure and managers demonstrated they were knowledgeable about people's needs, the key issues and challenges within the service. Staff felt supported and able to share their views with managers and the provider. Staff were positive about the improvements made since our last inspection which had resulted in more effective communication and improvements in the care provided.

The provider had systems in place to monitor the quality of the service. These included audits of key aspects of the service. People and those important to them were supported to share their views about the quality of care they received. These were used to drive improvements and develop the service to ensure people received good care.

Royal Manor provides residential and nursing care to older people including people recovering from physical and mental health issues and some who are living with dementia. Royal Manor is registered to provide care for up to 25 people. At the time of our inspection there were 23 people living at the home.

Royal Manor had a registered manager in post. The registered manager was also the provider, and he was supported by a care manager at the home. 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.

At the last inspection we asked the provider to record issues that affected people which were seen as informal complaints. Audits and checks of the service were carried out by the provider but issues forwarded through the quality assurance questionnaires had not been recorded. These audits also failed to recognise pattern with formal complaints. The absence of this analysis failed to ensure the service continuously improved.

There were appropriate arrangements for the recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines. However the accurate recording of people’s hydration, when topical creams were applied and where injuries had occurred were not recorded consistently.

Though some staff had not been provided with safeguarding training they were still aware and had an understanding of their responsibilities to protect people from harm. The registered manager understood their responsibilities to manage any safeguarding concerns raised by staff. The provider ensured all notifications required by law had been sent to us in accordance with the legislation.

Staff worked as a team, however were not deployed to provide the appropriate level of observation to keep people safe. The noise levels in the home were noticeably raised, and at times people presented with behaviour that challenged staff. Poor staff deployment did not assist staff in being able to deflect this behaviour.

People were offered meal choices however some staff did not clearly explain what meals were on offer. Staff recorded the food and fluid people ate and drank. However governance of these records did not reveal that staff did not complete them consistently.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship with them before working with people on a one to one basis.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. However they were observant of peoples dignity at all times.

Care records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Plans around behaviours were written to reinforce positive behaviour rather than concentrating on the negative. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through detailed records for each person. Risk assessments and management plans covered aspects of people’s needs and included health and daily routines.

The provider had recruitment procedures that ensured staff were of a suitable character to work with people and ensure they remained safe. Most staff had received training in the areas the provider considered essential for meeting the needs of people in a care environment safely and effectively. Planned training was in place for the remainder of the staff to ensure all staffs’ knowledge was up to date.