CQC report explained · a residential care home
What the CQC found at Royal Garden Hotel
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2018
Royal Garden Hotel was rated Good overall; inspectors found kind, safe care, but the home’s leadership and records needed improvement.
Inspectors visited the home without warning on 24 May and 1 June 2018. They spoke with people living there, relatives, staff and managers. They observed care and medicines being given, and checked care records, medicines records, training, complaints and management records.
People told inspectors they felt safe and were treated kindly and respectfully. Staffing levels were sufficient, medicines were managed safely, the home was clean, and people had access to food, activities and healthcare. The five main areas were rated Good except for well-led, which was rated Requires Improvement.
Seven of the 31 people living at the home did not have detailed care plans or identified risks when inspectors arrived. These were completed by the second day. The home’s checks had not found this problem, and records of staff supervision, staff meetings and some training were incomplete.
The overall Good rating means inspectors found the home met the required standards in most areas. It does not mean everything was perfect. The home had improved its staff support since the previous inspection, but inspectors said they would check whether the management improvements were sustained.
People felt safe
People said they felt safe and inspectors found that risks were generally assessed and managed. Staffing levels and recruitment checks were also considered safe.
“People told us they felt safe living at the home.” from the report
Kind and respectful care
Inspectors observed warm interactions. Staff supported people’s independence, protected their privacy and respected their choices.
“We observed friendly, warm interactions between staff and people and that staff were polite and friendly.” from the report
Safe medicines and clean home
Medicines records showed prescribed medicines were given safely. Inspectors found the home very clean and fresh-smelling.
“Medicines were managed safely. We looked at the storage of medicines and the way medicines were recorded.” from the report
Personalised support
Care plans included people’s routines, preferences, health needs, activities, religion and communication needs. Staff knew people well despite some missing plans.
“People received personalised care that was responsive to their needs; care plans were kept electronically.” from the report
Improvement since the previous inspection
The previous problem with staff supervision and appraisals had been addressed sufficiently for that regulation to be met. Further records and systems were introduced after this inspection.
“At this inspection, we found that improvements had been made and that this regulation had been met.” from the report
Some care plans were missing
seriousSeven people did not have detailed care plans or assessed risks when inspectors arrived. The plans were completed by the second day, but the missing information meant care needs had not been fully documented.
“Out of 31 people who lived at the home, seven people did not have detailed care plans at the time of our inspection.” from the report
Management checks were not effective
needs fixingQuality systems had not identified the missing care plans, gaps in staff support records or some training gaps. Inspectors said they would check whether the improvements were sustained.
“Systems had been established to monitor and measure the quality of care provided and the service overall, but these were not effective at the time of our inspection.” from the report
Staff records and meetings were incomplete
needs fixingSome planned supervisions and appraisals had not taken place or were not recorded. Staff meetings happened informally but there were no minutes for meetings during 2018.
“Records were not kept to show that staff received regular supervision meetings or an annual appraisal.” from the report
Some policies and communication needed updating
minorSome policies were out of date and a Duty of Candour policy was missing. One relative also said updates about care varied according to which staff were on duty.
“Some policies we looked at were out of date and in need of review.” from the report
- 01How do you now make sure every new resident has a detailed care plan and risk assessment promptly after admission?
- 02How are staff supervisions and annual appraisals recorded, and are all staff up to date?
- 03How do you analyse falls and other incidents to identify patterns or repeated risks?
- 04Which policies have been updated since the inspection, including the Duty of Candour policy?
- 05How will relatives receive consistent updates about their family member’s care, regardless of which staff are on duty?
This was an unannounced comprehensive inspection covering all five key questions; the report also compares the findings with the previous inspection in January 2017. This explanation was written from the published report of 7 December 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2017
Rated Good overall; inspectors found kind, safe and personalised care, but the home’s leadership and staff supervision needed improvement.
This was an unannounced inspection on 29 December 2016 and 3 January 2017. The inspector and an expert by experience observed care, spoke with people, relatives and staff, and checked care records, medicines, staffing and management records.
People generally felt safe and well cared for. Staffing levels were sufficient, care plans were detailed, and people were treated with kindness, dignity and respect. The home was clean, and people had access to food, drink and healthcare.
The main weakness was management. Staff did not receive regular recorded supervision or annual appraisals. The manager was also not familiar with the current regulations. The home was rated Good overall, with Safe, Effective, Caring and Responsive rated Good, but Well-led rated Requires Improvement.
Kind relationships
Inspectors saw positive relationships between staff and people. People and relatives spoke highly of the staff.
“From our observations, it was clear that staff knew people well and genuinely cared about people's wellbeing.” from the report
Personalised care
Care plans included people's preferences, routines, interests and support needs. Staff were kept informed when plans changed.
“Care plans provided detailed information and guidance to staff on how to support people in line with their preferences.” from the report
Safety and staffing
People's risks were assessed and there were enough staff on duty to meet their needs. Recruitment checks were completed.
“There were sufficient numbers of suitable staff on duty to keep people safe and meet their needs.” from the report
Food and healthcare
People had access to food and drink that met their needs and to healthcare professionals. Their weights and nutrition risks were monitored.
“People were supported to maintain good health and had access to healthcare services and support.” from the report
Staff supervision
seriousThere was no effective system to make sure staff had regular supervision, and annual appraisals were not completed. This was the report's breach of Regulation 18.
“The above evidence shows that staff did not receive regular supervision meetings or annual appraisals to support them to carry out their duties.” from the report
Medicines left unattended
seriousInspectors saw medicines left on top of the trolley while a staff member went elsewhere. The manager addressed this at the time and said the trolley should be locked between administrations.
“This is not safe practice as anyone, in passing the trolley, could have helped themselves to the unattended medicines.” from the report
Confidential information
needs fixingSome do-not-resuscitate notices were displayed in an open staff office. The provider removed them and stored them securely after inspectors raised the issue.
“Since the door to the staff office was left open, anyone could have walked into the room and had access to this information.” from the report
Current legal guidance
needs fixingThe manager was not familiar with the current regulations or the duty to be open and transparent. CQC recommended that the provider and manager obtain and use the latest guidance.
“We recommend that the provider and the registered manager obtain a copy of 'Guidance for providers on meeting the regulations' published by the Commission.” from the report
- 01How often does each member of staff now receive supervision, and where is this recorded?
- 02Are annual appraisals completed for all staff, and how are any actions followed up?
- 03What changes were made to stop medicines being left unattended during medicine rounds?
- 04How are staff observed and their competence checked when administering medicines?
- 05How are confidential notices and other health information kept secure?
This was an unannounced inspection covering all five CQC questions and the overall quality of the service, using observations, discussions and records. This explanation was written from the published report of 31 January 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Royal Garden Hotel
2 rated inspections over 2 years: the service has held its Good rating throughout.
- December 2018Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 30 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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