CQC report explained · a nursing home
What the CQC found at Royal Leamington Spa Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, May 2019
Rated Good in all areas; inspectors found kind, safe care, but some care and safety records needed improvement.
Inspectors visited on 10 and 11 April 2019. The first day was unannounced. They spoke with people living at the home, relatives, staff and healthcare professionals. They observed care and checked care records, medicine records, staff files, complaints, meetings, audits, the building and equipment.
The home was rated Good overall and Good for Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe recruitment, personalised care, good support with food and healthcare, and respectful relationships. People and relatives generally said they felt safe and were happy with the care.
There were some shortfalls in records and checks. Two people's treatment was not given in line with their care plans, one person's topical medicine was not clearly recorded, and fluid records were not always accurate. The fire risk assessment had not been reviewed as expected. The manager took immediate or planned action during and after the inspection.
The previous inspection in 2016 had found one Requires Improvement area in Responsive. Inspectors said improvements had been made, so all five areas were now rated Good.
Enough staff
Inspectors found enough clinical and care staff for people's varying and complex needs. People and relatives were happy with staffing levels.
“There were enough clinical and care staff to meet people's varying and complex needs.” from the report
Kind relationships
Staff knew people well and treated them with compassion, dignity and respect. Inspectors saw thoughtful interactions and support for people's personal and spiritual needs.
“We observed some very kind and thoughtful interactions between people and staff.” from the report
Personalised support
Care plans included people's backgrounds, interests and hobbies. Staff used this information to offer activities and support that mattered to each person.
“Care plans focussed on people's whole life and gave staff information about people's backgrounds, interests and hobbies.” from the report
Meaningful outcomes
Staff helped people build confidence, access the community and take part in activities linked to their wishes and interests.
“Staff used innovative ways to achieve excellent outcomes for people.” from the report
Learning from incidents
The home had started recording and analysing accidents and incidents. It identified a period when falls were more common and increased staffing at that time.
“The registered manager's analysis had identified falls happened most frequently between nine o'clock and midnight.” from the report
Some care was not delivered as planned
seriousInspectors found two examples where treatment did not follow people's care plans. One wound dressing had not been changed and one person had not been repositioned within the required timeframe.
“we found two examples of where treatment was not delivered in line with the person's care plan.” from the report
Medicine records
needs fixingMost medicines were administered and recorded safely, but one person's records did not show that topical medicine had been applied as directed.
“one person's records did not evidence that topical medicines, medicine applied directly to a person's skin, had been applied as directed.” from the report
Fluid records
needs fixingStaff encouraged people to drink, but records did not always show when drinks were refused and fluid totals were not always correct.
“However, staff did not always record when people were offered drinks but refused and fluids were not always added up correctly.” from the report
Fire risk assessment
needs fixingThe last fire risk assessment was from May 2016 and had not been reviewed in line with Fire Authority standards. The manager said a new inspection had been booked after the visit.
“the last fire risk assessment had been completed by an external contractor in May 2016 and had not been reviewed since as per Fire Authority standards.” from the report
Audits missed some risks
needs fixingThe home's monitoring systems did not always identify the gaps in topical medicine, repositioning and fluid records. The provider said it had strengthened its audits.
“However, these systems had not always identified risk to people's safety.” from the report
- 01What checks now make sure wound dressings and repositioning are completed at the times set out in care plans?
- 02How do you record topical medicines, and how do you check that they have been applied as prescribed?
- 03How do you record refused drinks and calculate fluid totals accurately?
- 04Has the fire risk assessment been reviewed since this inspection, and can we see the outcome?
- 05What changes have you made to audits so they identify care-record gaps quickly?
This was a planned inspection covering the overall service, all five CQC questions, the premises and the care provided. This explanation was written from the published report of 8 May 2019 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, October 2016
Rated Good overall; inspectors found safe, kind care, but the home was not always responsive.
This was an unannounced inspection on 25 August 2016. Inspectors spoke with people living in the home, relatives, staff and healthcare professionals. They looked at care records, medicines records, staff files and the home's checks on quality and safety.
The home was rated Good for safe, effective and caring services, and for how it was led. Inspectors found enough staff to keep people safe, safe medicines management, suitable training, respectful care and good quality checks.
Responsive care was rated Requires Improvement. New and agency staff did not always know people's needs. Some people waited for help or meals, fluid records were incomplete, and some relatives were unsure whether informal concerns had been acted on.
The home had breached two legal requirements at the previous inspection in April 2015. Inspectors found the required improvements had been made, so the home was no longer in breach at this inspection.
Safe staffing and recruitment
Inspectors judged there were enough staff to keep people safe. Recruitment checks were completed before staff started work.
“There were enough staff to keep people safe.” from the report
Respectful care
Staff communicated kindly, protected people's privacy and supported them to remain as independent as they wished.
“People were treated with dignity and respect and supported to be as independent as they wished.” from the report
Person-centred care plans
Care plans described people's likes, dislikes, history and preferred ways of receiving support. Staff said the records were clear and up to date.
“Care plans were written in an individual and person centred way and gave clear information about what people liked and did not like” from the report
Improved training
The manager identified gaps in training and arranged further training for care staff. Inspectors found very few gaps in the updated training record.
“The training had taken place over a six week period and care staff had now received the training the registered manager considered to be essential” from the report
Agency staff lacked local knowledge
needs fixingNew and agency staff did not always understand people's needs or the home's routines. This sometimes caused delays and inconsistent care.
“new staff and agency staff did not always know people's care needs.” from the report
Incomplete fluid records
needs fixingFluid charts were not consistently completed or totalled. This made it difficult to know whether people were drinking enough and whether more drinks were needed.
“the fluid charts we looked at were not consistently completed or totalled” from the report
Delays with meals and assistance
needs fixingSome people waited around 45 minutes for lunch during the inspection. People could also wait for staff to respond to requests for help.
“there was a significant delay of around 45 minutes in some people receiving their lunch.” from the report
Concerns were not always tracked
needs fixingSome relatives were unsure whether informal concerns had been listened to or acted on. There were no records showing what had been done about some concerns.
“There were no records to assure relatives that staff had acted on the concerns they had raised.” from the report
Privacy at handover
minorA lunchtime handover took place in an open area. This meant personal information was not shared completely confidentially.
“the information was not shared in a completely confidential way.” from the report
- 01How do you make sure agency and newly recruited staff understand my relative's care needs and daily routines?
- 02How do you check that fluid charts are completed and totalled, and what action do you take if someone is not drinking enough?
- 03What changes have you made to prevent delays with meals and responses to call bells or other requests for help?
- 04How are informal concerns from relatives recorded, investigated and followed up?
- 05How do you protect people's privacy when staff share information during handovers?
This was an unannounced inspection of the overall service, covering all five key questions and checking improvements required after the April 2015 inspection. This explanation was written from the published report of 14 October 2016 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 Leamington Spa Nursing Home
3 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- May 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Royal Leamington Spa Nursing Home →
- October 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
Read what inspectors found at Royal Leamington Spa Nursing Home →
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- May 2011
Registered with the Care Quality Commission on 24 May 2011.
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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At least 100 live-in carers within about an hour of Warwickshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £950 to £1,260 a week. 77 can care for a couple. 11 years' experience on average.
“If you bump into her in the night on her way to the bathroom she will still inquire how you are and if everything is alright.”
“I have never met a person who is so kind and thinks about others before himself to such an extent as Chris Malagala.”
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