CQC report explained · a nursing home
What the CQC found at The Royal
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2022
Rated Requires Improvement; inspectors found problems with medicines, infection control and management checks.
This was an unannounced focused inspection on 29 June 2022. Inspectors looked only at Safe and Well-led. They spoke with people, relatives and staff, observed care, and checked care, medicine and management records.
The home did not always show that medicines had been given as prescribed. Some prescribed medicines were out of stock, and some medicines to be given when needed did not have clear instructions. Inspectors also found stained seating, areas needing a deep clean, poor separation of clean and dirty linen, and too few bins for used protective equipment.
The systems used to check quality had not found all these problems, and some earlier actions had not been completed promptly. Inspectors did find enough staff during their visits, suitable recruitment checks, appropriate risk management and kind interactions. The overall rating changed from Good in 2018 to Requires Improvement. The provider was asked for an action plan and said it had taken steps to improve, but these changes still needed to become routine.
Staff available during the visit
Inspectors found enough staff to meet people's needs promptly during their observations.
“We observed staff interacting with people and found there were enough staff available to meet people's needs in a timely way.” from the report
Kind and respectful care
Staff knew people well and were polite, respectful and considerate in their interactions.
“We observed staff interacting with people and found they were polite, respectful and considerate.” from the report
Risks were managed
People's care risks had been identified and plans were in place to manage them.
“Risks associated with people's care were identified and managed appropriately.” from the report
Safe recruitment
The records checked showed that required pre-employment checks had been completed before staff started work.
“We looked at three staff files and found pre-employment checks had been carried out prior to staff commencing in their role.” from the report
Medicines were not always safe
seriousRecords did not always show that medicines had been given as prescribed. Some medicines were unavailable, and some instructions for medicines given when needed were missing.
“The provider could not always evidence that medication had been administered as prescribed.” from the report
Infection control problems
seriousSome seating needed deep cleaning or replacement. Clean and dirty linen were kept together, and there were not enough bins for used protective equipment.
“For example, we found chairs in need of a deep clean or replacing as they were heavily stained.” from the report
Quality checks missed problems
needs fixingThe home's audits had not identified the medicine and cleaning problems found by inspectors. Earlier actions had also not been completed promptly.
“The provider had a system in place to monitor the quality of the service however, this had not always been effective.” from the report
Limited bathing access
needs fixingMany bath and shower rooms were out of order, limiting people's access to bathing and showering facilities.
“We found many bath/shower rooms were out of order, therefore people had limited access to bathing and showering facilities.” from the report
- 01How do you now check that every medicine, including creams and medicines given when needed, is recorded and available?
- 02What has been done to deep clean or replace the stained seating and improve the handling of clean and dirty linen?
- 03How many bath and shower rooms are currently available, and how do you make sure people can bathe when they need or want to?
- 04What new checks are being used to find medicine and infection control problems before they affect people?
- 05How will you keep relatives informed when a person's needs change or when there is an issue with their care?
This was a focused inspection of Safe and Well-led only; the other question ratings carried over from the previous inspection and were used in calculating the overall rating. This explanation was written from the published report of 5 August 2022 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, June 2018
Rated Good; inspectors found kind, safe care, with some medicines records and building areas needing improvement.
This was an unannounced inspection on 21 March 2018. Inspectors spoke with people living at the home, visitors, staff and healthcare professionals. They also observed care and meals, and checked care records, medicines, staff files and audits.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People and visitors said they were happy with the care and felt safe. Inspectors found enough staff, suitable training, kind interactions and care plans that generally reflected people's needs and preferences.
There were some shortfalls, but inspectors did not find serious risks or concerns. Medicines records had some gaps, a few records needed updating, and some areas had smells or needed refurbishment. The home was also rated Good at its previous inspection in May 2016.
Safe staffing
Inspectors found enough staff to meet people's needs. Relatives said call bells were answered promptly and care was provided in good time.
“The registered provider continued to ensure that there was enough staff to meet the needs of the people being cared for.” from the report
Kind and respectful care
Staff treated people with patience and respect. They supported privacy and offered choices about daily care, food and where people ate.
“We saw staff were kind, patient and respectful to people, and people seemed relaxed in their company.” from the report
Personalised care
Care plans included people's likes, dislikes, history, culture and interests. Staff were observed to know people well and support their independence.
“People's needs and preferences were recorded in their care plans, which included information about people's likes and dislikes as well as their history, culture and interests.” from the report
Activities and communication
The home provided group activities, one-to-one time and trips into the community. Information was available in accessible formats, including pictures and large print.
“They organised group activities and spent one to one time with people reading or talking with them.” from the report
Positive management
People, relatives and staff spoke positively about the registered manager. Staff said they could raise concerns and suggest improvements.
“Staff members told us the registered manager promoted a good, open culture in the team.” from the report
Medicines records
needs fixingSome medication administration records had gaps. Some creams were not dated when opened, and prescribed thickener was not labelled with the person's name.
“We did see some gaps, where staff had not signed the MAR sheets to say medicines had been given.” from the report
Audits did not find all medicines issues
needs fixingThe most recent medicines audit had not identified some of the problems found during the inspection. The manager said an improved system would be put in place.
“However, we did find that the most recent audit of medication had not identified some of the issues which we found.” from the report
Record keeping
minorA small number of risk records needed updating. Inspectors also said some care plans were difficult to use because of their layout and language.
“However, in a small number of cases documentation needed some updating.” from the report
Environment
minorSome areas sometimes smelled of urine, and parts of the corridors needed attention. The home had started replacing floor coverings and had plans for refurbishment.
“However, there were some areas where a smell of urine could be detected at times.” from the report
Diet information
needs fixingA change to one person's diet had not been communicated effectively to the staff supporting lunch. Inspectors also did not see adapted cutlery or crockery being used to support independence.
“However, a change to one person's diet had not been communicated effectively to the staff who were providing lunchtime support.” from the report
- 01What changes have been made to medicines checks since inspectors found gaps in medication administration records?
- 02How do you make sure creams are dated and prescribed thickener is labelled correctly?
- 03How are changes to a person's diet recorded and passed on to every staff member supporting meals?
- 04What refurbishment has been completed since the inspection, including work to floor coverings, corridors and areas where smells were noticed?
- 05How are care plans being made clearer and easier for staff and people using the home to understand?
This was an unannounced inspection of the overall service and all five key questions; the Good ratings had remained unchanged from the May 2016 inspection. This explanation was written from the published report of 9 June 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.
Every inspection of The Royal
3 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- August 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2018Goodstayed GoodSafe: GoodWell-led: Good
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016
Registered with the Care Quality Commission on 19 February 2016.
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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