This inspection took place on 23 April 2015 and was unannounced.
Royal Leamington Spa Nursing Home is an older style property, divided into two houses and over three floors. The home consists of two buildings identified as houses ‘14’ and ‘16’. People living in house 14 were considered by care staff to have higher level care needs.
The home is registered to provide nursing or personal care for up to 46 older people. At the time of our inspection there were 38 people living at the home.
A registered manager was not in post as they had left the service in May 2013. 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 and associated Regulations about how the service is run. A new manager had been appointed and they planned to complete the process for registration.
Most people at Royal Leamington Spa Nursing Home had high level nursing needs. Many of them were cared for in bed and required two carers to support them. People told us they felt safe living at the home and their care needs were met, but they often had to wait for long periods for staff to assist them with their care.
Some people told us staff were respectful and kind towards them, however others said at times staff could be abrupt in their approach. They told us staff were not always caring and on occasions people’s dignity was not respected.
Care plans contained some relevant information for staff to help them provide the care and treatment people required. However, we found these contained primarily medical information and little information about people’s histories, preferences and interests. Risk assessments were minimal in their detail and did not identify risks clearly, and ways to reduce these or prevent them. This did not protect people from the risks associated with their high care needs.
Checks were carried out prior to staff starting work at the home to ensure their suitability for employment. A period of induction then enabled them to understand systems within the home and people’s individual needs. We saw staff had training in areas considered essential to meet people’s needs safely and consistently. Staff were encouraged to continue to develop their skills in health and social care by managers.
People told us they liked the food and we saw there were a variety of food and snacks available which people could access when they were hungry. However at times drinks were not always accessible. People with special dietary needs were catered for, and relatives could come and eat a meal with their family member if they wished to do so.
Most people we spoke with were positive about the management and the running of the home. We saw systems were in place to make sure the environment was safe for people that lived there. Records of complaints were not up to date so we were unable to see how they had been managed and whether people were satisfied with the outcome. Some people told us they did not feel their concerns had been addressed.
Medicines were stored securely and systems ensured people received their medicine as prescribed. People’s health and social care needs were reviewed regularly with appropriate referrals made to other professionals.
Written consent forms had been completed for some areas of care, but we saw that often relatives had signed these on behalf of their family members. Many of these people had capacity to make their own decisions, so these were not being completed appropriately and within legal guidelines.
Staff responsible for assessing people’s needs, understood the Mental Capacity Act, and we saw that when there were concerns about people’s capacity, some assessments had been completed to determine people’s ability to make certain decisions. Where people were assessed as lacking capacity, decisions were made in their ‘best interests’.
The provider was not meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection, no applications had been made under DoLS for people’s freedoms and liberties to be restricted. The manager had not contacted the local authority in line with recent changes to DoLS to ensure people’s liberties were not being restricted.
People were given choice about how they wanted to spend their day and were able to retain some independence in their everyday lives. Family and friends were able to visit without restrictions and staff encouraged relatives to maintain a role in the lives of their family members.
Some people told us they were supported to be involved in pursing their own hobbies and interests. Activities were available for people living in the home and one to one activities were provided for people who were cared for in bed. Some people felt more activities could be provided to meet their social needs.
You can see what action we told the provider to take at the back of the full version of the report.