Inspection on 11/06/09 for Royal Garden Hotel

This inspection was carried out on 11th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Royal Garden Hotel 30/06/08

Royal Garden Hotel 12/06/07

Royal Garden Hotel 19/12/05

Royal Garden Hotel 24/01/05

Royal Garden Hotel 02/09/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Royal Garden Hotel 1 Princess Avenue Bognor Regis West Sussex PO21 2QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Liz Palmer     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Royal Garden Hotel 1 Princess Avenue Bognor Regis West Sussex PO21 2QT 01243841026 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): martin@royalgarden.net Crescentworth Limited Name of registered manager (if applicable) Mr Martin Glass Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender: Either whose primary care need on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Royal Garden Hotel is a care home providing personal care and accommodation for thirty-six persons (OP) of old age not falling within any other category. Crescentworth Limited owns the home. The responsible individual on behalf of the company is Mr C Lindsell. The Royal Gardens Hotel is purpose built and provides a high standard of accommodation throughout. It is positioned in Bognor Regis over looking the Marine Gardens and sea front. Shops and other local amenities are close by. The property is 0 Over 65 36 care home 36 Care Homes for Older People Page 4 of 26 Brief description of the care home equipped with a 12-person passenger lift to all floors and has an assisted spa bath and shower units. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to the home over a period of four and a half hours, starting at 9.30am. During this time three staff were spoken to and deputy manager assisted with the inspection. The manager who was not on duty came in to speak with the inspector briefly . Three service users were met and spoken to, others were observed during the inspection. Care plans, medication records, policies and staff records were sampled. Other information used to make judgements about the standard of care in the home included the homes Annual Quality Assurance Assessment (AQAA) that they completed and returned to us. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are assessed to ensure that only those whose needs can be met are admitted to the home. However, people are at risk if changes to initial assessments are not recorded, risk assessed acted upon. Evidence: Two assessments were looked at, they contained information about the persons health, medication, care needs and issues relating to their mental well being. One person who was staying on respite told us that she needed a toilet frame that had not been provided by the home. The deputy manager who assisted with the assessment said this had not been asked for by the resident at the assessment stage nor had it been picked by them. The resident said she had asked for the frame on arrival in the home and after a week one had still not been provided. No risk assessment had been completed once they knew a frame was needed however a raised toilet seat had been provided. The home said they did not have a suitable frame nor had they ordered one Care Homes for Older People Page 10 of 26 Evidence: from a supplier. A frame was provided to the resident during the inspection at the request of the inspector. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their health and personal care needs met in a way that respects their views and upholds their right to privacy. People are encouraged to live the life they chose, however they could be at risk due to the unstructured approach to risk assessment. Evidence: Four care plans were looked at. These are drawn up from the initial assessments undertaken prior to moving in. There were improvements in the amount of detail as required by us at the last inspection. They contained information about support needed for washing and dressing, personal preferences about food and drink, how people like to spend their time. They were seen to be kept under regular review and changes made as necessary. Residents said they were treated with respect and that staff were always lovely and kind. One told us that she can use her telephone to get staff assistance or use her call bell and staff come immediately. Improvements to risk assessments were seen, as required by us at the last inspection. Care Homes for Older People Page 12 of 26 Evidence: Those at risk of getting lost when out, for example, were seen to have recorded measures in place to minimise the risk whilst promoting their independence. On the morning of the inspection one resident tried to get into the inspectors car whilst it was being parked on a main road near the home. The care plan and risk assessment for this person stated they were at high risk of getting lost. When the incident of them trying to get in the inspectors car was discussed with the manager he stated that this resident had got worse in the last couple of weeks. No update to reflect this was recorded in their risk assessment which had last been reviewed on May 12 2009, almost a month ago. A referral under safeguarding procedures was made by us in respect of this person. Residents told us they could get medical assistance if they needed it and care plans showed us details of medical needs being followed up as necessary. The medication procedures were sampled. The deputy informed us that they were in the process of changing their storage and dispensing methods. A new trolley was seen which was not yet secured so was not in use. Medication was seen to have been transferred from its original pharmacy supplied and labeled container and placed by a member of the staff, on a daily basis, into another container for later administration This is called secondary dispensing. This is an outdated and unsafe practice and is not in line with best practice as described in The Handling of Medicines in Social Care, produced by The Royal Pharmaceutical Society of Great Britain. This practice was also described as frequently associated with medication errors in a report by the Department of Health, Building a safer NHS for patients. The deputy said she was dispensing to these pots up to 24 hours before administering to residents. The deputy stated this was a temporary measure until the new trolley was suitably secured. She had put in place a system of signing the record sheets once when the medication was dispensed to the pots and again when the resident actually took the medication. This was observed during the inspection. An immediate requirement was left for this practice to stop as it is against the Royal Pharmaceutical Society guidance. The home informed us of the actions taken within 48 hours. They tell us they have addressed the issue and medication is now stored and administered safely. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a wide range of activities on offer in the home and they are happy with the choices. Everyone is satisfied with the food provided. Evidence: At the last inspection we found the home to be exceeding the standards in this outcome group. At this inspection we did not look in detail at this area. However their AQAA tells us they continue to offer, bingo, bowls, visiting productions, church service, keep fit, art classes, visiting hairdressers, chiropodists, manicurists and provide a mobile shop selling essential supplies. They also told us that they continue to encourage individuals to interact and socialise externally and make new friends. They say they have seem some friendships developing over the last year. Residents are supported to attend local church coffee mornings, stroke and bridge clubs and make use of local amenities. Residents birthdays are celebrated by the home and relatives are invited to join in these celebrations. Residents tell us they are consulted on the activities and are free to choose whether to join in or not. People are supported to pursue their own hobbies and remain as independent as possible. One resident said she enjoyed knitting, another was looking forward to playing whist. Staff said there were plenty of activities and entertainment and residents are free to spend their days Care Homes for Older People Page 14 of 26 Evidence: how they wish. Those who are able go out to the local shops. People are free to come and go as they please as are their visitors. There are residents meetings held every three months. One resident said they discussed the menu and activities. They said they felt their views were listened to. Residents said their visitors are welcome and offered drinks when they visit. Some residents have their own telephones to enable them to keep in touch with friends and family. Residents spoken to said they felt they had choice and control of their lives. Residents said they enjoyed the food and there was always a choice. Residents can choose where to eat and some prefer to eat in their rooms. There was evidence of fresh fruit and vegetables available on the day. Food preferences, dietary requirements, likes, dislikes and nutritional requirements are recorded in residents care plans. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to complain and are protected by the homes policies for safeguarding them. Evidence: A complaints procedure is displayed in the home and residents spoken to say they know how to make a complaint and feel that any concern they may have would be dealt with by the staff or the manager. There was an open and relaxed atmosphere and staff dealt promptly with requests. The homes AQAA tells us that complaints are handled quickly and quietly to an agreed and acceptable conclusion. They say their Safeguarding of Vulnerable Adults policy is in place and adhered to. Training in the safeguarding of vulnerable adults is carried out as part of the induction process and ongoing training programme. Staff spoken to were aware of the policy and were confident about their responsibilities within it. We made a referral to Adult Services under safeguarding, with reference to the resident who tried to get into the inspectors car. A senior practitioner from West Sussex Adult Services investigated this and found that the risk assessment for this person had been rewritten and was now up to date, with suitable safeguards in place. The matter was unsubstantiated and is now satisfactorily concluded. Care Homes for Older People Page 16 of 26 Evidence: No safeguarding issues are on going in the home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a clean and homely environment, which is well maintained. Evidence: The outside of the home is maintained to a high standard. Inside the home is decorated and furnished to a very high standard and is kept clean and hygienic. In their AQAA they say the home is in an unrivalled location with excellent views across the gardens and sea. There was evidence of continued improvement and investment into the maintenance of the home. Residents told us their rooms are cleaned regularly and staff were seen to be wearing suitable gloves and aprons on the day. Residents are encouraged to personalise their rooms with their own belongings. Memory boards were seen for those assessed as needing them. Suitable laundry facilities are available and allow residents involvement if they wish. The AQAA tells us that the grounds are kept to a high standard throughout the year by a gardener and all rooms are refurbished to a high standard and carpets and flooring are replaced as required between occupants. They tell us there is an going maintenance programme to ensure continuous update and improvement. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for recruiting and training staff have improved, however these improvements must be maintained to ensure that people are protected and receive the care they need in a consistent manner. Evidence: At the last inspection we made a requirement for the home to ensure staff are suitably trained. This included dementia and safeguarding training. Records showed this has been met and staff spoken confirmed they had attended these courses. They spoke highly of the dementia care training in particular. Staff have also undertaken a 16 medication course. In their AQAA the home tells us that staffing levels are always adjusted according to the levels of care required. Residents confirmed that there were usually enough staff to meet their needs and call bells are responded to quickly. The number of permanent care staff with National Vocational Qualification level 2 is now over 50 . The recruitment procedure ensures that Protection Of Vulnerable Adult first checks and Criminal Record Bureau Checks are in place and where possible a minimum of three references are obtained. Staff say they are well supported and two of the three had recently had a supervision Care Homes for Older People Page 19 of 26 Evidence: session with a manager. They said there were regulate staff meetings. All said the management are open, helpful and supportive. Evidence of appraisals starting to take place was seen. Staff said its a good place to work and they enjoyed their jobs. The induction programme for staff looked at and found to be quite basic. The home have not introduced the Skills for Care standard induction programme. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home would benefit from more proactive and effective management by a person who is registered with us. Evidence: At the last inspection we highlighted shortfalls in the service with regard to care planning, risk assessment and staff training. Some improvements were noted in all these areas, however, deficits were found in the assessment process and updating of care plans and risk assessments during this inspection. We also found unsafe practices regarding the storage and dispensing of medication. The current manager has completed the Registered Managers Award and was registered with us on August 6 2009. The homes AQAA tells us that they include a customer feedback form to temporary residents and they have regular quarterly residents meetings where individuals can air their views. Residents confirmed this. Minutes of these meetings and any actions Care Homes for Older People Page 21 of 26 Evidence: agreed are displayed on the notice board. They also tell us that in the next twelve months they plan to introduce an effective quality assurance system and carry out a full customer survey and draw up a business plan to ensure needs are met. The home tells us they carry out all the necessary safety checks, including for fire. We looked at records relating to water temperatures and found that the home has annual water checks carried out by a plumber who also randomly tests the water in one bedroom each month. Daily bath water temperature records are kept. No other safety records were checked on this occasion. No monies are held on behalf of residents. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 14 Pre-admission assessments must be reviewed, amended accordingly and acted upon to ensure peoples needs can be fully met. This includes people staying at the home for short stay respite. To protect people from harm or injury and ensure their needs are fully met. 29/07/2009 2 7 15 Care plans must be kept up to date when a persons needs change. This includes all risks to service users, such as going out on their own. To protect people from harm. 05/09/2009 3 9 13 In the interests of safe 05/09/2009 medication handling all medication must be administered directly from the original labeled container to the service user and not placed into any Page 24 of 26 Care Homes for Older People secondary container for later administration. To protect residents from errors of administering. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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