This inspection visit took place on 12 December 2017. At the last inspection in October 2016 the service was rated as Requires Improvement. At this inspection, we found the provider had made some improvements to the service and others were planned or in progress.

Royal Manor Nursing Home is a care home which provides residential and nursing care to older people including people recovering from physical and mental health issues and some who are living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Royal Manor Nursing Home is registered to provide care for up to 31 people. At the time of our inspection there were 24 people using the service.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

Potential risks people were exposed to had been identified and assessed. Risk assessments provided information and guidance to support staff to carry out their role. However, information in some records was contradictory and could be confusing for staff. Staff were knowledgeable about the needs of people whose behaviours could challenge. Records required further development to ensure staff were provided with clear guidance on interventions and responses to keep people safe.

Staff were able to describe the signs and symptoms of abuse and felt confident to report them. The provider's safeguarding policy required reviewing to provide people and staff with contact details for external agencies to support them to raise concerns outside of the service.

Effective recruitment processes were followed and there were enough staff to meet people's needs. People received their medicines safely and as prescribed.

Systems were in place to ensure the premises were kept clean and hygienic so that people were protected by the prevention and control of infection. We found two items of furniture that presented a risk to the control of infection.

There were arrangements in place for staff to monitor and take action when people experienced accidents or incidents. Further work was required to collect this information and use it to identify trends and patterns in accidents and incidents within the service to improve safety.

People's needs and choices were assessed and their provided in line with their wishes, preference and desired outcomes. People were supported to be involved and make decisions and choices about their care. We made a recommendation about care plans.

Staff were provided with regular opportunities to keep their knowledge and skills up to date. This included essential training and on-going development training. This supported staff to provide effective care based on current best practice.

People were supported to have sufficient to eat and drink in line with their dietary needs. People were supported by staff to use and access a wide variety of other services and health care professionals to maintain their health and well-being. Staff supported people to access health appointments when required to make sure they received continuing healthcare to meet their needs.

Staff demonstrated their understanding of the Mental Capacity Act 2005 (MCA). They gained people's consent before providing care and respected people's right to decline their care.

The provider was in the process of upgrading the décor of the premises to support people using the service.

People had developed positive relationships with staff, who were kind and caring and treated people with respect. Staff understood people's individual needs and preferred means

The inspection took place on 6 October 2016, and the visit was unannounced.

Royal Manor provides residential and nursing care to older people including people recovering from physical and mental health issues and some who are living with dementia. Royal Manor is registered to provide care for up to 25 people. At the time of our inspection there were 23 people living at the home.

Royal Manor had a registered manager in post. The registered manager was also the provider, and he was supported by a care manager at the home. 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 2008 and associated Regulations about how the service is run.

At the last inspection we asked the provider to record issues that affected people which were seen as informal complaints. Audits and checks of the service were carried out by the provider but issues forwarded through the quality assurance questionnaires had not been recorded. These audits also failed to recognise pattern with formal complaints. The absence of this analysis failed to ensure the service continuously improved.

There were appropriate arrangements for the recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines. However the accurate recording of people’s hydration, when topical creams were applied and where injuries had occurred were not recorded consistently.

Though some staff had not been provided with safeguarding training they were still aware and had an understanding of their responsibilities to protect people from harm. The registered manager understood their responsibilities to manage any safeguarding concerns raised by staff. The provider ensured all notifications required by law had been sent to us in accordance with the legislation.

Staff worked as a team, however were not deployed to provide the appropriate level of observation to keep people safe. The noise levels in the home were noticeably raised, and at times people presented with behaviour that challenged staff. Poor staff deployment did not assist staff in being able to deflect this behaviour.

People were offered meal choices however some staff did not clearly explain what meals were on offer. Staff recorded the food and fluid people ate and drank. However governance of these records did not reveal that staff did not complete them consistently.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship with them before working with people on a one to one basis.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. However they were observant of peoples dignity at all times.

Care records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Plans around behaviours were written to reinforce positive behaviour rather than concentrating on the negative. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through detailed records for each person. Risk assessments and management plans covered aspects of people’s needs and included health and daily routines.

The provider had recruitment procedures that ensured staff were of a suitable character to work with people and ensure they remained safe. Most staff had received tra

This inspection took place on 13 April 2015 and was unannounced.

Royal Manor Nursing Home is a care home that provides residential and nursing care for up to 25 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. At the time of our inspection there were 24 people in residence.

A registered manager was in post. 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 2008 and associated Regulations about how the service is run. The registered provider was also the registered manager at this service.

People’s care and support needs had been assessed and were used in the development of their plan of care. Staff had a good understanding of people’s care and support needs. People told us they were satisfied with the care provided and that this was delivered in the ways that they preferred, in order to meet their needs. However, some care plans did not reflect the care being provided. Staff understood the importance of enabling people to do as much for themselves as possible to maintain their skills and promote their independence.

People were involved in making decisions about their care and we saw that good relationships had built between people and the staff team. Staff were caring and attentive and people were treated with dignity and respect.

Staff had a good understanding of how to keep people safe. Most people told us that they felt safe and for the small number of people who told us that they did not always feel safe, the provider was taking actions to address the issues raised. Risks associated with people’s care had been assessed and we saw that care was provided in a safe way.

There were sufficient numbers of staff available to support people at the times they needed them. The provider had safe staff recruitment procedures and staff received relevant training and support so they could meet people’s needs.

Most people received their medicines as prescribed. Medicines were ordered, stored and disposed of safely. However improvements in record keeping were needed in relation to the management of people’s medicines, including ‘as required’ medicines.

People were provided with a choice of what to eat and drink and people’s individual nutritional needs were well supported. People enjoyed the food provided. Where changes in people’s health were identified, they were referred promptly to other healthcare professionals.

The provider had an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) so that people who lacked capacity to make decisions could be appropriately supported. Staff understood that they needed to gain people’s consent before delivering care.

People were supported to take part in social activities. The provider has accessed training which is planned for staff to ensure that the range of activities provided meet people’s individual interests, needs and preferences.

People told us that the provider was approachable and that they had opportunities to make suggestions and raise concerns. People told us they felt enabled to raise a complaint that they would be listened to and it would be acted on. However a system for recording other issues people may raise was not in place.

The management team were supportive to staff and worked with them to provide good standards of care. There were effective management systems to monitor and improve the quality of service provided.