Background to this inspection
Updated
13 January 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
RSG High Wycombe is a ‘care home’ with nursing. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return (PIR) prior to this inspection. However, they provided us with us a document that mimicked the PIR. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We looked at notifications received from the provider. A notification is information about important events which the provider is required to tell us about by law. This ensured we were addressing any areas of concern. We used all this information to plan our inspection.
During the inspection
We spoke with 16 people who used the service and 4 relatives. Some people living in the home could not verbally give us feedback. As such we looked around the home and observed the way staff interacted with people. We further received feedback from 8 relatives. We also received feedback from 2 healthcare professionals. We looked at 7 people's care records and 6 medicine administration records (MAR). We spoke with 14 members of staff including the registered manager, the quality assurance manager, dementia manager, nursing manager, operations manager, learning and development manager, clinical lead, nurses, carers, the chef, domestic staff, maintenance person and activities coordinator. We reviewed a range of records relating to people's care and the way the service was managed. These included staff training records, 5 staff recruitment files, quality assurance audits, incidents and accidents reports, complaints records, and records relating to the management of the service.
Updated
13 January 2023
About the service
Royal Star & Garter (RSG) High Wycombe is a purpose-built residential care home providing personal and nursing care to up to 74 people. The home was divided into 6 separate units, each of which has separate adapted facilities spread across three floors. The units were named after significant local military personnel. Three of the units were for people living with dementia. The service provided support to veterans and their partners. It is part of The Royal Star and Garter Homes which was established in 1916 to provide care to military veterans. At the time of our inspection there were 56 people using the service.
People’s experience of using this service and what we found
People received excellent care from consistent knowledgeable staff that exceeded their expectations. The service embraced technology to promote effective risk management as well as people's freedom. The provider had an excellent overview of risk and safety to inform action and business plans.
The service had exceptional staffing levels that met people's needs and kept them safe. There was a significantly high ratio of staff and very low turnover, which helped ensure staff had an excellent understanding of people's needs and personalities. The service had an inclusive approach to promoting the safety of its staff and was seen as a good place to work by staff and external organisations.
The staff excelled in caring for people living with dementia. The service had achieved an accreditation as a ‘Butterfly Care Home’. By fully embracing the Butterfly approach staff created a nurturing environment where people’s feelings mattered most. This culture was well embedded in the day to day care delivery and ensured people had support that recognised their personalities and individuality beyond their diagnosed conditions. People enjoyed a range of activities and staff took every opportunity to engage people in the activities of daily living. There was a collaborative approach to activities which meant all staff were involved in ensuring people participated in activities of their choice.
The provider ensured their practices were in line with the current good practice, guidance and legislation. There was a focus on continuous development, for example, the environment had been developed and was being improved in line with standards set out in research around environments that improved the impact on people living with dementia. People and relatives felt lucky to have secured a place at the home and without exception told us they would recommend the home.
There was a warm, welcoming atmosphere that was promoted by caring, compassionate staff. People enjoyed worthwhile relationships with staff, who valued and respected them. There was a strong commitment to providing personalised care that appreciated people for who they were and recognised the value of their life experiences. Relatives were considered partners in care and their involvement was key to providing person centred care. Professionals were extremely impressed by the positive outcomes people had achieved through the support and encouragement provided at the service.
The provider's vision and values put people at the heart of the service. These were centred around provision of a high-quality service to people whilst allowing people to live their lives the way they chose. People benefitted from exceptional care delivered by a dedicated staff team who were committed to the vision and values of the service. Staff excelled in managing people’s complex needs, including distressed behaviours by using effective distraction techniques that had a positive impact on people’s well-being. We saw many examples where staff successfully contributed to people’s quality of life.
There was strong emphasis on staff development and the provider had invested in specific and bespoke training based on people’s needs. Staff had completed high quality training that ensured they were confident and competent at delivering person centred care. Staff were encouraged and supported to develop their skills and follow a streamlined career progression path within the service.
Arrangements for social activities highly met people's individual needs and followed best practice guidance so people could live as full a life as possible. The service had gone the extra mile to find out what people had done in the past and evaluated whether it could accommodate activities and made them happen. The service had maintained close working relationships with healthcare professionals and provided commendable end of life care. The service had achieved an accreditation in gold standards framework for outstanding and innovation in providing person-centred end of life care based on best practice. People experienced a comfortable, dignified and pain-free death. People received exceptional personalised care and support specific to their needs, preferences and routines. Visiting professionals told us the service was focused on providing person-centred care and support and achieved exceptional results.
The registered manager provided exceptional leadership and had developed a dedicated staff team who were committed to the vision and values of the service. Staff were motivated by, and proud of the service. They loved being part of dedicated team and vowed to provide excellent care. The registered manager was fully dedicated to providing high quality care that achieved the best possible outcomes for people. Without exception, feedback about the registered manager and the management team was exceedingly positive in relation to her exceptional leadership skills and her caring, empathetic approach to everyone. The registered manager and provider constantly looked for ways to improve the service and had effective systems in place to monitor the quality of the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported to maintain good health and to meet their nutritional needs.
Rating at last inspection and update
This service was registered with us on 10 April 2019 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk