Royal Court Care Home

We found the following examples of good practice.

Clear and easily understandable signs were positioned at the main entrance and on internal entrance doors. These provided a step-by-step process for visiting requirements. There was a well-stocked PPE station, with guidance for putting on and taking off PPE, a thermometer and temperature check sheet, lateral flow tests, and a vaccination check for visiting professionals. Family members were advised they would be unable to have physical contact with people unless full PPE was worn. People were supported, if required, to have alternative visiting arrangements, for example, telephone and face-time video calls and window visits. The registered manager regularly contacted families to explain any changes to government guidance.

The home is spacious and purpose-built with three lounges and easily identifiable 'zones' to support social distancing and self-isolation, when required. Good procedures were in place and staff were aware of these about how to support someone who was self-isolating.

Admissions and re-admissions to the home were well-managed.

Staff were following appropriate donning and doffing procedures and correctly disposing of PPE.

Regular testing takes place as specified in current guidance.

The home looked clean and hygienic and was odour-free. Detailed cleaning schedules were in place. These were regularly checked. Appropriate cleaning products were in use. Additional touch surface cleaning took place. The home was kept well-ventilated.

The registered manager was well-supported by the provider who undertook frequent visits. The home has not experienced any staffing issues. Recruitment procedures had been updated to include mandatory checking of vaccination status. The registered manager has sought guidance and assurance from IPC professionals. Regular audits around IPC practices were undertaken.

Royal Court is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 40 people in one building. At the time of this inspection there were ten people living at Royal Court.

People’s experience of using this service and what we found

The service had significantly improved since the previous inspection. People and staff recognised the service had improved. One staff member said, “Everything is so much more relaxed and happier, everyone is happier, staff, people we support, completely different atmosphere.” The provider had recruited a new manager. People who lived at the service had met the new manager and had an opportunity to ask them questions.

The management team conducted audits and checks to further ensure the quality and safety of services provided to people. The operation of the quality assurance processes had significantly improved and actions arising from audits were being recorded and progressed. The premises were clean and there was good infection control practice in place. There was a friendly atmosphere at Royal Court, and we saw people looked well cared for.

People received safe and caring support at the service. Staff knew people and their needs well, and we saw caring interventions and conversations throughout our inspection. People received their medicines when they needed them, and there were systems in place to ensure people were protected against the risk of abuse. Risks were identified but staff did not always follow the measures to mitigate the risk. This could put people at increased risk of avoidable harm.

We have recommended that the provider refer to current clinical guidelines and best practice to ensure systems, processes and accurate records are in place.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training, which was relevant to their role and people's needs. Staff were supported by the management team and were receiving formal supervisions where they could discuss their on-going development needs.

People’s needs were assessed. Care was planned and delivered in a person-centred way, in line with legislation and guidance. People were supported to eat a healthy balanced diet. A range of meaningful activities were on offer to keep people occupied, according to their individual interests. Complaints and concerns were well managed, and the manager took prompt action to address any issues we raised during the inspection.

People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Although significant improvements had been made since the last inspection, further time was required to ensure that new systems were fully embedded, and consistency of improved practice was evidenced.

Rating at last inspection and update

The last rating for this service was inadequate and there were multiple breaches of regulation (published 07 December 2020). The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.

We undertook targeted inspections (published 05 December 2020) and (published March 2021) to check what improvements had been made. We found the service continued to be in breach of regulations but were not able to provide a rating. This is because we only looked at the parts of the key question, we had specific concerns about.

This service has been in Special Measures since December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Court Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Royal Court is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 40 people in one building. At the time of this inspection there were nine people living at Royal Court.

People’s experience of using this service and what we found

Since we last inspected the service the manager had left. Temporary management arrangements had been put in place by the provider to help maintain the running of the service, as well as address areas of concern. The service was temporarily being run by a regional manager and an interim manager, who were experienced and skilled at supporting services to improve.

Following the last inspection, improvements had been made to the governance and quality assurance systems. Internal audits had been completed and action plans had been developed to support the home to make necessary improvements. The provider had also acted on feedback from external healthcare professionals. However, the provider’s governance and quality assurance systems need to be embedded to evidence their effectiveness as well as demonstrate clear oversight and scrutiny of the service, so continuous improvements are made and sustained.

The design and layout of the premises did not meet the needs of people living with dementia. The provider had started a programme of refurbishment to improve the premises, but aspects of the environment still did not support safe infection control measures at the time of this inspection. Further work was required to make the premises fit for purpose in line with statutory requirements and to reflect national best practice guidance for people who are living with dementia.

The infection prevention and control (IPC) systems had improved since our last inspection. Prominent and clear IPC signs reminded everyone at the point of entry and throughout the home about procedures for infection control. The home was accessing regular COVID-19 testing, which had assisted them to identify an outbreak of COVID-19. Risks in relation to visitors had been assessed and action taken to minimise risks. Staff were seen wearing PPE correctly and management carried out checks to ensure this was maintained. However, we found the systems used by the provider to monitor IPC practices needed to be further embedded and sustained over time, to ensure the IPC system remained safe.

We received positive feedback about the service from relatives who said care met individual needs and they said they felt involved in decision making regarding their relative’s care. Staff demonstrated a strong sense of personal responsibility regarding the future of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 5 December 2020) and there were three breaches of regulation.

Why we inspected

We undertook this inspection for two reasons. Firstly, this inspection was part of CQC’s response to care homes with outbreaks of coronavirus. When a care home experiences a widespread outbreak of coronavirus, CQC conducts a review to ensure the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. Secondly, on 8 December 2020 there was a change in ownership of Healthmade Limited who are the registered provider of Royal Court Care Home. The new directors of Healthmade Limited had completed an action plan to show what they would do and by when to improve the service. A decision was made to inspect the service to check whether improvements were being made to the service.

This inspection was a targeted inspection. CQC have introduced targeted inspections to follow up on breaches of regulation or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. Therefore, the overall rating for the service has not changed following this targeted inspection. The service remains rated inadequate overall.

At this inspection we found some improvements had been made to the service’s IPC system and the provider’s governance systems, however further improvements were still needed.

You can read the report from our last comprehensive inspection and our last focussed inspection, by selecting the ‘all reports’ link for Royal Court Care Home on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.' This means we will keep the service under review, and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we next inspect it and it is no longer rated as inadequate in any of the five key questions, it will no longer be in special measures.

Royal Court is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 40 people in one adapted building. At the time of this inspection there were 16 people living at Royal Court.

People’s experience of using this service and what we found

Few improvements had been made since the last inspection. There continued to be many shortfalls in the service provided to people. There was lack of effective management and oversight of the service. There was no system to check the quality of the home and to drive improvements.

The design and layout of the premises did not meet the needs of people living with dementia. The décor of the premises continued to be tired and in need of a refresh. The provider told us they had a refurbishment plan in place.

People and relatives were happy with the care provided. One relative said, “Staff are lovely, marvellous and very caring. They are lovely with the residents." Staff were committed to the home and said they felt part of a team who could rely on one another.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 19 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had not made enough improvement and they were still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the premises and equipment, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. In addition, we also followed up on concerns we had received since the last inspection in relation to the care of people living at the home and staffing.

This report only covers our findings in relation to the key questions ‘is the service safe?’, ‘is the service effective?’ and ‘is the service well-led?’ which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this inspection were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the key question ‘is the service safe?’ 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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of the is full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the suitability of the premises, safe care and treatment and the governance system.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Royal Court is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 40 people in one adapted building. At the time of this inspection there were 16 people living at Royal Court.

People’s experience of using this service and what we found

There were not enough staff deployed to meet people’s care and support needs in timely way. Following this inspection, the provider told us they planned to recruit additional staff. The design and layout of the premises did not meet the needs of people living with dementia. The décor of the premises was tired and in need of a refresh. The provider told us they had a refurbishment plan in place and we could see work had started on this. People continued to tell us they wanted more things to do. The registered manager had started to introduce more activities for people to engage with.

There were some systems in place to monitor and improve the quality of the service provided, however they were not always effective. Medicines were not always stored within the recommended safe temperature ranges.

People told us they felt save living at Royal Court. Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the registered manager and director. Safe procedures were in place to make sure people received their medicines as prescribed.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs. Staff understood the requirements of the Mental Capacity Act 2005. 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 told us they enjoyed the food served at Royal Court, which we saw took into account their dietary needs and preferences. People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to best meet their needs.

Positive and supportive relationships had been developed between people and staff. People were treated with dignity and respect. Staff were committed to promoting people’s independence.

There was an up to date complaints policy and procedure readily available to people. People, their relatives and staff told us the registered manager and director were approachable and responsive to any issues raised. People’s care records reflected the person’s current health and social care needs.

People were asked for their opinion of the quality of the service via satisfaction surveys. Regular team meetings were to be introduced for staff. The service had up to date policies and procedures which reflected current legislation and good practice guidance. The latest versions were to be shared with staff. Safety and maintenance checks for the premises and equipment were in place and up to date.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27July 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had not made enough improvements and they were still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing levels, the suitability of the premises for people living with dementia and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Royal Court Care Home is a ‘care home’. 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 Court Care Home is registered to provide accommodation for persons who require personal care without nursing. The service can accommodate a maximum of 40 people. At the time of the inspection there were 23 people living at the home.

Our last inspection at Royal Court Care Home took place on 11 and 12 January 2017. The service was rated Requires Improvement overall. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People spoken with were very positive about their experience of living at Royal Court Care Home. They told us they were happy, felt safe and were respected.

Sufficient numbers of staff were provided to keep people safe. However, people spoken with said they want more staff on duty and there were periods when they had to wait for support. We made a recommendation for the registered provider to consider people’s views when making decisions about the staffing arrangements at the service.

Everyone we spoke with was complimentary about the food. We carried out observations during lunchtime and saw that there was a relaxed atmosphere. We found the overall meal experience had improved since the previous inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice. We saw the registered provider had no record keeping system in place to show when they had obtained people’s or their representative’s consent for care and treatment. This meant we were not able to verify proper consent had been obtained during the admission process.

We found the programme of activities provided was not effective at meeting people’s needs. People and their relatives gave mixed feedback about the quality of activities provided. This was a breach of regulation and improvements in this area are needed.

We identified improvements were needed to the design, adaptation and decoration of the service to make it more stimulating for people living with dementia.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role. Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

People’s care records contained detailed information and reflected the care and support being given. The care records checked showed people were provided with support from a range of health professionals to maintain their health.

There were some systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Royal Court Care Home is registered to provide accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 24 people living there at the time of our inspection.

There was a registered manager employed at the service. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements had been made. The home is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People told us they liked living at Royal Court and felt safe there. Relatives said they felt their family member was safe and well cared for at Royal Court.

People living at Royal Court and their relatives told us staff were caring and their privacy and dignity were respected. We saw and heard positive interactions between people and staff throughout the inspection.

We found effective systems were in place to ensure medicines were managed, stored and administered in a safe way. However, improvements were still required in the recording of topical medicines administration, such as prescribed skin creams.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

Safe recruitment procedures were followed to ensure that all the required information and documents were in place before staff commenced employment.

There were enough staff employed to meet the needs of people living at Royal Court.

Staff were not provided with regular supervisions and a yearly appraisal to ensure they were suitable for their job and supported in their role.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted.

People told us they enjoyed the food served at Royal Court, which we saw took into account their dietary needs and preferences. This meant their health was promoted and their choices were respected. Small changes in the furnishings of the dining area and presentation of food would improve the dining experience for people.

People had access to a range of health care professionals to help maintain their health and wellbeing.

Care records contained up to date risk assessments and these were reviewed regularly, however there was no evidence people and/or their relatives were involved in these reviews to ensure information was person centred and up to date

Some activities were provided for people during the week, but this required improvement to ensure all people had the opportunity to take part in hobbies and interests they enjoyed. The service had a mini bus but this was not currently being used. People told us they would like to go on trips out.

People living at Royal Court and staff working there, told us the registered manager was approachable and responsive to any concerns they had.

There was evidence of regular quality audits being introduced to ensure safe practice and identify any improvements required. However, these required further development to ensure all areas of practice were covered and actions taken were recorded.

People who lived at Royal Court, staff and visitors were not asked for their views about the service. The registered manager told us a questionnaire was about to be sent out. We saw a copy of this.

During our inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to person-centred care, staffing, and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Royal Court Care Home is registered to provide accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 28 people living there at the time of our inspection.

There was a registered manager employed at the service. 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 previous inspection on 9 and 14 September 2015 the service was rated inadequate and placed into special measures by CQC. This inspection found that there were not enough improvements to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Care staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management. However, there were no systems in place to monitor any allegations of abuse and any action taken.

Not all medicines were stored safely. There were no systems in place to regularly audit whether medicines were being administered correctly.

We saw that safe recruitment procedures were not always followed to ensure that all the required information and documents were in place before staff commenced employment. These procedures were required to verify people employed by the service were suitable to work with vulnerable adults.

Not all staff were provided with regular supervisions and appropriate training to ensure they were suitable for their job and supported in their role.

There were not enough staff to meet the needs of people living at Royal Court. We saw staff were rushed. People told us they needed more staff and more things to do.

The registered manager did not always ensure people consented to their care and treatment in line with relevant legislation such as Mental Capacity Act 2005. It could not be evidenced decisions were always made in people’s best interests.

The registered manager had applied to the Local Authority for Deprivation of Liberty Safeguards (DoLS) to be authorised for some people living at Royal Court.

Care records were not always regularly reviewed. There was no evidence people’s views and aspirations were taken into account when care records were reviewed.

We saw people had access to external health professionals and this was evidenced in people’s care records.

People living at Royal Court told us staff were caring. Staff we spoke with understood what it meant to treat people with dignity and respect and we saw they did this.

People living at Royal Court and staff working there, told us the registered manager was approachable and responsive to any concerns they had.

There was no evidence of regular quality audits being undertaken to ensure safe practice and identify any improvements required.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

All of the people using the service and their relatives that we spoke with were positive about the home. A comment from a person using the service included, 'The staff are very caring. I've been well cared for.'

People using the service and their relatives told us that they were treated with respect and their dignity was maintained.

People using the service told us that care and treatment was planned and delivered in a way that ensured people's safety and welfare. A comment from a person using the service included, "They look at the needs of the individual and involve people as much as they can.'

All the people and relatives we spoke with said they had no concerns regarding safety in the home.

We found that not all staff were up to date with appropriate training, or had received appropriate supervision and appraisal. This meant staff had not been provided with opportunities to develop and improve their skills to ensure they remained competent in their role.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.