Royal Court

Updated 27 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 7 and 8 August 2018 and was unannounced. It was carried out by one inspector 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. In this case they had cared for older people.

Prior to visiting the home, we reviewed the information we held about the service. This included notifications of events, which have an impact on people and which the provider must legally inform us about. The last Provider Information Return (PIR) was submitted, to us, by the provider in June 2017. This is information we require providers to send us at least once annually. We did not request another PIR prior to this inspection. We took this into consideration during the inspection.

During the inspection we spoke with twenty people about their experiences. We gathered the views of four relatives and of two visiting professionals.

We spoke with the registered manager, and deputy manager. We also spoke with the provider’s director of care, quality assurance manager, training manager and estates and maintenance manager. We spoke with six members of the care team, two members of the housekeeping team, one kitchen assistant, an activities co-ordinator, a member of the administrative staff and an agency member of staff (care).

We reviewed two people’s care files and other related care records for five other people. We reviewed documents relating to three people’s authorised Deprivation of Liberty Safeguards (DoLS) and people’s mental capacity assessments. We reviewed a selection of audits including the service’s compliance improvement plan. We reviewed all records pertaining to 13 complaints received since the last inspection as well as many compliments received. We reviewed three staff recruitment files. We reviewed the home’s maintenance records.

Updated 27 September 2018

This inspection took place on 7 and 8 August 2018 and was unannounced.

Following our last inspection on 29 and 30 August 2017 the service was rated ‘Requires Improvement’ and we found breaches of the legal requirements. The Care Quality Commission (CQC) had not been notified of all incidents which the provider must legally notify us of. Additionally, not all reasonably practical action had been taken to assess, manage and mitigate risks to people. Records relating to people’s care, risk management and complaints had not been sufficiently or accurately maintained. The provider’s quality monitoring systems had not identified these shortfalls to the legal requirements and had not led to action being taken to meet these.

Following our last inspection, we met with the provider to ask them to complete an action plan to show us what they would do to meet legal requirements and to let us know by when. We also asked them to show us how they would improve the key questions ‘Is the service safe, effective, responsive and well-led’ to at least good. During this inspection we found legal requirements had been met and improvements had been made to the key questions ‘Is the service safe, effective, responsive and well-led’. The service was rated ‘Good’ across all five key questions.

Royal Court 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 can accommodate 48 people in one adapted building, at the time of this inspection 37 people lived there. The home could also provide care to people who live with dementia and who are at the end of their life. Additional communal areas included lounges, a dining room and conservatory and adapted bathrooms and toilets. All outside areas had wheelchair access.

There was a registered manager 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.

People’s risks were identified and managed in order to keep people safe. People told us they felt safe. People were protected from poor practice, potential abuse and discrimination because staff knew how to recognise concerns and report these. There were enough suitable staff deployed to meet people’s needs. Staff were recruited safely and were provided with training and support to be able to meet people’s needs safely and lawfully. People were given appropriate support to take their medicines. People lived in a clean home where arrangements were in place to protect them from infection.

People were supported to maintain their physical and mental health needs. They had access to various professionals who helped them to do this. The staff adhered to the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards. This provided protection to people who lacked the ability to make independent decisions about where they lived and about their care and treatment. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff were caring, patient and thoughtful. People told us they felt cared for and that their needs were met by staff who knew them well. Staff ensured people’s dignity and privacy was maintained and they treated people in a respectful way. Relatives and people’s visitors were made to feel welcome and, where appropriate, were very much involved in people’s care and in maintaining their quality of life. People were supported to maintain relationships which mattered to them. People’s diverse preferences and needs were known to staff who respected and met these.

People’s care plans and other care records contained accurate and relevant information about their care needs so staff could be responsive to these. People were involved in planning and reviewing their care. They were provided with support and advocacy where needed. Activities and social events were organised to meet people’s differing preferences and abilities. Complaints were taken seriously, investigated and addressed where at all possible. People’s end of life care was delivered in such a way so as to achieve a dignified and comfortable death which respected their individual wishes.

The registered manager and other senior staff provided strong leadership which the staff respected. Staff had worked and continued to work as one team to improve the care and services provided to people. Robust and effective quality monitoring processes were in place to ensure the home remained compliant with all necessary regulations. These systems along with strong management had resulted in significant improvements to the service. The management team were proactive, looking for ways to continually improve services for people.