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Archived: Royal Court Good

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Reports


Inspection carried out on 30 July 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 8 and 9 January 2015 at which a breach of legal requirements was found. This was because the registered person did not have suitable arrangements in place in order to ensure staff were appropriately supported in relation to their responsibilities, by receiving appropriate supervision and appraisal. After this inspection we also received concerns in relation to how the provider dealt with complaints. We looked into these concerns as part of this inspection. This report only covers our findings in relation to these topics.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 30 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Royal Court’ on our website at www.cqc.org.uk.

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.

At our focused inspection on 30 July 2015 we found the provider had followed their action plan which they said would be completed by 31 May 2015 and legal requirements had been met. Staff were having one to one meetings and annual appraisals to discuss their performance and training needs. People’s complaints and those made on their behalf were listened to and investigated. A response was made to complainants to inform them about any action taken.

Inspection carried out on 7 January 2015

During an inspection to make sure that the improvements required had been made

This was an unannounced inspection which took place over two days on the 7 and 8 January 2015.

Royal Court provides care for 48 people in self-contained flats which have a bedroom, lounge, kitchenette and en suite facilities. Accommodation can be provided for people who wish to live together. People have access to shared dining rooms on each floor and to a shared lounge and dining room on the ground floor. Bathrooms are provided as well as a hair dressing salon. The grounds around the home are well presented and accessible to all people. At the time of our inspection nine flats were vacant. There were four people living in the home who had been diagnosed as living with dementia.

At the inspection on 8 April 2014 we asked the provider to take action to make improvements to make sure people’s care records were kept up to date and to make sure medicines records were kept accurately. The provider sent us an action plan to tell us how they would address these issues and said they would put all changes in place by December 2014. This action has been completed.

Royal Court has not had a registered manager since October 2014. 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 and associated Regulations about how the service is run. A new manager was appointed in July 2014 and was in the process of submitting applications to the Care Quality Commission to be registered with us.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Staff were not receiving one to one meetings or annual appraisals to discuss their performance or their training needs. The professional development of staff was not being supported through regular systems of appraisal. Staff did not have formal means of discussing or reflecting on the care and support they provided to people to make sure people’s needs were being met. You can see what action we told the provider to take at the back of the full version of the report.

Staff had access to training to equip them with the skills and knowledge they needed to meet people’s needs. A person told us, “ They’re (staff) being trained a lot more. The present manager seems to be an inspiration to them (staff).” A restructuring of teams had proven successful with staff and people who said they were happier with the new arrangements.

People were protected from possible harm by staff who recognised the signs of abuse and knew what action to take. Risks were managed whilst promoting people’s independence. Hazards were reduced to keep people safe from potential harm. Accidents and incidents were monitored and changes made to people’s care to prevent them happening again. Medicines were managed satisfactorily and people had their medicines when they wanted them.

People’s care was personalised and reflected their wishes, aspirations and the way they wanted to be supported. People had access to activities they liked and were supported to be as independent as possible. An assessment had been carried out in line with the Mental Capacity Act 2008 where people were unable to consent to their care and support. Some people had a lasting power of attorney who could make decisions on their behalf.

People were supported to stay well and to eat a healthy diet. People were referred to health care professionals when they were unwell or there were changes in their wellbeing. People’s dietary needs were considered and adjustments made to the menu to make sure they were catered for. People were treated with dignity and respect. Staff understood their individual needs and preferences and showed concern for their health and wellbeing. People’s views were sought and they were involved in making decisions about their care and support.

Quality assurance systems took into account feedback from people, their relatives and staff. Audits were completed and where actions were identified these were completed to improve the standard of service provided. One person said, “These people (the provider) are making differences, these people are keen. The standards are getting better – the staff we’ve got appear to be much more happy and if the staff are happy, the residents are happy.”

Inspection carried out on 23 September 2014

During an inspection in response to concerns

The inspection team who carried out this inspection consisted of one adult social care inspector. The focus of the inspection was to answer one of the five key questions; is the service safe?

As part of this inspection we spoke with six people who use the service, the manager, and five staff. We also observed how people were being cared for. We reviewed records relating to the management of the service which included maintenance records and staff records. Concerns had been raised with us about the safety and wellbeing of people living in the home due to water damage to an area of the home and a shortage of staff.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register. At the time of our inspection the provider did not have a registered manager in post. A new manager had been appointed and had started the process to become registered with the Care Quality Commission.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because hazards had been minimised and procedures were in place to keep people safe. Risks to the premises had been assessed and repairs had been carried out to ensure the home was maintained and provided a safe environment. There were sufficient levels of staff supporting people with the appropriate skills, knowledge and qualifications to meet their individual needs. The working structure had been reviewed and teams had been allocated to each unit of the home. This ensured teams of staff had the appropriate skills and knowledge to support people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. The manager was aware of recent developments (March 2014) in the case law around DoLS and that additional DoLS authorisations may need to be submitted as a result.

Inspection carried out on 8, 9 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

The inspection was completed by one inspector. We spoke with seven people who lived in the home, two visitors and eight members of staff. This is a summary of what we found.

Is the service safe?

Care records and risk assessments identified where people were at risk of falls. Equipment and specialist adaptations were provided where needed. Where people were having an increasing number of falls the appropriate action was taken. Other health professionals were contacted for advice to keep people safe.

There were no restrictions in place. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager was aware of how to apply for an urgent authorisation under the Deprivation of Liberty Safeguards. Strategies were in place to keep people safe such as providing them with personal alarms.

The management of medicines had been reviewed to make sure people received their medicines safely. Staff competency was assessed before they took responsibility for administering medicines.

Staffing levels were being reviewed to make sure they reflected the needs of people who lived in the home. The provider was monitoring the numbers and skill mix of staff providing care and support to make sure people remained safe.

Is the service effective?

Visitors were able to see their relatives in privacy. There were also facilities for visitors to remain at the home overnight. Visiting times were flexible.

People�s health and care needs were assessed with them or their relatives. Staff were aware of any changes in people's needs and ensured these were communicated to the team. However care records were not always being reviewed at the appropriate intervals. Care records for one person had not been updated to reflect changes in their needs. Some handwritten entries were illegible. Records for the administration of controlled drugs could be improved to reduce the risk of recording errors. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Where people needed adaptations or equipment to enable them to move independently around the home these were provided. Staff had received training and had a good understanding of people�s needs. A visitor told us, �staff do everything they can�. Another person said, �I have got the freedom to be independent�.

Is the service caring?

Feedback from people included, "staff helpful, cheerful and calm", "staff friendly and caring" and "well looked after". Visitors told us "staff are tremendous, no complaints". We observed staff supporting people professionally and sensitively. They treated people politely and with shared humour.

People�s preferences, interests, wishes and diverse needs were noted in their care records. Staff spoken with had a good understanding of how people wished to be supported and provided care in accordance with their wishes.

Is the service responsive?

People wishing to move into the home were assessed to make sure their needs could be met. When needed other social and health care professionals were involved to ensure the appropriate care and support was being provided. Specialist adaptations and equipment were provided where people�s needs had changed.

People told us they had seen improvements in the service in response to issues they had raised. There were now more activities throughout the week. They were looking forward to changes to the environment which would provide more shared areas and greater security.

Concerns about the supply of medicines had been looked into and the home was considering how improvements to this service could be implemented.

Is the service well led?

The provider listened to people and responded to their concerns. As part of the quality assurance process people had said, �could do with more staff" and "staffing levels well short�. The provider had reviewed their staffing levels. These had been increased. The provider was continuing to review and adapt the way in which staff worked to make sure people�s needs were met.

A quality assurance system was in place which included gaining the views of people who lived in the home and their representatives. People said they had been listened to and changes were being made to the service they received as a result. One person told us �there are more activities now�. Another person said the dining area was being increased so more people could eat downstairs if they wished instead of the smaller dining areas around the home.