This inspection took place on 10 and 14 September 2015 and was unannounced which meant the provider did not know we would be attending.
We last inspected this service in January 2015 where we found that the service was not meeting the requirements and was in breach of the regulations for: care and welfare of people, assessing and monitoring the quality of the service, management of medicines, consent to care and treatment, records and supporting staff. We took enforcement action for three of these breaches and informed the provider that they must take action to meet the regulations by June 2015. The provider also submitted action plans which set out how they intended to meet the regulations.
Royal Court Care Home is registered to provide care, accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 31 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.
We found not all of the actions in the provider’s action plan had been implemented and little improvement had been made to remedy the breaches identified at our last inspection.
The provider was still not meeting the requirements of the regulation to ensure medicines were managed in a safe way. We saw that medicines were not always being stored and administered safely. Medicines were not managed and handled in accordance with recognised guidelines and the service’s own policy.
Staff shortages at the service were not always covered and we observed that staff were rushed at times. Recruitment procedures were not sufficiently robust. Staff were still not provided with regular supervisions and appropriate training to ensure they were suitable and supported in their roles.
The provider did not ensure that people consented to their care and treatment in line with relevant legislation such as Mental Capacity Act 2005. It could not be demonstrated that decisions were always made in people’s best interests. The registered manager had made, and was in the process of making, Deprivation of Liberty Safeguard applications to prevent people being subject to unlawful restrictions.
Risk assessments were not always in place for people where required, and we found systems for safeguarding people from abuse were not effective. Care records were reviewed at regular intervals however some updates did not reflect people’s current needs.
Care records weren’t holistic as little information was captured about people outside of their care needs, such as their backgrounds and social past times. People told us they would prefer more activities which contradicted with staff comments that people weren’t interested in doing anything. Care was not being provided in a person centred way.
Comments about meals were mixed and we saw little choice being given to people. Although we saw staff assisted some people to eat, some people were not supported with appropriate prompting and encouragement.
We saw that people had access to external health professionals and this was evidenced in people’s care records.
People spoke positively about the staff and how staff cared for them. However, observations showed an inconsistent approach from staff . Some approaches were kind and caring yet some were the opposite and staff spoke to people in commands. We saw instances where people’s privacy and dignity was not respected.
No audits had been undertaken in order to monitor the quality or effectiveness of the service. Incidents at the service had been reviewed by the registered manager but not at a level that would identify trends and patterns. Staff told us they felt supported by the registered manager however team meetings were infrequent.
Observations showed that some aspects of the home were in need of attention, repair and cleaning. The provider told us they had no plan of redecoration and refurbishment for the home.
Residents and relatives meetings did not take place but the registered manager was trying to arrange these. No complaints had been made about the home at the time of our inspection.
We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms 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 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.