Archived: Royal Court Care Home

Royal Court Care Home is a residential care home providing personal care for up to 20 older people, some of whom may be living with dementia. At the time of this inspection, 16 people lived at the service.

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

People were happy and well supported. The home provided a safe place for people to live and enjoy their lives. Staff were kind and caring and had developed positive relationships with people. Staff treated people with respect and maintained their privacy and dignity.

Staff had a good understanding of people’s care and support needs. Staff were aware of risks to people and knew how to keep them safe. People received their medicines safely and had access to healthcare services. Most people were happy with the choice and quality of the food, and said they received plenty to eat and drink. The management team were continuing to improve the variety of meals provided.

There were mixed views about the temperature of some rooms in the home and the registered manager acted during the inspection to monitor this more closely to ensure people’s choices and needs were met. There was an ongoing refurbishment plan which included improvements to make the environment more dementia friendly.

Support was provided by a consistent team of staff who were visible around the service. Staff were recruited safely, well trained and received suitable support. People's diverse needs were assessed and respected. 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.

The registered manager promoted the visions and values of the service by embedding an open and person-centred culture. Systems were in place to continuously monitor the service and we made some suggestions to update aspects of the audit programme. People and staff told us the management team were approachable. All feedback was used to make continuous improvements to the service.

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

Rating at last inspection

The last rating for this service was good (last report published 11July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Royal Court Care Home is registered with the Care Quality Commission to provide personal care for up to 20 older people who do not require nursing care, but who may have dementia related conditions. At the time of our inspection, 15 people were living at the care home.

The service had a registered manager in place. 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. The registered manager was not present on the day of our inspection. We spoke with them after our inspection visit.

At the last inspection on 10 and 11 February 2015, we found the provider was meeting the requirements of the regulations that were inspected. However, we identified that activities for people living with dementia required improving. At this inspection in June 2017 we found activities were available that met the needs of all the people living at Royal Court Care Home. The provider kept clear records of activities offered and who participated. On the day of our inspection we observed, people reading, completing jigsaws and a relaxed and informal game of bingo, which included relative participation and lots of smiling and laughing.

At this inspection, staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. We noted when the instruction identified a variable dose could be administered, for example, one or two tablets, there were no instructions to guide staff on the amount to administer.

We have made a recommendation that the provider introduce person centred protocols to guide staff on the amount of medicine to administer when a variable dose is prescribed.

During this inspection, we noted the provider had systems that ensured people who lived at the home were safe. We found staff were knowledgeable about the support needs of people in their care. They were aware of what help people needed to manage risks and remain safe.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Records we looked at indicated staff had received safeguarding training related to the identification and prevention of abusive practices. They understood their responsibilities to report any unsafe care or abusive practices related to safeguarding of adults who could be vulnerable.

Staff received further training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with people who may be vulnerable. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff and records we looked at.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home. The deployment of staff was organised directing staff with their allocated tasks.

Family members told us they were involved in their relatives care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Relatives told us and observations indicated people were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

Care plans were structured organised and identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Comments we received, and feedback we read, demonstrated relatives were satisfied with the care delivered. The provider and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

We found people had access to healthcare professionals and their healthcare needs were met. There were established relationships with community based health professionals. We saw the management team had responded promptly when people had experienced health problems.

A complaints procedure was available and people and their relatives we spoke with said they knew how to complain. Staff spoken with felt the registered manager was accessible, supportive and approachable.

The manager had sought feedback from people living at Royal Court Care Home and their relatives.

The provider had regularly completed a comprehensive range of audits to maintain people’s quality of life, keep them safe and manage risk.

We re-visited the service to check that the necessary improvements had been made. We found improvements were made to the care plan records; people's needs in all areas had been properly assessed and personalised, up to date care plans were in place to direct staff on the care support required.

We reviewed the staffing arrangements and found that the provider had increased staffing levels following the last inspection and these levels remained in place. We found sufficient staff were available to meet the needs of the people who used the service.

People who used the service told us they were satisfied with the care support they received. They also confirmed they were happy with the staffing arrangements. Comments included, 'The staff care about us, they make sure we are comfortable and well looked after' and 'Very helpful and obliging staff. Never have to wait long, there's always someone around.' Relatives we spoke with told us, 'It's lovely here, they look after people very well, it's what we call, 'good old fashioned care.' Staff are very kind and helpful, they are always chatting to people and there's plenty of activities.'

We found people did not always receive care and support as described in their plan of care and this put their health, safety and welfare at risk. However people who used the service and their relatives spoke positively about their care. One person told us, 'We are well looked after. The staff are nice and helpful.' A relative told us, "Mum is well cared for and happy here. Staff make sure she looks nice.'

People received a varied menu and their preferences had been taken into account. However staff were knowledgeable about people's individual nutritional needs and monitored their intake. Delays with repairs to the weighing scales meant people's weights had not been regularly monitored.

People spoken with told us they liked their home. One person told us, 'I'm very pleased with my room, I had a few issues about noise when I first moved in but they were addressed by the owner.'

Where people needed specific equipment as part of their care delivery, for example to help with their mobility, it was readily available. Where staff were using equipment to help people they did so in a safe and appropriate manner.

People spoke positively about the staff and the support they provided. We found there were not always enough staff to ensure people's safety and welfare was properly monitored.

We spoke to three members of staff about their understanding of abuse; they could independently describe the different types of abuse and told us what actions they would take if they suspected abuse had occurred. A community nurse that we spoke with told us, 'The staff are very caring with the palliative care patients.'

During the inspection we looked at three staff files, we saw evidence of an effective recruitment and selection processes. People employed were working lawfully and had all the necessary training and qualifications to be competent in their role. This ensured that people using the service were receiving the care and treatment that they required.

The owner of the home explained to us that bi-monthly 'service user/relative meetings' were held and if anyone had any issues they were generally raised at the meeting before they became a reason to make a formal complaint. We looked at the notes of the meetings and saw that people had made suggestions and they were acted upon promptly.