We carried out a review of the data available to us about Royal Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Royal Court, you can give feedback on this service.
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.
This was the service’s first inspection under the registered provider who acquired the home on 1 August 2016.
This service is registered to provide care to a maximum of 48 people. The home does not provide nursing care. People’s accommodation comprised of flats which could be singularly occupied or shared. Communal areas such as lounges, dining rooms and a spacious conservatory were used on a daily basis by people and for social activities. Additional bathrooms and toilets were provided on each floor. Outside there were areas to sit, which were accessible by wheelchair and the gardens were well tended. One corridor, on one floor, provided accommodation for people who lived with dementia and who benefited from a smaller and more secure environment. People from this area also used the main part of the building and the gardens. They were supported to join in activities in other parts of the home and join others for meals.
The home was managed by a registered manager. 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 inspection was prompted in part by concerns we had received about the quality of service being delivered to people who lived with dementia and by the notification of an incident, following which a person using the service sustained a serious injury. This incident is subject to a separate process and as a result this inspection did not examine the circumstances of that incident. However, the information shared with CQC about the incident indicated potential concerns around the management of risk in relation to people’s agitation and associated behaviour. This inspection examined those risks and how they were managed.
The provider was not meeting all necessary regulations. They had not sufficiently assessed people’s risks and reviewed the risk management plans they had put in place to ensure these were effective in keeping people safe. Repeated incidents, of a similar nature, had taken place without thorough review, to ensure action would be taken to prevent these from recurring. Necessary learning from these incidents and adjustment to people’s support had not always followed. Although incidents which had put people at harm had been discussed with the local county council’s safeguarding team, CQC had not always been appropriately notified about these. As a result the necessary enquires to ensure people were safe had not taken place. The above shortfalls related to risks and incidents involving people who lived with dementia becoming agitated, distressed and disorientated.
Records required in relation to people’s care and how the home was managed were not always in place or sufficiently completed. In practice we observed people being supported to make decisions, staff promoting independence and acting in people’s best interests when delivering care. However, records did not always demonstrate how decisions had been made for people who lacked the capacity to make decisions about their care independently, so as to ensure their rights were upheld. Records did not always demonstrate that complaints had been sufficiently investigated, acted on and responded to. These shortfalls had not been identified by the provider’s quality monitoring and assurance processes. This process, therefore, had not been sufficiently robust and effective enough to ensure improvement in these areas had taken place and best practice applied.
Staff were aware of their responsibilities in relation to preventing potential abuse. Staff had received training and support to be able to meet people’s needs. Care plans did not always give staff sufficient guidance on how people’s needs were to be met. The potential impact of this and associated risks were lowered because staff knew people well and there were experienced care staff employed. The provider had already identified that changes to people’s care plans was needed and this was being addressed. There were enough staff in number to meet people’s needs. Staff prioritised people’s needs so that when people were distressed, agitated or required immediate support this was provided. Sometimes, there were too many needs for staff to manage alone and the provider was due to review how staffs’ work was organised and allocated. More senior care staff were due to work at the home to provide direction and support in this area.
People’s medicines were administered safely and securely stored. Medicine errors had been reported to us. In both cases there had been no significant impact on the people involved and action had been taken to prevent these from happening again. People lived in a home which was kept clean and where there were measures in place to prevent the spread of infection.
People were supported to eat and drink and to receive a diet which met their nutritional needs. Our observations showed that people’s dining experience needed improvement and actions were subsequently taken to start addressing this. People were supported by health care professionals where there was a need for their involvement. Staff communicated with and worked in conjunction with many different health care specialists to ensure people’s health needs were supported and met.
People were cared for by staff who genuinely cared for them and were interested in them as individuals. Comments from people had included staff are “caring and sympathetic” and “fantastic”. People told us they felt able to talk to the staff about anything. Relationships between people and staff were observed to be relaxed. Comments placed on a website used by people and relatives in order to review the home included, “The staff are caring and interested in me as a person” and “They always have time for you.” Where possible, people’s preferences were respected.
Managers in the home and representatives of the provider were committed to doing their best to improve people’s quality of life. Our visit, however, identified that the processes needed to achieve this had not always been well managed or monitored. There was however, evidence to show that some monitoring systems had led to actions being taken and improvements being made. Staff felt supported and well communicated with. There were arrangements in place which helped the senior management team and members of the board of trustees remain ‘in touch’ with the views of people and of their progress.
It was recognised by the provider that the building presented some challenges, in particular, when looking after people who lived with dementia. Some improvements and adaptions had been made to the building and grounds to better accommodate people’s diverse needs.
It was evident through our conversations with the registered manager and Director of Care they were motivated to continually improve the service and were keen to take action to ensure good care was provided to people. The provider had already identified a need for care plans to change as they wished to bring these in line with those used in other services managed by them.
You can see what action we told the provider to take at the back of the full version of the report.
Following our visit, we requested the provider forward to us an initial action plan on how they planned to keep people safe and how they planned to address the shortfalls we had fed back to managers during our visit. We will continue to communicate with the provider on their progress with these. We will be following up the provider’s improvement actions in a future inspection.