Royal Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety. Changes had been made to improve how accidents and incidents were reported, recorded and investigated, however, these changes needed time to embed fully. The registered manager held daily meetings with team leaders and seniors to discuss any incidents over the past 24 hours and actions needed. They were proactive in seeking external support where needed.

During the assessment the management listened to our feedback and started to act on information raised. For example, the registered manager was proactive in contacting the providers IT team to support with more specific information the management team could use for auditing purposes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Information was shared with agencies to ensure continuity of care. Assessments of people’s needs prior to moving in were carried out by the care home staff. Some people at Royal Court lived with complex distressed behaviours that required external support. The service sought support from the GP practice, mental health team and care home support team where necessary. The service worked with the local community nursing service to ensure people who needed nursing support could access this in a timely way.

Mental capacity assessment and best interest decisions were being completed. However, these were not always decision specific and did not demonstrate all the relevant information and how the person was involved in the process. Following feedback, the provider told us they have arranged additional Mental Capacity Act 2005 and Deprivation of Liberty Safeguards training for staff.

There were systems, processes and practices to protect people from abuse, neglect, harassment and breaches of their dignity. These were communicated with people, staff and visitors to the service. We identified a concern that had not been reported to the relevant authorities. The registered manager acted on the concerns through internal processes and following our feedback took measures to report to the statutory authorities.

People and their relatives told us they felt safe. One relative told us, “I have no safety concerns, Mum bruises easily and they explain this and that. They never try and cover anything up, they will be honest and tell you how things are.”

The service was in the process of updating their monitoring tool for Deprivation of Liberty Safeguards. Where people lacked capacity to make their own decisions, we found appropriate referrals for Deprivation of Liberty Safeguards were made and monitored.

The provider did not always work well with people to understand and manage risks. The service had a range of risk assessments for people,however the quality and consistency of risk assessments varied and there were gaps in some people’s care records. We gave feedback during the assessment and the registered manager acted on this promptly.

Whilst some documentation was not as detailed as it could be we found staff knew people well and people had positive experiences living at the service.

One relative told us, “They have gone above and beyond. At home she had a fall and had a fracture. She came here and they got her walking again. She would stay in bed, then they got her in to a chair and then got her walking. [Person] has improved markedly; she was not eating but the carers sorted that out.” A person told us, “I’ve not had a fall because they know my condition and I’ve been here before. I have two carers when I walk away from here [lounge area]. I don’t go anywhere on my own.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Facilities, equipment and technology were well-maintained and used for their intended purpose. Effective arrangements were in place to monitor the safety and upkeep of the premises, bringing in professionally qualified people to complete the necessary environmental and equipment checks.

The service employed a maintenance person who worked with the registered manager to ensure the home was safe for people to live in.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

Where we identified some gaps in training, the registered manager acted on this immediately and during the assessment this was arranged. The service provided a range of online and face to face training, held in the training suite of another of the provider’s homes.

Some people at Royal Court lived with complex distressed behaviours. Whilst the service sought support from the care home support team, Mental health (MH) and GP, staff were not always equipped to deal with some of these distressed behaviours. Staff had received basic training in supporting people with distressed behaviours. We discussed this with the registered manager and provider during the assessment period; the provider told us it had been difficult to source specific positive behaviour support training. The provider has since arranged specific training for staff.

Feedback about staffing levels was generally positive. Some people told us they had to wait for care and support. One person told us, “I don’t wait long unless they have some sort of problem and they come and tell me if there is.” Another said, “[It] can cause some problems, sometimes a wait of around 10 minutes or so.”

Staff were recruited safely; regular supervisions took place.Staff had the opportunity to develop their skills, knowledge and career with the provider. All staff including agency staff had completed the Care Certificate (this is a set of standards for health and social care workers to ensure they have the core skills, knowledge and behaviours for safe and compassionate care).

Staff told us they had access to training and could ask for other training of interest if they wanted. Staff told us they had the opportunity to progress into different roles with the provider.

The service recognised the importance of providing staff with ongoing support and training in Dementia, the provider employed a Dementia lead who spent time each week with staff and people living at the service.

One staff member told us, “Very good training received” and another said, “The training is very good and you can ask for more training if you want it”. One person told us, “They are all well trained to get me help me in and out of my wheelchair safely”. And another said, “They do know what they are doing. They know I can’t get about by myself and help me. They do training, they tell me."

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Infection prevention and control was well managed within the home. The home looked visibly clean. People and relatives told us infection prevention and control was managed well.

A relative told us, “[Staff} always put on gloves and aprons when they are doing care and take them off before they go” and a person said, “[I] always have a good wash and a shower when I want one. Do my nails and look after me well. The laundry is very good, quick, comes back the next day, clean.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

The service had a process in place for ordering and recording incoming and outgoing medication. We identified some medicine incidents which, whilst they were being recorded and investigated internally, were not formally being logged as incidents. As and when medication (PRN) protocols were being completed but they did not contain all the information required to ensure staff knew how best to support the person. We saw evidence protocols had been updated during the assessment period. We did not find anyone had come to harm.

One person told us, “Medication is alright. They have explained everything to me, what they are for and how much. They always make sure I take them at the right time.” Another person told us, “[Staff] always bring my medication at the right time, after meals, morning, mid-day, night. My medication has not changed since I’ve been here.” One relative told us, “We do get updates on medication, when [name] was put on morphine, they explained what happens. [name] has improved and is not on it now. When she was in real pain the district nurse came out. The GP comes in regularly to check on her.”

Some people had their medicines given covertly, we observed staff administering medicines in a safe and person-centred way.