The inspection visit at royal Court Care Home took place on 06 June 2017 and was unannounced.

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 org

At the scheduled inspection on 7 August 2013 we identified shortfalls with some of the care records. We also found at our August inspection that there were not enough qualified, skilled and experienced staff to meet people’s needs. The provider wrote to us to confirm the action they would be taking to address the shortfalls.

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.”

People confirmed that their care and treatment options were discussed with them and they were asked for their consent.

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.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person we spoke with told us that, “A dapper fellow comes in and sings he gets everyone singing, he’s great.” A relative told us the, “Staff are excellent, very caring, very considerate. We are really happy with the care my mum gets.”

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.

People told us about living in the home and about how they spent their time. A person said, “After dinner I do write letters, and I go out. I listen to music and I read. I like a walk around. Your dignity is respected.” Relatives confirmed to us that they were happy with the care their relatives received. A relative told us, “They are caring and we have no complaints.” Another relative also told us about activities in the home. They said, “I visit three times and we all come and see her through the week. For activities, someone comes on Tuesday and people are involved in a gardening club. There is nail care and other activities. Someone comes in to do an exercise programme.”

People we spoke with and their relatives told us they felt safe in the home. A relative told us, “Nothing has come up to give me any concerns with the staff I see when I come.” Another relative said, “Mother is safe in here.” A person receiving their medication observed to us, “She does a good job.” A relative told us, “I’ve got faith in them about medication. If there was ever a problem they would ask me.”

People spoke to us positively about the staff that worked with them. A relative told us, “All the staff are really helpful, nothing is too much trouble and the rapport is good. My mother is all right with them.” Relatives we spoke with also confirmed they had received and completed surveys, and knew about the provider’s complaints process.

We undertook this unannounced inspection on the 10 and 11 February 2015. Royal Court provides accommodation and personal care for up to 20 older people who may have a dementia related condition. On the days the inspection took place there were 15 people living in the service.

The service had 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.

Staff completed safeguarding training and there were policies and procedures in place to make sure they had guidance about how to safeguard vulnerable people from the risk of harm and abuse.

New members of staff were recruited safely and there were enough staff on duty to make sure the needs of people who used the service were met. Staff received training, support and had supervision meetings to help with their development.

Throughout our inspection we saw staff supporting people in a caring, responsive and patient manner. They encouraged people to be as independent as possible while taking into consideration any risks associated with their care. People who used the service and the visitors we spoke with were complimentary about the care and support provided. One person said, “I can’t fault the care, the staff are kind and caring and nothing is too much trouble.”

We found people received their medicines as prescribed and received visits from community health care professionals when required.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit applications to the local authority for a DoLS where it was identified this was required to keep them safe. At the time of the inspection three people who used the service had DoLS authorisations in place.

Staff supported people to make their own decisions and choices about the care they received. When people were unable to make their own decisions, staff followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.

People who used the service had their needs assessed and plans of care were in place which were personalised; these provided staff with guidance about how to care for people taking account of their preferences and wishes.

There were activities for people to participate in which helped to provide meaningful stimulation. People told us they enjoyed the activities they took part in, but could choose not to participate.

People’s nutritional needs were monitored and they had input from dieticians where necessary. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked. Comments included, “The food is lovely, very nice” and “Food is excellent, plenty of choice and brilliant for a home.”

People who used the service and their relatives told us staff were kind, caring and listened to them. Comments from people included, “They are always sunny with her” and “Lovely kind staff.”

Checks were made on the quality of the service and people’s views were obtained through meetings and questionnaires.

People told us they had no complaints, but would feel comfortable speaking to staff if they had any concerns. We saw the complaints policy was easily available to people using or visiting the service. When concerns had been raised these had been investigated and resolved appropriately.

The environment was safe for people who used the service and equipment was well maintained. We found areas of the environment had been adapted to meet people’s needs.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt they were listened to.