Royal Court Care Home

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

Some improvements were required to records to ensure information about dietary requirements was up to date and correct. This was a recording concern and had no impact to people. People’s risks were assessed, and care plans contained guidance for staff about how to safely support people in emergency situations. People were safeguarded from the risk of abuse. Staff were trained and knowledgeable about how to protect people from unsafe harm and staff told us they felt able to report concerns. Infection, prevention and control systems were now in place and the service was visibly clean and free from malodours. Medicines were now safely managed. The provider had undertaken a refurbishment of communal areas of the home and had purchased new furniture and equipment. The environment was fit for purpose and safe for use. People were supported by enough suitably qualified staff and staff told us the morale within the team had greatly improved since our last inspection. Accidents and incidents were monitored, and action was taken to learn lessons from incidents.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Where people had an accident or incident, this was recorded, monitored and action taken to address concerns. For example, where there had been a recent increase in falls this was identified, and staffing numbers were increased during high risk times. Where people required input from external professionals, appropriate referrals had been made, such as involvement from speech and language therapist (SALT’s) and GP’s.

The management team monitored and reviewed accidents and incidents, these were also recorded and discussed during quality monitoring visits. Staff understood their roles and responsibilities to record and report accidents and incidents. Lesson learned following incidents were also discussed through supervisions and staff meetings. One staff said, “We manage people’s risks, for example if someone is at risk of falls, we have equipment in place that can alert staff.”

Systems were in place to record, monitor and learn lessons from accidents and incidents. For example, a falls tracker was in place and action taken as required to keep people safe. The manager reported notifiable incidents to external agencies, such as CQC and the local authority.

People received support from social workers who reviewed their care packages. People and relatives told us they were happy with their support. 1 person said, “Staff look after me, listen to me and give me what I need.”

Staff were aware of the importance of sharing information between services and supporting people to transition between service. One staff said, “Before [name] came to us, we had lots of information, we had visits and we discussed likes and dislikes, [name] got to know staff before they moved in.”

We received positive feedback from partners who worked with the service, they told us communication and continuity of care had improved at the service. The service was working closely with dietician services, to ensure people received support where they were at risk of malnutrition. A professional told us, “People have put weight on, this shows staff are following our advice.” Another professional said, “There was a previous lack of communication from the service, this has improved tenfold. They now call and report any incidents, such as falls to us.”

Since our last inspection no one was admitted to the service, however systems were in place to assess people's needs prior to people living at the home. Digital care records were in place and could be shared easily where appropriate.

People were protected from the risk of abuse and unsafe harm. People and relatives told us they felt safe living at the service. 1 person told us, “I feel safe, it is nice here, I like it.” A relative said, “[Name] is safe, I don’t have any concerns.”

Staff understood their responsibilities to keep people safe and staff told us since the new management team were in place, they felt comfortable to raise concerns, and were confident action would be taken. One staff said, “I would report anything to the new manager, they would definitely take it seriously.”

We observed staff treating people with respect and kindness. We saw people were comfortable in he presence of staff and their was a relaxed atmosphere in the home.

Systems, policies and procedures were in place to protect people from the risk of abuse. Safeguarding concerns were recorded, investigated and actioned. The new management team were open and honest and reported concerns to external agencies where required.

Since our last inspection improvements had been made about how staff managed risks posed to people. People and relatives told us they had equipment in place to help keep them safe and staff checked on them regularly. 1 person said, “Absolutely (staff keep me safe), when I walk, they help me and make sure I am alright.” And another person said, “Staff look after me well, they are around when I need them.”

Staff had recently received training, which provided them with knowledge and skills to manage people’s safety, such as moving and handling training. 1 staff said, “We have everything we need now, all new equipment to safely move people and we have had face to face training.”. Staff told us they had read peoples risk assessments and understood peoples individualised risks. Another staff said, “If someone is at risk of choking, staff sit with them whilst they are eating.” Staff were trained in basic life support and safety procedures were discussed with staff during meetings and supervisions.

Care records evidenced people were supported safely. For example, daily records detailed people were repositioned as required and had received food and fluids in line with their assessed needs. We observed people eating diets which had been advised by SALT teams. Since our last inspection, the provider had purchased various new safety equipment, such as bed rails, assisted baths and slings.

Some care plans required updating to ensure they contained the correct information throughout. This was a recording concern, and we found no harm to people. Where people were at risk of pressure damage, records evidenced people were supported in line with their needs and had district nurse input, however some care plans required improving to ensure they contained the correct repositioning times throughout. Positive behaviour support (PBS) plans were now in place and staff completed appropriate records when people had incidents of distress. Staff were knowledgeable about people's dietary needs and choking risk. However, some care records required updating to ensure information was up to date and clear for staff guidance. We found where people had incidents of choking, staff responded appropriately, and referrals were made externally to SALT teams and GP's.

People and relatives told us the environment had improved. People and relatives told us they were provided with safety equipment, such as falls sensors and call bells. One person said, “I asked for a lock to be fixed in my room, the maintenance staff are very good, they fixed it straight away.” Where people used equipment, such as hoists, regular servicing and checks were in place to ensure they were safe for use.

Staff told us the environment had improved and equipment was safe for use. Maintenance staff were dedicated and organised, to ensure the environment was safe for people. They told us, “It has changed so much, when I ask for anything needed for the home, the provider gets its straight away. The home has vastly improved, you can visibly see the difference and it smells better.”

We saw people being supported safely to do the things they wanted around the service, including assisting people to mobilise. We found food, equipment and medicines was now stored appropriately.

Since our last inspection improvements had been made to the quality and safety of the environment. Several items of equipment had been replaced to ensure people were kept safe, such as new bed rail bumpers and lifting equipment. Maintenance checks of equipment and the environment were in place, such as slings, bedrails and lifting equipment checks. Appropriate risk assessments and maintenance was in place to manage fire safety and legionnaires disease.

People were supported by enough suitably qualified staff. Most people and relatives and told us there were enough staff to safely support people. One relative told us, “I think there is enough staff, my relative seems well looked after.” A visiting professional told us, “Staff are good, they have given me all the information I need for my visit, there are enough staff.”

Staff were recruited safely, and appropriate pre-employment checks were in place. Staff had undergone a Disclosure and Barring Service (DBS) check prior to commencing employment, this could further be improved by undertaking regular DBS checks of staff who had been employed for long periods. This was fed back on the day of inspection and plans were in place to undertake these for those staff who required them. A staff said, “For the number of people we currently support and their needs, we have sufficient staff. The staff team has changed, and things have improved.”

During our inspection we observed people being supported by enough staff and people having their needs met. This was further evidenced through daily audits undertaken by the management team, who checked call bell wait times and people’s daily needs being met.

The rota confirmed staffing numbers were maintained and included a senior carer on each shift. The provider had implemented a new staff team and staff told us this had improved the communication, culture and morale within the staff team. Agency staff were used to cover any shortfalls, but this was minimal. Since our last inspection, various training and development had been put in place for staff. Staff told us this had benefited the. One staff said, “The training has improved since the new management team has been in place. We have lots of training booked and I have done eLearning and face to face training.”

People and relatives told us cleanliness in the service had improved. Comments included, “It is very clean, staff come around and clean and they are very nice.” And “[Name] bedroom is always clean.” A visiting professional said, “The home is a lot brighter and cleaner. We see staff cleaning all the time.”

Staff were trained and understood their responsibilities in relation to IPC. Staff said, “It is a lot cleaner now, much better. We have schedules in place, and we do daily checks of people’s bedrooms.”

The service had undergone refurbishment, including new chairs which were easy to clean, new bathing equipment and facilities, new flooring and redecoration. This had improved the odour in the home and the overall cleanliness. New PPE stations were in place, and we observed staff wearing PPE. Some minor improvements were still required, such as appropriate storage of toilet paper.

Since our last inspection improvements had been made to ensure IPC systems were robust. The number of domestic staff hours had increased, and cleaning schedules were in place. Regular audits and daily checks were undertaken by the management team to ensure IPC practices were upheld.

People received their medicines as prescribed, and staff monitored people for signs of pain. People and relatives told us they received their medicines on time. 1 person said, “I have medicines brought to me throughout the day, including my eye drops. I don’t have any problems with my medicines.”

Staff were trained and had their competencies checked prior to administering medicines to people. Staff told us they felt confident and skilled to administer medicines to people. A staff said, “I have had my competencies assessed, I have had training, and we have refresher training.” We observed staff following good practice guideline, such as wearing ‘do not disturb’ tabards during medicines administration.

Medicines were mostly managed safely. We found some MAR records relating to creams and patches contained gaps, this had been identified on an audit being undertaken on the day of inspection. Medicines were appropriately stored, administered and disposed of. Where people received ‘as required’ medicines, protocols were in place to guide staff about how and when these should be administered. Regular audits and stock checks were in place to ensure people were receiving their medicines as prescribed.