We carried out this inspection on 16 May 2018. The inspection was unannounced. This meant no-one at the service knew we were planning to visit.

Royal Court Care Home 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 Care Home is registered to provide accommodation for persons who require personal care without nursing. The service can accommodate a maximum of 40 people. At the time of the inspection there were 23 people living at the home.

Our last inspection at Royal Court Care Home took place on 11 and 12 January 2017. The service was rated Requires Improvement overall. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 spoken with were very positive about their experience of living at Royal Court Care Home. They told us they were happy, felt safe and were respected.

Sufficient numbers of staff were provided to keep people safe. However, people spoken with said they want more staff on duty and there were periods when they had to wait for support. We made a recommendation for the registered provider to consider people’s views when making decisions about the staffing arrangements at the service.

Everyone we spoke with was complimentary about the food. We carried out observations during lunchtime and saw that there was a relaxed atmosphere. We found the overall meal experience had improved since the previous inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice. We saw the registered provider had no record keeping system in place to show when they had obtained people’s or their representative’s consent for care and treatment. This meant we were not able to verify proper consent had been obtained during the admission process.

We found the programme of activities provided was not effective at meeting people’s needs. People and their relatives gave mixed feedback about the quality of activities provided. This was a breach of regulation and improvements in this area are needed.

We identified improvements were needed to the design, adaptation and decoration of the service to make it more stimulating for people living with dementia.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role. Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

People’s care records contained detailed information and reflected the care and support being given. The care records checked showed people were provided with support from a range of health professionals to maintain their health.

There were some systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

We carried out this inspection on 11 and 12 January 2017. The inspection was unannounced. This meant no-one at the service knew we were planning to visit.

Royal Court Care Home is registered to provide accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 24 people living there at the time of our inspection.

There was a registered manager employed at the service. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements had been made. The home is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People told us they liked living at Royal Court and felt safe there. Relatives said they felt their family member was safe and well cared for at Royal Court.

People living at Royal Court and their relatives told us staff were caring and their privacy and dignity were respected. We saw and heard positive interactions between people and staff throughout the inspection.

We found effective systems were in place to ensure medicines were managed, stored and administered in a safe way. However, improvements were still required in the recording of topical medicines administration, such as prescribed skin creams.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

Safe recruitment procedures were followed to ensure that all the required information and documents were in place before staff commenced employment.

There were enough staff employed to meet the needs of people living at Royal Court.

Staff were not provided with regular supervisions and a yearly appraisal to ensure they were suitable for their job and supported in their role.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted.

People told us they enjoyed the food served at Royal Court, which we saw took into account their dietary needs and preferences. This meant their health was promoted and their choices were respected. Small changes in the furnishings of the dining area and presentation of food would improve the dining experience for people.

People had access to a range of health care professionals to help maintain their health and wellbeing.

Care records contained up to date risk assessments and these were reviewed regularly, however there was no evidence people and/or their relatives were involved in these reviews to ensure information was person centred and up to date

Some activities were provided for people during the week, but this required improvement to ensure all people had the opportunity to take part in hobbies and interests they enjoyed. The service had a mini bus but this was not currently being used. People told us they would like to go on trips out.

People living at Royal Court and staff working there, told us the registered manager was approachable and responsive to any concerns they had.

There was evidence of regular quality audits being introduced to ensure safe practice and identify any improvements required. However, these required further development to ensure all areas of practice were covered and actions taken were recorded.

People who lived at Royal

We carried out this inspection on 25 July 2016. The inspection was unannounced. This meant no-one at the service knew that we were planning to visit.

Royal Court Care Home is registered to provide accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 28 people living there at the time of our inspection.

There was a registered manager employed at the service. 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.

At the previous inspection on 9 and 14 September 2015 the service was rated inadequate and placed into special measures by CQC. This inspection found that there were not enough improvements to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Care staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management. However, there were no systems in place to monitor any allegations of abuse and any action taken.

Not all medicines were stored safely. There were no systems in place to regularly audit whether medicines were being administered correctly.

We saw that safe recruitment procedures were not always followed to ensure that all the required information and documents were in place before staff commenced employment. These procedures were required to verify people employed by the service were suitable to work with vulnerable adults.

Not all staff were provided with regular supervisions and appropriate training to ensure they were suitable for their job and supported in their role.

There were not enough staff to meet the needs of people living at Royal Court. We saw staff were rushed. People told us they needed more staff and more things to do.

The registered manager did not always ensure people consented to their care and treatment in line with relevant legislation such as Mental Capacity Act 2005. It could not be evidenced decisions were always made in people’s best interests.

The registered manager had applied to the Local Authority for Deprivation of Liberty Safeguards (DoLS) to be authorised for some people living at Royal Court.

Care records were not always regularly reviewed. There was no evidence people’s views and aspirations were taken into account when care records were reviewed.

We saw people had access to external health professionals and this was evidenced in people’s care records.

People living at Royal Court told us staff were caring. Staff we spoke with understood what it meant to treat people with dignity and respect and we saw they did this.

People living at Royal Court and staff working there, told us the registered manager was approachable and responsive to any concerns they had.

There was no evidence of regular quality audits being undertaken to ensure safe practice and identify any improvements required.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 12 January 2015 and was unannounced. We last inspected this service in September 2013 where we found that the service was not meeting the requirements of the regulation for supporting staff. This was because staff did not receive regular supervisions and appraisals and there was no system to monitor staff training needs.

Royal Court Care Home is registered to provide care, accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 28 people living there at the time of our inspection.

There was a registered manager employed at the service. 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 provider was not meeting the requirements of the regulation to ensure medicines were managed in a safe way. There was no guidance in place to ensure people received prn (as needed) medicines in a safe way. Medicines were not managed and handled in accordance with recognised guidelines and the service’s own policy. There was a lack of information about people’s medicines and support required in relation to these in their care records.

The provider did not ensure that people consented to their care and treatment in line with relevant legislation. There was a lack of understanding around the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005. It could not be demonstrated that decisions were always made in people’s best interests and that people were not being deprived of their liberty with appropriate authorisation.

The requirements relating to supporting staff were still not being met. Staff did not receive regular supervisions and appraisals which meant there were limited opportunities available for staff to develop in their roles. There was a lack of an effective system to monitor and identify staff training needs.

Risk assessments were not always in place for people and not frequently updated where these were in place. Care records were not reviewed at regular intervals and one person had conflicting information in place regarding how they were to be supported. There was no information available about how people should be supported in the event of an emergency. One staff member told us they would have to use their initiative. The lack of clear information about what support people needed meant there was a risk they may receive inappropriate and unsafe care. This meant the requirement relating to the care and welfare of people using services was not being met.

There was no audit system in place to monitor the quality or effectiveness of the service. Incidents at the service were not routinely monitored to identify trends and reduce risk of recurrence. We found occasions where some incidents should have been notified to the care quality commission and had not been. The service did not operate in accordance with many of the policies set out and records were lacking in information. Team meetings did not take place regularly to make sure important information was shared.

All of the people living at Royal Court and relatives we spoke with were positive about the care they received and the staff who supported them. Our observations showed that staff interaction was predominantly caring. We saw that people were offered choice about what they wanted to do and staff explained to people what they were doing whilst providing support. People at the service were supported to access healthcare services and received assistance with nutrition where required. There was evidence of involvement with health and community professionals.

There was no activities co-ordinator employed at the service, although we saw and were told about various activities that took place. We also observed some periods where there was a lack of stimulation available for people. Some relatives told us of activities they participated in on a regular basis. No formal relatives or residents meetings took place to share information and obtain people’s views. All of the people we spoke with told us they would feel comfortable that any complaints would be dealt with. There were no complaints at the time of our inspection.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our visit we spoke with three people using the service, three relatives and four members of staff. We also followed up on a previous compliance action for Outcome 21.

All of the people using the service and their relatives that we spoke with were positive about the home. A comment from a person using the service included, “The staff are very caring. I’ve been well cared for.”

People using the service and their relatives told us that they were treated with respect and their dignity was maintained.

People using the service told us that care and treatment was planned and delivered in a way that ensured people's safety and welfare. A comment from a person using the service included, "They look at the needs of the individual and involve people as much as they can.”

All the people and relatives we spoke with said they had no concerns regarding safety in the home.

We found that not all staff were up to date with appropriate training, or had received appropriate supervision and appraisal. This meant staff had not been provided with opportunities to develop and improve their skills to ensure they remained competent in their role.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

During our inspection we spoke with three people currently residing at Royal Court Care Home. People spoke positively about the home, the manager and the staff. They all told us they were happy living at the home and felt safe. We received comments such as “They are all ever so good, very kind”, “We’re well cared for here, they (the staff) really look after you”, “You couldn’t wish for a better boss (the manager)” and “It’s really good”.

People told us that the menus were varied and they enjoyed the food. We received comments such as “The food is lovely”, “The food is really good”, “There is always plenty to eat” and “The menus are set but if you don’t like what’s on you can always ask for something else”.

We spoke with one relative who came frequently to visit their relative who was currently residing at the home. They told us that they were very happy with the care provided by the home.

No one we spoke with had any concerns or complaints and could not think of any areas where the home needed to improve. Everyone we spoke with felt confident to raise any concerns they may have with the manager or a member of staff.

This inspection took place on 10 and 14 September 2015 and was unannounced which meant the provider did not know we would be attending.

We last inspected this service in January 2015 where we found that the service was not meeting the requirements and was in breach of the regulations for: care and welfare of people, assessing and monitoring the quality of the service, management of medicines, consent to care and treatment, records and supporting staff. We took enforcement action for three of these breaches and informed the provider that they must take action to meet the regulations by June 2015. The provider also submitted action plans which set out how they intended to meet the regulations.

Royal Court Care Home is registered to provide care, accommodation and personal care for up to 40 older people in Hoyland, Barnsley. There were 31 people living there at the time of our inspection.

There was a registered manager employed at the service. 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.

We found not all of the actions in the provider’s action plan had been implemented and little improvement had been made to remedy the breaches identified at our last inspection.

The provider was still not meeting the requirements of the regulation to ensure medicines were managed in a safe way. We saw that medicines were not always being stored and administered safely. Medicines were not managed and handled in accordance with recognised guidelines and the service’s own policy.

Staff shortages at the service were not always covered and we observed that staff were rushed at times. Recruitment procedures were not sufficiently robust. Staff were still not provided with regular supervisions and appropriate training to ensure they were suitable and supported in their roles.

The provider did not ensure that people consented to their care and treatment in line with relevant legislation such as Mental Capacity Act 2005. It could not be demonstrated that decisions were always made in people’s best interests. The registered manager had made, and was in the process of making, Deprivation of Liberty Safeguard applications to prevent people being subject to unlawful restrictions.

Risk assessments were not always in place for people where required, and we found systems for safeguarding people from abuse were not effective. Care records were reviewed at regular intervals however some updates did not reflect people’s current needs.

Care records weren’t holistic as little information was captured about people outside of their care needs, such as their backgrounds and social past times. People told us they would prefer more activities which contradicted with staff comments that people weren’t interested in doing anything. Care was not being provided in a person centred way.

Comments about meals were mixed and we saw little choice being given to people. Although we saw staff assisted some people to eat, some people were not supported with appropriate prompting and encouragement.

We saw that people had access to external health professionals and this was evidenced in people’s care records.

People spoke positively about the staff and how staff cared for them. However, observations showed an inconsistent approach from staff . Some approaches were kind and caring yet some were the opposite and staff spoke to people in commands. We saw instances where people’s privacy and dignity was not respected.

No audits had been undertaken in order to monitor the quality or effectiveness of the service. Incidents at the service had been reviewed by the registered manager but not at a level that would identify trends and patterns. Staff told us they felt supported by the registered manager however team meetings were infrequent.

Observations showed that some aspects of the home were in need of attention, repair and cleaning. The provider told us they had no plan of redecoration and refurbishment for the home.

Residents and relatives meetings did not take place but the registered manager was trying to arrange these. No complaints had been made about the home at the time of our inspection.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.