This inspection took place on 7 and 8 August 2018 and was unannounced.

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 ne

This inspection took place on 29 and 30 August 2017 and was unannounced.

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 w