This comprehensive inspection took place on 06 November 2018 and was unannounced.

The inspection team consisted of two inspectors.

The Royal is a residential care home which is registered to accommodate up to seven people and provides support for people with a Learning Disability, Mental Health needs, Autism Spectrum Disorder and additional needs. The Royal is a converted public house which offers seven bedrooms and is located on a high street with easy access to local facilities and good public transport links. At the time of inspection six people were accessing care and support at the service. The design and location of The Royal was complaint with the values underpinned in Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

The Royal is a ‘care home’. People in care homes receive accommodation and 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.

There had been no change in the registered manager since the last inspection. 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 are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible; however, the policies and systems in the service do not always evidence this practice. We saw peoples consent was sought in daily interactions, however where people were unable to give informed consent to their care and treatment the provider failed to follow practices in line with the Mental Capacity Act 2005 (MCA). We have recommended the provider seeks updated knowledge and information on current legislation and best practice.

Where people were identified as being unable to consent to their living arrangements the provider failed to follow legislation guidance in accordance with the MCA and Deprivation of Liberty Safeguards to seek the appropriate lawful authority to deprive people of their liberty.

Quality audits were carried out by the management team; however, these were not always effective and did not identify the concerns we found around the robustness of risk assessments, training and compliance with the MCA and DoLS legislation. The registered manager responded promptly when we identified areas for improvement.

People and relatives told us they felt safe at The Royal and there were systems and processes in place to safeguard people from potential abuse or neglect. The registered manager and staff had a good understanding of their role and responsibilities to protect people they support.

There were systems in place to identify and reduce potential risks to people, however information on how to reduce potential risks were not always person specific in people’s care plans. Following the inspection, we have been assured that action had been taken to address this.

People had access to suitable levels of staffing to meet their needs and staff demonstrated a good understanding of the people they support. Where people required additional support to engage in activities we saw there was flexibility in staffing levels. The provider had safe and effective recruitment practices in place for new staff.

People were supported with their medicines as required and there were clear processes in place to manage the storage, administration and disposal of people’s prescriptions. Staff received appropriate training and oversight to ensure people received their medicines in line with best practice guidance.

The environment was observed to be clean and tidy and people were protected from the risks of infection. Where people were able to

This inspection took place on 22 November 2016 and was unannounced.

The Royal is a care home in a converted public house situated on a high street with local shops. It caters for seven people with additional learning needs. Six of the seven bedrooms had a bedsit type arrangement and people were provided with a kitchenette type area which they can use to be more independent if they wished.

At the last inspection on 30 April 2014 we found the registered provider was meeting the required standards.

The service had in place 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.

Risk assessments were in place for people who used the service and staff understood the potential risks and required safeguards to keep people safe.

Checks were carried out by the registered provider and the registered manager to ensure the building and its contents were safe for people to live there.

Staff had been trained in how to safeguard vulnerable adults and they felt if they had any concerns about a person the registered manager would respond well to them raising the concerns.

Accidents and incidents were monitored to prevent re-occurrences. Medicines were appropriately administered and recorded. Staff had been assessed as competent to administer medicines

The registered provider had in place a recruitment and selection procedure which involved carrying out relevant checks when they employed staff. Staff were suitably supported through training, regular supervisions and appraisals.

We found the staffing levels were appropriate to meet people’s care and support needs. Staff supported people to access their hospital appointments and took them to their G.P. if they required medical attention.

Consent had been obtained from people to use CCTV in communal areas using a pictorial format to enable people to understand the issue under discussion.

Staff were aware of, and supported people with, their nutritional needs. Specialist food had been purchased to meet one person’s particular needs and staff were aware of people’s diagnosed conditions which required particular attention to their nutritional intake.

In a discussion about a television programme which exposed poor care staff demonstrated they understood what good care means. They showed their caring ways and were shocked and dismayed at how people were treated in a care home.

Staff treated people with dignity and respect and were able to describe to us how they helped to maintain people’s independence.

People were protected by the staff from social isolation. We found activities were arranged for people who used the service and these were based on people’s preferences.

We found people’s care records were up to date and accurately reflected people’s needs. Keyworkers supported people to be involved in the review of their care plan.

Staff felt supported by the registered manager and described her as having an “Open door.” We saw the registered manager carried out checks and surveys to measure the quality of the service.

People were enabled to access community facilities by public transport.

We carried out a routine inspection to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led? On the day of our inspection there were five people using the service. We spoke with three of them to understand their experience of the service and observed the care and support delivered in the shared areas of the home. We looked at records and files. We spoke with the registered manager, a visiting social worker and three members of staff.

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed positive, friendly interactions between staff and people who used the service. One person we spoke to said, “I like the staff and I like the other people.” Another person told us there was nothing they would change about the service.

We found the service had systems in place to ensure medicines were managed and administered safely. Support plans were written so as to ensure people’s safety and welfare. Arrangements were in place for foreseeable emergencies. Support was provided with people's consent. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Is the service effective?

People told us that they were satisfied with the care and support they received. One said, “I like it here. I like it all.” Feedback from people’s families was positive about the quality of service provided.

We found people’s care and support were based on thorough assessments and detailed and personalised support plans. Systems were in place to ensure care was delivered according to people’s plans.

Is the service caring?

Relatives of a person using the service had commented, “This is [name]’s third placement and the happiest he has been.” We observed care and support that showed staff were concerned with people’s comfort and well-being .

Staff we spoke with were motivated to provide high quality care. They demonstrated knowledge of people’s needs and how they preferred to have their care delivered.

Is the service responsive?

People’s support plans were based on a thorough assessment of their needs. Care and supported were provided with their consent. The service responded to changes in their needs or circumstances.

We found the service had systems in place to ensure the care provided was appropriate to peoples’ needs.

Is the service well-led?

Staff told us they were supported to deliver a high standard of care. They said if they raised concerns with the manager, they were dealt with appropriately.

Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints.

At the time of our inspection there were six people living at the service. The service was clean and well presented. However the lounge had sparsely decorated walls. The manager told us that the people who lived there were yet to decide on the decoration. We spoke with two people who used the service, one relative, three staff and the manager.

All of the people we spoke with told us they were happy with the care and support they received. One person who used the service said, “They muck around with me and we have a laugh”.

We found that people’s views and experiences were taken into account in the way that the service was provided and the way their care was assessed and delivered. People told us they had the freedom to “do as they pleased” and their day to day decisions were respected by the staff.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A relative said; “I really can’t fault them [staff]”. They also told us how their family member spent a lot more time in the lounge with other people since moving into the home which was of great benefit to their wellbeing.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person who used the service said; “I am safe here”.

There were enough qualified, skilled and experienced staff to meet people's needs. All the staff we spoke to told us they felt well supported by the manager and had their training needs met. One said; “I really like working here”.

The home had a range of policies and procedures in place to underpin the management and delivery of the service. A member of staff we spoke with told us they would always assist the person who they were supporting to complain if needed.

We spoke with one relative who told us that they were happy with care provided. They said that members of staff were supportive. They told us there were a number of activities to undertake and members of staff ensured people using the service were active. They told us people who used the service had a choice in what activities to participate in.