Country Court

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider assessed and reviewed people’s health, care, wellbeing and communication needs with them, but improvements were required to ensure consistency. Care plans were generally person-centred and specific, with clear instructions for staff. For example, one plan detailed how to support a person with dementia and included input from their partner. However, some risk assessments were generic and lacked detail, such as those for diabetes and mobility. Reviews were inconsistent, with gaps of several months or years in some cases. People’s voices were evident in care plans, with some written in the first person, but it was not recognised that for those who were unable to communicate their views, it was inappropriate to write care plans in the first person. One person told us, “I feel safe here and the staff are very good.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider did not always ensure care and treatment reflected best practice guidance. Whilst staff demonstrated kindness and compassion, care plans for end-of-life and palliative care lacked detail and were not sufficiently person-centred. For example, one plan stated only that ‘just in case’ medication would be prescribed, without guidance for staff on how to support the person’s wishes. Diabetes care plans contained basic information but omitted complications and monitoring requirements. Medication protocols were present but confusing and as and when required medication charts were signed incorrectly. Although audits were in place, they did not consistently identify these issues. Staff told us they felt improvements were hampered by a lack of provider engagement and undermined improvements made by the external consultant.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked collaboratively to meet people’s needs and were observed to be caring and respectful. Team meetings were held regularly, and lessons learned were shared during supervisions. Staff spoke positively about the acting manager and deputy, describing them as “the heart and soul of the home.” However, they expressed frustration about the provider’s lack of understanding of social care, which they felt hindered progress made by the external consultant. Visiting professionals echoed these concerns. Despite this, staff demonstrated commitment and teamwork, covering shifts to maintain continuity of care. One person told us, “The staff are lovely and always help when I need it.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider supported people to maintain health and wellbeing, but improvements were needed in care planning. Kitchen staff understood nutritional needs and offered alternatives when required. They sought feedback and monitored those at risk of weight loss. Lunchtime observations showed people were offered choice, meals were appetising, and staff promoted dignity.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor and improve outcomes were in place but not always effective. Audits covered all areas, including medication and care files, but failed to identify issues such as inconsistent reviews and gaps in positional change records. For example, one person required two-hourly turns, but these were not completed consistently. Environmental audits highlighted refurbishment needs, yet actions were not always taken by the provider. Whilst accident and incident analysis had improved, lessons learned were not always embedded. Staff and visiting professionals voiced concerns about underinvestment and lack of provider responsiveness. The provider told us they planned to make further investments into the home in the future.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not consistently obtain and record consent in line with the Mental Capacity Act. Whilst some care plans included consent forms and best interest decisions, others were generic and covered multiple decisions rather than being decision specific. For example, there was no documented consent or best interest decision for the use of CCTV, and one consent form was signed by a relative without the appropriate legal authority. Although staff had completed Mental Capacity Act training, for people unable to manage their own risks due to cognitive impairment, best interest decisions were not specific to individual choices and consent processes were unclear, limiting people’s control over their care.