Kings Court Care Home

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• 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. This is the first assessment for this service. This key question has been rated 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 54 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People's needs were assessed and reviewed to help ensure they received appropriate care and support. Assessments completed before admission considered people's health conditions, communication needs, mobility, nutrition, wellbeing and identified risks. Care plans were reviewed regularly and updated when people's needs changed.
People and relatives were generally positive about staff understanding individual needs. One relative told us, "They [staff] know him very well," while another said staff understood their family member's routines and preferences. Several people told us staff responded appropriately when their health needs changed and sought professional advice when required.
We observed staff supporting people in line with their assessed needs, including assistance with mobility, personal care and mealtime support. Adapted equipment and specialist seating were used to promote safety and independence.
There was evidence of involvement from a range of healthcare professionals, including GPs, occupational therapists and speech and language therapists. Staff sought professional guidance when required and care records reflected ongoing review of people's health and support needs. Although some care plans would have benefitted from more detailed guidance in specific areas, we found that people's needs were generally assessed, reviewed and supported through multidisciplinary involvement.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Care was not always delivered, recorded or monitored in line with people's assessed needs and planned interventions.
We found examples where care plans clearly identified the support people required, but daily records did not consistently show those interventions had been provided. For example, one person's care plan stated they required adapted cutlery and support to cut food into manageable pieces. However, daily records did not consistently evidence this support. Another person's care plan highlighted the importance of meaningful interaction, emotional support and encouragement to participate in activities to reduce social isolation. Despite this, daily records focused largely on physical care tasks and medication administration, with little evidence these interventions had been delivered.
Care planning was not always sufficiently detailed to support consistent delivery of care. For example, one person living with primary progressive aphasia and fluctuating capacity had care planning which identified communication needs, support required for decision-making and recognition of emotional distress. However, daily records did not consistently demonstrate how this guidance was being implemented in practice or how staff were supporting the person in line with the identified approach. This increased the risk of inconsistency in care delivery.
These findings showed the provider did not always ensure planned interventions were translated into day-to-day care and support.

The provider did not always work effectively across teams and services to support people. Systems for communicating and sharing information about people's needs, care and treatment were not always consistent, which increased the risk of people experiencing fragmented care.
Relatives described communication as variable and told us they were not always kept informed about changes in people's health, treatment or care. One relative said they found it difficult to obtain clear updates about their family member's wellbeing and often had to seek information themselves. Another relative described receiving conflicting information from different staff members regarding their family member's care and support.
Staff told us communication between nursing and care staff was supported through handovers, communication diaries and discussions with senior staff. One nurse explained that nurses worked closely with GP services and other healthcare professionals and relied on handovers and written information to maintain continuity of care.
We saw evidence of staff working with healthcare professionals to monitor people's health needs and respond to changes in their condition. However, information about people's changing needs, professional involvement and aspects of care delivery was not always communicated consistently between staff, teams and those important to people. This increased the risk of inconsistent care and support.
Although systems were in place to promote communication, they were not always effective in ensuring information was shared consistently and accurately across teams and services.

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. People generally had access to the healthcare support they needed. Relatives told us staff contacted health professionals when concerns arose and many spoke positively about the support people received to manage long-term health conditions.

One relative told us staff were proactive in seeking medical advice when required, while another described good support during periods of deteriorating health. We observed staff supporting people to maintain their independence and wellbeing. People were encouraged to attend activities, spend time in communal areas and maintain relationships with family and friends. During the inspection we observed healthcare professionals working alongside staff, including GP involvement in discussions about future care planning and support for people approaching the end of life.

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. Our review of care records identified examples where care plans contained clear interventions and expected outcomes, but daily records did not consistently demonstrate whether these had been achieved. For example, one person's care plan identified the need for staff to support emotional wellbeing, reduce social isolation and encourage participation in meaningful activities.

However, daily records were largely task-focused and did not evidence whether these outcomes were being monitored or reviewed. For another person, records showed monitoring of falls and completion of post-fall observations. However, there was limited evidence showing how information from repeated incidents was analysed to understand patterns, measure the effectiveness of interventions or improve outcomes. Records showed some interventions were being completed; however, the provider could not demonstrate that care interventions were consistently evaluated to determine whether they were improving people's wellbeing and outcomes. As a result, opportunities to review progress and improve care were missed.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Our review of care records identified gaps in guidance for staff supporting people with impaired communication and fluctuating capacity. For example, one person living with primary progressive aphasia had care planning which recognised the impact of communication difficulties on consent and decision-making. However, records did not consistently demonstrate how staff applied this guidance in day-to-day practice, supported the person to express preferences using individualised communication tools, or evidenced decision-making discussions. This reduced assurance that people were consistently involved in decisions about their care and treatment. We also found examples where care records contained standardised information but lacked evidence of how individual choices and preferences had informed care delivery. As a result, people could not be assured people were consistently involved in decisions about their care and treatment.
However, many people and relatives told us staff were respectful and generally sought agreement before providing care. During the inspection we observed staff explaining what they were doing, offering reassurance and supporting people to make day-to-day choices. Records also showed people had access to Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms, lasting powers of attorney were recorded where applicable, and Deprivation of Liberty Safeguards (DoLS) applications had been completed appropriately when required.