Kings Court Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this service. This key question has been rated inadequate. This meant services were not planned or delivered in ways that met people’s needs.

This service scored 36 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. People and relatives told us they felt decisions were sometimes made without sufficient consultation. One resident told us there was "no consultation" regarding arrangements affecting the home, while others felt organisational priorities were sometimes given greater consideration than individual preferences. Relatives also raised concerns about changes to bedroom personalisation and the limited involvement of residents in decisions affecting their living environment. Our review of care records identified examples where care plans recognised people's emotional wellbeing, social interests and preferred routines, but daily records focused predominantly on physical care tasks.

For example, care plans identified the importance of meaningful interaction, reducing social isolation and supporting emotional wellbeing, yet records did not consistently demonstrate how these aspects of care were delivered or reviewed. As a result, people could not be assured people's wider wellbeing needs remained central to care delivery. However, we also found positive examples of person-centred care. People told us staff knew them well and understood their preferences. During the inspection we observed staff engaging with people about topics important to them, supporting family contact, encouraging participation in activities and adapting support to reflect individual needs and abilities. Activity sessions were well attended and people appeared relaxed and engaged.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.
People and relatives frequently raised concerns about continuity of care. Several relatives told us the turnover of staff and reliance on agency workers affected consistency of support and meant people were not always cared for by staff who knew them well. One relative told us there was a "lack of continuity of care" whilst another said staff did not always have the same understanding of people's preferences, routines and communication needs.
The provider used a number of agency workers on a regular basis and systems were in place to support continuity, including handovers, communication diaries, care records and oversight from senior staff. However, staff told us continuity relied heavily on these communication arrangements because staffing teams were not always consistent across shifts.
A nurse explained that nurses relied on handovers, written information and senior staff to maintain continuity between shifts. Although these systems supported information sharing, the assessment identified concerns that information about people's needs and preferences was not always communicated consistently.
People generally had access to healthcare services when required and we saw evidence of involvement from healthcare professionals. However, people's experiences and staff feedback indicated that continuity and coordination of care were not always consistently achieved, particularly during periods of workforce change and increased reliance on temporary staffing arrangements.
 

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Our review of care records identified a number of recording inconsistencies. For example, one person's daily record referred to another resident by name, and other records contained contradictory information about whether care interventions had been provided. We also found inconsistencies between care plans and daily records, including differing information about mealtime support and uncertainty regarding night-time monitoring arrangements. As a result, staff could not always rely on care records to provide clear and consistent information about people's needs and support requirements.

Some relatives told us information was not always communicated clearly or consistently. One relative described difficulty obtaining updates about their family member's care, while others told us they sometimes received conflicting information from different members of staff. However, care plans generally contained detailed information about people's health conditions, communication needs, preferences and risks. We saw examples where care records included guidance to help staff communicate effectively with people living with sensory impairments, dementia and other complex needs. People and relatives also told us staff were usually approachable and willing to answer questions about care and support. Overall, whilst information was available to guide care, the provider did not always ensure records and communication were sufficiently accurate, consistent and tailored to support people's individual needs.
 

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result. People and relatives told us they did not always feel their views resulted in meaningful action. Several relatives described repeatedly raising concerns about staffing, communication and aspects of care but felt little had changed as a result. One relative told us they contacted the CQC after becoming frustrated with the lack of progress following concerns they had raised directly with the service. Another explained they were reluctant to complain further because they lacked confidence that doing so would improve outcomes.
People were not always involved in decisions that affected them. Residents, relatives and staff told us there had been no consultation before agency workers were accommodated within the home, despite the impact this arrangement had on people living there. Some residents also expressed concerns that wider decisions affecting life within the home were implemented without meaningful discussion or engagement.
Opportunities for people to influence the service were limited. One relative told us there had only been two resident or relative meetings over an extended period and several people questioned whether their feedback influenced decision-making. The provider's complaints processes were not consistently operated in line with policy. We reviewed complaint responses and found complainants were not always provided with information about independent organisations they could contact if they remained dissatisfied with the outcome. The provider also did not have an accessible version of its complaints procedure available until this was identified during the assessment. These findings demonstrated the provider had not created a culture where people, relatives and staff felt confident their views would be listened to, acted upon and used to improve the service.
 

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. People, relatives and observations gathered during the assessment demonstrated delays in accessing care. People did not always receive support when they needed it. Relatives told us staffing pressures sometimes affected access to care and reassurance. People described staff as caring and hardworking but frequently busy meeting competing demands.
Staff also told us staffing shortages affected their ability to respond promptly to people's requests for support. Although healthcare services were generally available when required, people could not always be assured they would receive basic care and support at the time they needed it.
 

Staff and leaders did not actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. Our review of care records identified a recurring theme whereby people's emotional wellbeing, social isolation, communication needs and psychological health were recognised within care plans but were not consistently reflected in daily records or care delivery. Care plans for several people identified risks associated with loneliness, anxiety, communication difficulties and reduced social engagement. However, daily records predominantly focused on physical care tasks and medication administration, with limited evidence of how these needs were actively monitored, reviewed or addressed.
People's experiences reflected these concerns. One person told us, "I am afraid I will be told to leave if my needs significantly increase." This indicated a lack of confidence that the service could continue to meet their changing needs. During the assessment, the Regional Manager confirmed that where people's needs increased significantly, they may be required to seek alternative placements despite the home being registered to provide nursing care. This meant some people experienced uncertainty about their future care and support at a time when they were becoming increasingly vulnerable. These findings demonstrated that people with more complex, deteriorating or changing needs could not always be assured that care would be adapted to support continuity, wellbeing and equitable outcomes.
 

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Our review of care records found that whilst some people had ReSPECT forms, advance care plans and documented preferences for future care, the quality and detail of planning varied between records. In some cases, records contained information about current needs but provided limited evidence of discussions regarding future deterioration, changing support requirements or how people's wishes would be respected as their circumstances changed.
For people experiencing progressive conditions, care planning did not always demonstrate how future risks, communication needs and increasing dependency would be anticipated and managed. We found examples where care plans identified significant deterioration in health, mobility or cognition, but there was limited evidence of corresponding forward planning to ensure people and their representatives could make informed decisions about future care arrangements. However, there were positive examples. Some records contained clearly documented ReSPECT forms, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, lasting powers of attorney and evidence of family involvement in future care discussions. We also observed GP involvement in discussions regarding end-of-life planning and future treatment decisions for some people.