Royal 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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 care was reviewed and sections developed within the care electronic system to better reflect people’s needs. Some care plans were more detailed than others’ and not all contained specific information relating to people’s needs. However other sections of the care plans were detailed and reflected people’s likes, dislikes, communication preferences, diet and nutrition well.

Some people had specific eating and drinking plans in place, their care plans clearly reflected their needs. We observed staff at mealtimes following these care plans when serving and supporting people with their food. Kitchen staff had access to people’s dietary needs and had a good knowledge of people’s allergies.

Care plans were reviewed and updated regularly. A relative told us, “We’ve been through all [name] past life and care needs. I feel they do know [name] well.” A person told us, “The first time I came here they asked me about things I like and don’t like and all about me. They do know about my condition.”

The provider did not always plan and deliver people’s care and treatment with them.

The service supported people who were insulin dependent. During the assessment we found staff were administering insulin for a diabetic person. Some medicines cannot be routinely administered by a care worker (for example injections such as insulin). A registered nurse (RN) from the community can delegate the administration of these medicines to a care worker. The nurse needs to ensure the care worker is competent and trained to carry out the task. However, in this case, assurance had not happened. There was no protocol in place between the two services. We did not find anyone had come to harm as a result of this. We addressed this during the assessment and the registered manager acted immediately to address the concern. We found that there was confusion about responsibility for the oversight of this task from local health professionals. The Care Quality Commission have followed this up with the local healthcare board.

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. The service made referrals for people where additional support was required. The service met regularly with the local GP practice to share and review people’s health. Where people required medical appointments, the service liaised with family and other health professionals and ensured a multi-disciplinary approach was followed.

One person told us, “I’ve seen the physio, the GP and had my feet done by the chiropodist.” Another person said, “I’ve had my feet done and glasses checked once.”

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 had access to social activities and were supported to take part in activities which suited their abilities and preferences. The care home promoted people’s independence. The service employed a physiotherapist who visited the service weekly and demonstrated a clear commitment to the providers ethos. The positive impact that the physiotherapist had for peoples mental and physical wellbeing was evident during our assessment, people were engaged in the physiotherapist sessions. People spoke highly of the physiotherapist and how their support had greatly improved their motivation and mobility.

One person told us, “The physio is brilliant, got me walking again.” Another said “We have the most amazing physiotherapist [name]. He does exercises and has worked with the carers who do them with me. He has given me a sheet of special exercises.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was evidence of regular reviews and action being taken immediately following any changes to people’s health needs. People’s skills, life experience and strengths were discussed with them and those involved in their care, and what outcomes they wanted from their support.

One person told us, “I have two carers who help me. They are well trained to get me into my wheelchair but I know they are considering getting me a walker.” Another person told us, “When I first came here, I couldn’t walk, and they had to lift me in and out of bed. A brilliant physio came in and got me walking. I can also chat to people.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider was in the process of making improvements to records of assessments relating to the Mental Capacity Act 2005 (MCA.) Where appropriate those with legal authority were involved in decisions.

We observed staff explaining the care and support offered to people and asking for consent before hand. For example, a person who required support with eating and drinking, the carer clearly explained what and how they would support the person. Whilst supporting the person with their meal the staff member paused and went at the person’s pace, giving them time.

One person told us, “They knock on my door, and tell me who it is. Ask my permission to do the care.” Another person told us, “They never do anything without asking me first”. A relative told us, “I’ve seen them asking Mum’s permission before they do anything.”