The Royd

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 needs were appropriately assessed and staff and teams consistently worked together to provide good outcomes for people.

This service scored 67 (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 were effective becausethey did not always check and discuss people’s health, care, wellbeing and communicationneeds with them.

The service had recently migrated to a new electronic monitoring system. We found some support plans were missing, such as personal care plans. These were added promptly once identified. It appeared the plans had been completed previously but had not migrated over and so were not available for staff to see. Although care plans were generally thorough and detailed, they did not always include essential medical information. For example, one care plan referenced how to respond to hyperglycaemia but did not provide guidance on managing hypoglycaemia. Another did not include information about how a person’s dementia affected them or how staff should support them. Absence of this information does not support staff to deliver safe, person‑centred care. Staff confirmed that reviews took place every six months or sooner if needs changed. One staff member told us, “Everyone has a weekly plan, monthly plan, and six-monthly review. If there are changes, we update before the review.” Relatives told us they were not invited to participate in reviews which may limit opportunities for family involvement in care planning. All people at the service had capacity at the time of the assessment, meaning relative involvement was not required; however we were not assured that family involvement had been considered.

However, people at the service felt that staff understood their needs, “I feel staff understand my personal needs and give me the right support.” People’s needs were assessed comprehensively, covering physical, mental, sensory, social, and communication requirements. People were involved as much as possible, and advocacy was arranged when needed. One person living at the service told us “I am involved in decisions about my care”. Communication needs and individual risks were clearly documented, and staff were kept updated through handovers to ensure continuity of care.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff appeared confident and competent when providing care and were able to contact the GP and other health professionals to ensure people’s needs were met. A person using the service told us “Staff arranged for a doctor to visit the home when I needed it”. People’s nutritional and hydration needs were assessed and managed effectively. Support plans included clear instructions for supporting individuals with complex needs, such as swallowing difficulties or specialised diets. Most support plans detailed individual’s preferred meals, drinks, routines, and staff were aware of these requirements. Nutrition and hydration care plans were in place. These included guidance on recognising signs when dehydration may be more likely due to an individual’s mood and how staff could encourage fluid intake. People had access to the kitchen to make drinks, or they could request support from staff. One person explained, “The home is flexible around my wishes and if I am out at mealtimes they will arrange for a meal when I return home”. We observed staff asking people what they wanted for supper and engaged positively during mealtimes. On the day of inspection, Friday was “takeaway day,” and meals were served with drinks of choice. People told us they were happy with the food and drink provided. One person said, “I feel very happy with the food and drinks they have, and happy with the choices available.” Another commented, “I am provided with good choices of food and drink every day.”

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, teams and external services generally worked well together to deliver coordinated, person-centred care. Information was shared effectively, and all staff had access to care plans containing essential details and contact information for healthcare professionals. Any updates, appointments or concerns were communicated during handovers, ensuring staff were aware of any changes. One healthcare professional explained how they worked with the service to ensure people got the necessary support they needed. They also helped to sign post the service to other healthcare professionals when required. The healthcare professional stated, “We have built a rapportbetween each other… they are always available to take my call”.People told us they felt supported to access healthcare and mental health services, and relatives said they were generally kept informed of changes.

However, we noted a delay in making a referral for specialist support. A choking incident was recorded in the daily logs, and while a care plan was put in place immediately. The referral to the Speech and Language Therapy (SALT) team was not made until 11 days later. The service explained this was due to delays in response from external professionals, but the timeframe could have placed the person at risk. Despite this, staff were proactive in working with other services and followed up on actions when multidisciplinary involvement was required.

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’s day-to-day health and wellbeing needs were met, and staff worked to promote positive outcomes. People told us they felt supported with healthcare and lifestyle choices. One person said, “I am supported with all my healthcare appointments,” while another commented, “If I want to go out, the staff will support me.” Staff empowered people to be involved in managing their own health and wellbeing. Key worker sessions took place regularly, giving individuals the opportunity to discuss their mental and physical health, medication, confidence, self-esteem, and anything they would like to do. For example, one session recorded a person’s wish to reduce the number of cigarettes they smoked daily. The plan included practical steps, such as offering positive praise and reminders to help them stay motivated. Support plans promoted independence and considered both the benefits and risks of activities. For instance, encouraging someone to help prepare food was seen to maintain confidence and motivation, while reducing the risk of losing autonomy. A relative told us, “They help and encourage [the person] to maintain their independence.”

The provider did not always ensure that outcomes were positive and consistent, or that they met the expectations of people.

Support plans included goals and outcomes, however these were not always person-centred and sometimes appeared written from a staff perspective rather than reflecting what mattered to the individual. For example, one goal stated, “Increase confidence in communicating needs,” this lacked personal context. There were missed opportunities to make goals more meaningful and tailored. For instance, a person told us, “I really like the soup [staff member] makes, I would like to have that more often.” This could have been developed into an outcome, such as supporting the person to enjoy the soup regularly or learn to make it with staff support. We found inconsistencies between care plans and daily logs. In some cases, personal care tasks recorded in daily notes were not reflected in the care planning documents. The lack of alignment reduced the ability to track progress and ensure goals were being met.

Staff supported people with their preferences through key worker sessions and informal conversations, and we saw positive outcomes, such as someone being supported to buy new clothes to “feel good.” However, these achievements were not reflected in support plans. While staff were committed to improving people’s experiences, the lack of personalised goals and clear documentation limited their ability to monitor progress and ensure outcomes were meaningful.

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

People’s rights and decisions around consent were understood and respected by staff. Staff demonstrated awareness and the importance of obtaining consent before delivering personal care, support or treatment. During the inspection, we observed staff seeking consent from people when offering personal care and medication. People told us it was routine practice with one person saying, “Staff always ask me for my consent before providing support”. Staff told us how they supported individuals to make informed choices. One staff member said, “We give people options and time to decide. If someone wants to buy something, we help them make a list, check with the manager, and make sure they get what they need.”

People were involved in consent decisions as much as possible. Staff took practical steps to ensure individuals understood what they were agreeing to and provided appropriate information and support. All staff had completed training on capacity and decision-making and demonstrated a good understanding of the Mental Capacity Act.

At the time of inspection, everyone living at the service had capacity, staff were clear about what to do if this changed. Advocacy services were available when needed, staff told us how they would seek independent advocacy if someone was unable to make decisions. One staff member told us, “If someone can’t make a decision, we make sure they have someone to represent them. We always aim for transparency and meeting the person’s needs.”