Rawreth 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 changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The provider was previously in breach of the legal regulation in relation to need for consent and meeting nutritional and hydration needs. Improvements were found during this inspection, and the provider was subsequently no longer in breach of these regulations.

This service scored 63 (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.

The provider used both the local authority’s referral documentation, and their own pre-admission assessments to gather information about people to determine if the service was suitable and could meet their needs. Information gathered though this process had also been used to assist with the care planning and risk assessment process. We reviewed a number of care plans and risk assessments and confirmed these mirrored the information provided during assessment and reflected people’s wishes about how care should be provided.

A relative of someone who uses the service told us, “The staff treat [person] so well, all of them, the whole team. I can’t complain. They talk to [person] and [they] love it. From the very first day I came in, it’s been amazing. They keep me up to date. They ask us how [person] likes things.”

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

People’s care and treatment were not always delivered in line with the most up to date and current evidence-based guidance, recognised best practice or the provider’s own procedures. Although the service used a range of assessment tools to identify and monitor people’s needs, these were not consistently reflected in day-to-day practice. This meant the provider could not always demonstrate that people received care and support in accordance with their assessed needs and associated risks.

Records relating to nutrition, hydration, diabetes monitoring and medicines management were not always completed accurately or consistently, limiting the provider’s ability to monitor care delivery and respond effectively to changes in people’s needs.

For example, one person required blood glucose monitoring 4 times a day. We found multiple instances where this did not occur. Management were aware and gave assurances that this would be improved.

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 provider worked closely with other professionals, to ensure people’s care needs were met. Referrals had been made in a timely way to services such as the falls team, dietician service and speech and language therapy. Care records explained why the referral had been made and logged feedback received following any consultations or visits. Due to the service being an NHS provider, referrals and information sharing were seamless.

Although it was not recorded, we saw evidence of daily checks being conducted by the registered manager and action points being addressed. Observation records, fluid charts, care plans among other checks were conducted daily on a sample of people at the service. In response to our feedback, the registered manager put in place a daily checklist for consistency and to evidence the work already occurring.

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 a range of healthcare professionals, including GPs, speech and language therapists, dieticians, podiatrists, opticians and dentists. A full-time physiotherapist supported falls prevention, rehabilitation and mobility, delivering both group and one-to-one interventions. Weekly multidisciplinary meetings involving therapy, nursing and medical staff helped ensure care remained current and responsive to people's needs.

We saw evidence of positive outcomes, including people becoming more mobile and independent following admission to the service. One relative told us, “We really can’t praise it highly enough. They literally go above and beyond. It’s been a massive improvement for [person], in the way that [they] are and the way that [they] live [their] life.” Another relative told us, “My [relative] has not really been eating, but they’ve been brilliant, asking [them] what [they] like. The nurses have been very encouraging, feeding [them] build-up drinks. The kitchen asks [them] what [they] like. The food looks good and there is plenty of choice. They offer me a meal, it’s nice you know they make me feel welcome. All the staff, I speak so highly of them. The physios had [them] out of bed and into a chair, which I wasn’t expecting! I really would recommend this place to friends and have done. It’s marvellous. The staff are just so, so helpful.”

Nutrition and hydration were managed well overall. Pictorial menus were used to support choice and stimulate appetite, and people could request alternative meals based on their preferences. A dining room champion supported mealtimes and monitored nutritional intake. One relative told us, “Since [they’ve] been here (Rawreth Court), it’s changed [their] outlook completely. [They] are a lot, lot brighter. [they] don’t tend to eat much, but they’ve tried all different things. They even offered [relative] a 15-ounce steak. If [they] wanted it, they offered to go and get it from the supermarket.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

Whilst the provider had systems in place to monitor people's care and treatment, these were not always effective in identifying concerns or improving outcomes for people. We found examples where care records were incomplete or inconsistent, including gaps in blood glucose monitoring records, repositioning charts and medicines records. This meant the provider could not always demonstrate that people had received care in line with their assessed needs, or that risks to their health and wellbeing had been effectively monitored. Although governance systems had identified some areas requiring improvement and action had begun, further work was needed to ensure oversight processes consistently identified concerns, drove improvement and resulted in positive outcomes for people. The provider recognised these areas for development and had already started implementing changes; however, further time was needed for these improvements to become fully embedded and consistently effective in practice.

The provider did not always ensure the principles of the Mental Capacity Act 2005 were consistently applied in practice. This meant people could not always be assured that decisions about their care and treatment were supported by appropriate consent, capacity assessments or best interest processes.

People's rights to make decisions about their care and treatment were not always fully supported in line with the Mental Capacity Act 2005 (MCA). While consent, mental capacity assessments and best interest decision-making had been considered for some people, these arrangements were not always consistently maintained or applied in practice.

For example, a person was listed as not needing an independent mental capacity advocate (IMCA) due to having a family member who will advocate. However, when a mental capacity assessment was carried out, there was no involvement from the family member. This meant that the person had no person to sufficiently advocate on their behalf when decisions were being made. This and other recording errors and errors in practice were highlighted to the registered manager and assurances were provided that this would be addressed.