Lynden Hill Clinic

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 changed to 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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.The pre-admission assessment was conducted via an enquiry form, which did not contain sufficient information about people’s care needs. Staff also commented the process could be improved to ensure more information was gathered that would support more effective and smooth assessment process and then consequently admission to the service.The care planning system used was online. People had care plans in place. However, the plans were not person-centred. We reviewed 7 care plans. Some of the records were identical, except a few differences such as the names of people. There was minimal information about people’s history, except a brief medical history. The body maps were also not completed. When people came with skin integrity issues, this was not always noted to support an effective healing process.It was also confirmed by clinical staff that the care plans were generated by the online system and then minimally modified. The records did not include enough or personalised information for staff to follow so that they could meet individual people's needs safely and effectively.People told us they were not sure if they had a care plan. Some people told us they were aware of their physiotherapy exercises. However, they were unsure if all the required information to support their care and treatment was recorded. This meant we were not assured people’s needs were consistently assessed and understood to maximise the effectiveness of people’s care and treatment.

The provider did not always plan and deliver 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.The registered manager and staff did not always communicate with people, their relatives and/or partners about their care and treatment according to current good practice, relevant to people’s care. For example, one person had low blood pressure in the hospital. But this was not discussed with the person at the service. They said, “If I would get low blood pressure again, there is no machines around that could test that, I don’t think. If you would have a relapse, it is something that would not be covered here.I would have been expected to have checked my blood pressure after being discharged, but it did not happen.”For another person, it was apparent there were conditions due to the type of medications they took as prescribed by a medical professional. The clinical lead was unable to find for us details on the system regarding the previous medical history of this person or how this was discussed with them. Therefore, if the person collapsed or became unwell, the staff were not able to inform the attending physician or paramedic crew of this. It is essential that all current existing medical conditions are clearly set out on people’s profiles and easily accessible for effective treatment when needed.

The registered manager told us how they managed people’s nutrition and hydration needs to ensure it was met in line with current guidance. The information was gathered on the enquiry form before the admission such as special diets or likes and dislikes. The registered manager noted they were not accepting people with swallowing difficulties.People were mostly complimentary about the food, snacks, drinks and choices. One person noted, “I said can we have smaller portions? [Staff] said, it just comes like that, you have what you are given. They’d [staff] rather have you too much but not bother.” This did not demonstrate staff and catering team always considered people’s preference in meals or what mattered to people. But people had a choice at each meal-time including options such as vegetarian. People told us their food was of good quality.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.One person told us they had support from the physiotherapist who was informed about person’s medical condition. The only care plans they were given were the exercise plans. They also had strong medicine to manage pain. But they did not feel the communication in the team was great about managing it all. They said, “The communication between [the staff], they have not made the arrangement, and I had to remind them regularly because the communication here is not very good. Someone is communicating but you have to keep reminding them.”Another person told us they were not sure if they had a pre-admission assessment to gather specific information about their care and treatment or how it was all arranged. They did not feel the team and other services worked together as well as they could, and communication was not very good between the services. Some staff felt the service had variable amount or sometimes limited knowledge of people on admissions. They were constantly reviewing or checking and asking for more information about the people’s needs or support required. The registered manager did not always ensure all teams had the same information about people’s care and treatment to ensure it was co-ordinated effectively.

People were referred to health professionals to address their health issues or changing needs. Staff contacted professionals such as the GP or community nurses for advice. There were some records of physiotherapist and nurses reviewing some people and their progress, and infections, but this was not recorded consistently. Some actions were noted such as to continue monitoring people or following guidance for support, but there was no follow up information if these actions were taken and successful.People were positive about the care and support they received, particularly with physiotherapy.The staff supported people to manage their health and wellbeing, and people felt they could maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Some people added, “[Staff] respond to my well-being, very much so. I’ve been upset all the way around. My blood sugar has gone all over the place. They are responding very well to that” and “Yes. I feel very supported. I have a goal that I want to achieve, and the staff are helpful.”

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. The provider did not have effective monitoring systems and processes in place to ensure people using the service had the opportunity to share feedback or suggestions regarding their care or treatment.

Details were often lacking in plans of care and daily notes to ensure the support required was provided and monitored. For example, one person had a breathing problem, their plan of care contained information such as using a nebuliser, providing privacy and dignity, assessing breathing every day, reminding to use an oxygen cylinder when going out. However, the daily notes did not confirm this support was carried out regularly. Another person had a photo of a surgical wound. The wound was not reflected in a body map on the system and, daily notes did not always demonstrate this was monitored to ensure good level of support and outcomes. The daily notes were often brief and contained limited information such as “Bowels opened” and “Mobilising with 2 sticks”. Some entries described good support given for example, when a person felt unwell. However, the entries did not always use people’s names, but only “patient”.It did not demonstrate there were effective and consistent approaches to monitor people’s care and treatment and their outcomes. This meant that continuous improvements were not always made to people’s care and treatment. The registered manager did not gather or use this information to monitor and audit for any themes, trends and learning opportunities to improve people’s care, and how this was shared with staff to ensure continuity in care.There were more detailed entries noted around physiotherapy sessions and progress of it.The registered manager told us the people came to the service to get better after surgery, regain independence, confidence and be safe when back to their home. People agreed they were supported to achieve this and they had regular physiotherapy input.

The registered manager needed some prompting to fully explain and demonstrate to us that they had the skills or knowledge in the appropriate application of the Mental Capacity Act 2005.The registered manager told us how they communicated and supported people with their choices and wishes. The registered manager told us they did not accept people who may lack capacity. Therefore, they had not needed to assess anybody's capacity to consent to the delivery of their care. However, there was no clear information for staff to ensure they were equipped and trained in MCA should this become relevant, or process to follow for an assessment to support people’s decisions.

The service used CCTV at different parts of the service. The registered manager assured us this was not in people’s rooms. They noted this was used for safety reasons, but they were unable to comment further if people were informed about CCTV before coming to the service. The service did not have a clear policy or procedure about the use of CCTV and no assessment of the potential impact on people's right to privacy had been completed.

People told us they were making their own choices and were involved in decisions on a day-to-day basis about the aspects of their lives, such as, what they ate and how they spent their day. People's rights to make their own decisions, where possible, were protected and respected. Staff sought people's consent before providing care or support. We observed staff were polite, kind and respectful towards people and respected their decisions. People’s views and wishes were taken into account when their care was planned. People said, “Yes they do [seek consent]. You have seen now when [staff] came with my medication how they do it. They do this every time. They always ask and I can even say what medication I don’t want…I can always say if there is something I don’t like” and “Oh yes. [Staff] ask me if they can help me first. Yes, they respect my decisions.”