Lillington House

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 83 (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 and their relatives had a meeting with therapy staff within 24 hours of moving into the home. Staff assessed people during the meeting so they could understand the person’s condition and formulate a treatment plan based on what was important to them and what their goals were. A member of staff explained, “We do the assessment as an integrated team to identify what input is needed. This is our starting point, and we then do further assessments.”

Assessments were holistic and covered all aspects of people’s clinical and personal care needs. They were regularly reviewed to ensure they continued to meet people’s needs, and any changes were identified and responded to.

The provider always 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. They worked to develop evidence-based good practice and standards.

The provider used evidence-based approaches to support the delivery of high-quality care and achieve positive outcomes for people. For example, therapy staff used recognised and accredited assessment tools to provide a baseline measure of people’s psychological, social, functional and practical state. Progress was regularly reviewed using a multidisciplinary approach to measure progress towards planned goals and outcomes.

Some people at Lillington House were in a Prolonged Disorder of Consciousness (PDOC). The provider used a structured, multi-disciplinary pathway to support people in PDOC. The pathway enabled staff to identify subtle signs of consciousness which helped tailor rehabilitation to the person’s exact level of response. It also provided an evidence-based framework to assess responsiveness over time and supported decision making by other healthcare professionals involved in the person’s care. We were given examples of how the pathway had been used to achieve positive outcomes for people. This included people who had transferred to Lillington House in PDOC and were now able to communicate and express choices and participate in decision making. Case studies had been shared with other organisations to develop learning and boost skills to apply this approach in different care settings

Assessments of people’s nutritional risks were supported by proven best practice and validated screening tools. The provider had employed their own Speech and Language Therapist (SALT) who liaised with dieticians to regularly review people’s nutritional care needs. Detailed and up to date information about people’s individual dietary needs and feeding regimes was available to staff. The chef demonstrated a good knowledge of people’s modified diets and explained how they adapted meals to ensure they had the right nutritional value for people’s specific needs.

People and their relatives were positive about meal standards. Comments included: “The food here is pretty good, I always get a choice”, “[Name] gets a good choice and they like the food” and “The food here is nice, they do give me a choice. I get loads of drinks.”

The provider required staff to regularly refresh their training and records demonstrated a good level of compliance in line with the provider’s expectations. Where people had complex medical conditions or required specialist equipment, training was arranged with specialists in that area. For example, ventilator respiratory specialists and tracheostomy nurses. Clinical staff were supported to keep up to date with their training to improve clinical outcomes for people and comply with their professional regulatory standards. The clinical manager explained, “The nurses recognise they need to keep up to date, particularly as they work in an autonomous state. They have to recognise when to escalate concerns and how to do so appropriately and that can only come through training.”

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.

Care, clinical and therapy staff shared information effectively which meant people received the care and support they required to be safe and achieve planned outcomes. One staff member told us, “Teamwork is second to none. Not just the therapy team but the nurses and the care staff. We all work together to achieve people’s aims and to keep them safe.”

Staff described strong collaborative working relationships with external healthcare professionals to ensure people received the support and medical interventions they needed. There were established links with the GP, neuropsychologist and other specialist consultants who visited the home regularly. One staff member told us, “I have never worked anywhere previously where there is such close teamwork, effective communication, and collaboration. We work in partnership with consultants and that is amazing, we review and problem solve jointly. We are able to share our ideas, our knowledge and experience. The benefits for the patient are immense; it gives real consistency.” Healthcare professionals told us information sharing was appropriate and timely.

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.

A visiting healthcare professional told us staff were very good at completing any requested checks and took appropriate and timely action to support people’s health. They told us, "The nature of the residents is so super complex, and it is the detail and the little things that make a difference to people's care here. The healthcare assistants are the ones picking up the little changes, and that gets escalated to the nurses. It is that early intervention that stops pressure sores developing. It is the interventions from the therapists that keeps people's mobility and the work in maintaining function so people can sit comfortably in a chair and are not bed bound. They work hard to maintain people's stimulation." A relative confirmed, “[Name] has never had any falls or sores or anything like that.”

There was a strong emphasis on supporting people’s oral health to keep them well and reduce risks. One staff member told us, “Supporting good oral hygiene is a high priority as poor oral hygiene is a primary cause of infection.”

The provider monitored all people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent and fully met clinical expectations and the expectations of people themselves.

There was a multi-disciplinary approach to supporting people and their families to identify and achieve goals and planned outcomes. On site health professionals included a speech and language therapist, physiotherapists, occupational therapists and a psychologist. The therapists worked together, with clinical and care staff and external healthcare professionals to help people achieve what was important to them. A member of the therapy team told us, “Each therapy session is individual. Specifically designed for the person, the stage of their recovery as each person’s recovery can look very different, and the specific outcome they are looking for.”

Outcomes were formulated around what was important to the person and staff recognised that monitoring progress against social and emotional outcomes was as important as physical achievements. One staff member explained, “We have to accept the focus needs to be on what the person wants and what is important to them to improve their quality of life. I may think the focus for the person is strengthening their muscles so they can stand but this could use too much energy so the person would be fatigued and unable to spend time talking to their family which is important to them. So, communication becomes the priority which could mean for example a focus on building strength in their hands so they can independently face time their family and friends.”

Staff held regular and effective multidisciplinary meetings to monitor people’s progress and formulate different approaches to maximise people’s potential to achieve planned outcomes. One staff member explained, “We speak to people about their aims and goals and then combine that with our assessments to identify short, medium and long-term goals. During our weekly meetings we share these with the neuro rehabilitation consultant. They will look over them and agree or amend. We share these outcomes with the person or their family and then agree how we are going to work towards achieving these.”

Staff gave examples of how they had supported people to achieve their planned outcomes through effective monitoring. This included people who had been receiving their nutritional intake through a tube directly into their stomach and were now able to experience the pleasure of taking some food orally. A staff member commented, “You should have seen [Name’s] face when they had their first soft and bite sized meal. They smiled so much it was absolutely lovely.” Another member of staff explained the positive impact on a person who was now able to communicate independently with family and friends. They told us, “It has changed [Name’s] life and improved their emotional well-being.”

A visiting healthcare professional told us, “I am particularly happy with the way that the team works in goal setting. They have a positive and team working mindset, and they come up with very nice SMART [specific, measurable, achievable, realistic and time-bound] goals with my guidance. They follow the mutually agreed plan, and they are very respectful of my input.”

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

The provider recognised that whilst some people had communication challenges, it did not mean they could not communicate in a meaningful way or lacked the capacity to make their own decisions. People were given the support, time and equipment to maintain their voice in decision making and exercise choice and control in their lives. This ranged from day-to-day choices to decisions about clinical care.

Where people’s capacity to make a specific decision was questioned, formal capacity assessments had been completed.

Where people had been assessed as lacking capacity, staff consulted with others involved in people’s care to ensure any decisions made were in the person’s best interests. One staff member told us, “If a person does not have capacity, then we attend mental capacity assessments and best interest decision making meetings. Each best interest meeting is decision specific. We work with IMCAs and families. Many of the residents have LPAs in place. The focus of the best interest meeting has to be the person. They are at the centre of the decision-making process.” The clinical manager told us, “When we have best interest meetings, we always ask relatives to focus on what their family member would want, not what they want. This can be difficult and needs time and patience to explore.” IMCAs (Independent Mental Capacity Advocates) support people assessed to lack capacity and who do not have any family and friends to consult about the decision, to make a best interest decision. An LPA is a lasting power of attorney who can make decisions on behalf of people who do not have capacity.