Lillington House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 82 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff delivered care that focused on people’s individual needs and goals. However, the clinical manager recognised that for some people, many of the interactions with staff were because of scheduled medical interventions. They told us how values-based recruitment, observations of practice and regular training helped ensure staff remained focused on the person rather than the task. One senior member of staff told us, “Empathy training was something they did for all the staff. When there are tasks involved, seeing the human being can be lost sometimes, but there is a will to make sure that does not happen."

People’s care was regularly reviewed, evaluated and updated to ensure it was responsive to any changes in their needs.

The provider always understood the diverse health and care needs of people so that care was joined-up, flexible and supported choice and continuity.

The ethos of the service was based on collaborative working to support people to achieve goals and planned outcomes. Clinical, therapy and care staff worked with external healthcare professionals to ensure continuity of care that was flexible to people’s individual needs. One member of staff told us, “All our work is collaborative with the patient, their family, external organisations, and our therapy team. Each of our disciplines are linked and don’t operate in isolation. Central to everything we do is the patient.”

Therapy staff worked in an integrated and co-ordinated way to maximise the benefit of each care intervention. A member of staff explained, “Each person has a MDT (multi-disciplinary team) timetable, including individual and joint sessions. This is important to ensure the patient is not fatigued. If the management of the plan is making the patient tired, then we won’t make any gains, and the plan is not effective. We always work flexibly in a way that is responsive to the patient. The plan will be jointly managed, monitored, reviewed, and updated.”

Managers and staff were enthusiastic about the benefits of staff from different fields working together. A member of the management team explained, “We work in an interdisciplinary way to achieve a goal using different disciplines to achieve this. It’s not multidisciplinary working, that is working in silos. Interdisciplinary teams are more detailed, more personalised. This approach is essential to goal setting.” A staff member commented, “The level of interdisciplinary working here, whilst it is not innovative in the sense everyone, everywhere knows they should work in this way, we truly do and I am very proud how well we do it. This way of working is invaluable for the people we support.”

Exceptional continuity was underpinned by the way staff worked together and with other organisations. When people transitioned back to their home or to other services, therapy staff compiled discharge reports about the therapy the person was currently receiving and their long-term goals. This included detail about the number of care staff needed to meet the person's needs and any specialist equipment they required.If people chose to transition their care to their home country, staff liaised with the ongoing health professionals, via interpreters if required, to ensure continuity of care. The clinical manager explained, “We have 1 resident pending discharge back home so we will go to the resident’s accommodation to see if it is suitable and liaise with the community teams. We would also accommodate bringing in domiciliary care facilities so they could get a comprehensive overview of what that person requires." This ensured people continued to receive their ongoing care and rehabilitation as they transitioned home or to a new care provider.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Therapy staff demonstrated a clear understanding of the accessible information standards and their responsibilities in relation to this. People’s communication needs were assessed, regularly reviewed and updated where needed. Assessments resulted in the identification and supply of appropriate high-tech equipment to enable and aid people’s ability to communicate.

Communication aids included eye gaze and head and hand switches. Eye gaze equipment responds to people’s eye movements and enables them to use their call bell to request assistance or operate their television independently. Head and hand switches are devices that act as a button or sensor and send signals to a communication aid when pressed.

The provider’s speech and language therapist told us they worked closely with the local NHS communication technology team to undertake joint assessments. They explained, “Once the equipment is in place we work together to teach the resident, their family, and staff how to use the aids. It has to be an inclusive approach for it to be effective.” One relative told us how the technology had facilitated and improved communication with their family member.

Where required, communication passports ensured staff understood the most effective way of communicating with people.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People’s care plans and risk assessments considered and reflected people’s wishes and choices. Relatives were given opportunities to share their views during meetings and care plan reviews. One relative told us, “[Name] has a care plan and they do reviews. Multi-disciplinary reviews are done annually with the staff.” Another relative said, “We attend care planning meetings with all the departments, nurses and dieticians.”

The provider’s process for managing complaints was displayed in the entrance to the home. One person told us they had shared an issue with the management team and commented, “I was happy with the way they handled it.” A relative said their family member had recently raised a concern. Records demonstrated this has been recorded and investigated to identify areas where practice could be improved.

Processes were in place to address minor concerns before they escalated to formal complaints. The provider had recently appointed a liaison officer to improve communication within the provider group. The liaison officer was available to people and their relatives to answer questions and address any minor issues. This staff member explained, “Families can communicate with me if they want to know what is going on but they don’t know who to speak to. If communication is difficult, barriers can come up. Sometimes there might be nothing to resolve but people just want to be listened to. Things may turn into complaints, but that is hopefully not what we want to get to." One relative reflected on this approach and told us, “I’m here every day so they tell me everything and we deal with it then. I have had no need to raise any concerns.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The GP and other specialist healthcare professionals regularly visited the service. Staff monitored people to identify any deterioration in their medical conditions, so people had prompt access to these services. Where people could not verbalise their pain, staff used assessment tools to ensure discomfort was identified and addressed promptly.

A visiting healthcare professional told us staff knew people well so were able to identify quickly when people needed escalating to other healthcare professionals. They commented, “The nurses and care staff are the eyes and ears, they are hardworking and attentive. The nurses that are here, know everything and that is the very nature of the service."

Staff ensured people had the equipment they needed to promote their independence, mobility and access to the community. One relative told us how staff had supported them to obtain a smaller and more appropriate wheelchair, so they were now able to regularly take their family member on visits outside the home.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

People’s care was planned with them and regularly reviewed to identify any required adjustments which could improve the quality of people’s life and enhance their outcomes. Whilst risks were carefully managed, these were skilfully balanced with people’s wishes and preferences and in such a way as to add meaning to people’s lives and not reduce the potential for rehabilitation.

Where people had been assessed as lacking capacity, staff worked together to ensure people were still given every opportunity to achieve positive experiences and outcomes. A member of the management team explained, “It can be difficult to take a decision that may be risky when making the decision for someone else, but being risk adverse could result in someone being medicalised. With an interdisciplinary approach the decision making is shared and therefore responsibility is shared. Discussions are held about what steps do we need to go through, what are the risks, what is the balance between not taking the risk and taking the risk. Talking things through and considering all views can open the mind to the potential value of positive risk taking.”

Managers and staff recognised how people’s health conditions and medical needs could limit their experiences and were innovative in developing solutions to address this. Targeting therapy support and rehabilitation enabled 1 person to independently maintain important connections, thereby reducing their isolation and improving their emotional and social wellbeing. Complex arrangements enabled another person to experience home visits with support from clinical staff. Careful risk management and therapeutic interventions meant improved outcomes for another person who was able to eat a modified diet after previously receiving their nutrition through a tube directly into their stomach.

The provider had equality and diversity policies which were reinforced by staff training in these areas. One staff member told us they would feel confident to challenge inequalities and commented, "I feel so strongly about that, everyone is different and we are all unique. Just because someone can't communicate, their needs are just as important, and we will speak up for them.”

Processes were in place to ensure people had the correct care, therapy and funding to achieve positive outcomes. One staff member told us, “I believe 100% the work our team does makes a positive difference to people’s lives.”

Relatives raised no concerns about the care their family member received and told us they had never witnessed discrimination within the service.

People were given support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Managers and staff helped people and their families explore and record their wishes about care at the end of their life and how these were to be met. This included supporting people to understand what was important to them and how they could achieve this against their medical needs and clinical diagnosis. Discussions had considered people’s language, communication, capacity and ability to understand to ensure their views and opinions were central to decision making.

People were supported by staff and external healthcare professionals who had the competency and skills to assess their needs and ensure they were kept comfortable and pain free. A visiting healthcare professional explained how they liaised with people and their relatives to understand the options as people neared the end of their life and when clinical interventions were no longer a realistic option.

There were members of staff who could provide emotional support and provide counselling services to support people, their family and friends during decision making and as people moved to the end of their life.