Lillibet 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 inspection we rated this key question requires improvement. At this inspection the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 38 (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 make sure people’s care and treatment was effective. Care plans were not always in place for people’s known support needs. People’s daily records were not being reviewed to identify if people’s support needs had changed or if their care plan needed updating. People’s care plans contained conflicting information in many areas such as, how many staff were needed to support them with their needs such as moving and handling or personal care or what consistency their food needed to be. People were being supported to start living at the service with complex support needs and it was not always clear how these had been considered in relation to people who were already living there. One person said, ‘‘I find it difficult when other people living here [show how they are feeling] and it is very loud.’’

However, people and their relatives were positive about their experiences when they started living at the service. One relative said, ‘‘Since [family member] has lived here the staff have looked after them well and their health has improved.’’

The provider did not plan and deliver people’s care and treatment with them, including what was important and mattered to them. People were living with specific conditions such as dementia or health conditions like diabetes or Huntingdon’s disease. However, people did not always have care plans and risk assessments in place for these support needs. Most of the staff team were not trained to support people living with dementia or their specific support and health needs. The registered manager and provider were unable to evidence how they kept up to date with current best practice guidance about how to support people.

However, people and their relatives were happy and felt staff supported them well. One relative told us, ‘‘[Staff] have taken the time to learn about how to help [family member] with [support needs].’’

The provider did not always work well across teams and services to support people. Staff were not working together or communicating as effectively as they could have been. They were not handing over incidents or changes to people’s support needs with each other to help ensure good continuity of care for people. Some staff told us they did not feel they had enough opportunities to meet and discuss what happened whilst they were supporting people. Staff were not relaying information to senior staff so it could be escalated if there was evidence people may not be safeguarded from abuse or may need different support with their care needs.

However, the staff team linked and worked with other service and health professionals such as GP’s and district nurses. These professionals were positive about their working relationship with the staff team. One person told us, ‘‘I see [health professionals] on a regular basis and staff will make sure they help me with the appointments if I need them there.’’

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or, where possible, reduce their future needs for care and support. People’s care plans identified where they needed support in areas such as pressure area care or the amount they eat and drink through the day. However, they did not specify how often people needed support with pressure area care or how much they needed to eat and drink to be healthy. Staff were not always recording when they supported people in these areas to stay healthy making it harder still to see if people were being supported effectively in these areas.

However, we saw people being offered food and drink regularly throughout the day. People at risk of pressure area care had not developed pressure ulcers. People were positive about the food and drink given to them and this looked and smelled appetising. One person said, ‘‘The food here is good and they change the menu quite often.’’ A relative told us, ‘‘I think a lot of the food is home cooked and you can tell.’’

The provider did not routinely monitor people’s care and treatment to continuously improve it. People’s outcomes were not always positive and consistent.

It was not clear how people were being consistently supported to achieve outcomes in relation to their emotional health and wellbeing. Care plans and risk assessments did not detail how people were to be supported in these areas in enough detail. Staff were not recording how people were feeling in their daily records or how they were supporting them when they felt upset or anxious. People’s care was not being effectively reviewed to make sure they were being supported to achieve their health-related outcomes. For example, staff were not raising concerns if a person drank very little throughout the day. The management team were not reviewing care records to help identify when people’s outcomes had been met or whether they needed more support to improve their outcomes. A relative said, ‘‘I think the staff could be a little more on the ball with things. [Family member] could have more support with [support need] but things are slow moving it seems.’’

Other relatives were more positive about how their family member was supported with the monitoring of their care. One relative told us, ‘‘[Staff] monitor [family members support need] well and there have been some improvements in this.’’

The provider did not always respect people’s rights when delivering care and treatment. Staff were supporting people with personal care when they refused to have this and there were no capacity assessments or decisions made to show this was in people’s best interests. Staff were supporting people to have medicines covertly when there were no capacity assessments or decisions made to show this was in people’s best interests.

However, capacity assessments had been completed for people in other areas of their care, for example being supported to stay at the service or the use of CCTV (closed circuit television). Decisions had been made in people’s best interests where necessary. These capacity assessments and best interest decisions contained good detail.