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 inadequate. At this inspection the rating has remained inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 33 (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 because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed when they started using the service. However, people’s care records and plans were not being reviewed regularly or in detail to see if there had been any changes to people’s assessed needs. As a result, care plans contained conflicting information about how to support people. For example, how people should be supported to eat safely or whether they were able to walk by themselves independently. There was no evidence people already living at the service had been considered in relation to the support needs new people moving into the service may have on them. There was limited evidence to show how people and their relatives were involved in discussion about assessed needs and how these may be changing.

However, relatives of people were positive about their experiences when their family member started living at the service. One relative said, ‘‘[Family member] tried several different places but [service] really worked hard to understand and take them on board. I am very grateful for that.’’

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

It was more difficult for staff to support people in line with best practice. It was unclear if staff training and competence in areas such as supporting people living with specific health conditions was effective. Training records were not readily available, and actions identified in competency checks were not completed to help staff support people in line with evidence-based care and treatment. People’s care plans for specific health conditions continued to lack detail to help guide staff how to support them in the best way possible. The manager and provider did not evidence how they were keeping up to date with evidence based best practice in relation to supporting people.

However, people’s relatives told us they felt staff supported their family member well. One relative said, ‘‘I think staff all really try their best to do all they can. They know [family member] and know how to calm them down.’’

The provider did not always work well across teams and services to support people. Staff were not working well together and were not always communicating with each other to share information. Staff were not reporting concerns about people’s support to the management team in a timely or effective manner. This meant changes to benefit people were not being made in a timely manner. Staff told us they had meetings and 1 to 1 discussions however these were not supportive. They told us they did not focus on information sharing and were not used as an opportunity to discuss how to best support people consistently across the staff team.

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. A relative said, ‘‘[Staff] are quick to get help from [health professional] if [family member] needs it.’’ A person told us, ‘‘[Staff] take me to see the doctor.’’

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff made records about people’s support in areas such as how much they eat and drink or how often they were supported to reposition to help avoid pressure area damage. There were multiple occasions where records showed people had not been supported to eat and drink or reposition in line with their care needs. These had not been effectively reviewed to make sure people were safe or had been supported in line with their identified needs. We observed staff supporting 1 person to eat and drink at the same time, which according to their care plan was unsafe for them to do. In some cases, people had become unwell and needed to go to hospital. Due to the lack of effective review of records, we could not be assured the deterioration in people’s health was unavoidable. Staff working in the kitchen did not have training about how to safely support people living with specific dietary needs. The provider started to put audits in place to effectively oversee these areas. However, we could not be assured this would have happened without our direct intervention and feedback. A relative said, ‘‘I am worried [family member] has been given food they cannot tolerate, and this is not something I would expect to happen.’’

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 available and this looked and smelled appetising. Food was prepared for people in line with their support needs. One person described the food as ‘delicious’. A relative said, ‘‘I wouldn’t mind eating what [family member] eats. They always seem to enjoy the food.’’

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care plans and risk assessments continued to contain conflicting information about how to support them to monitor and improve outcomes. Staff were still not recording how people were feeling in their daily records or how they were supporting them when they felt upset or anxious. The management team were still not effectively 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,‘‘[Staff] know [family member] uses [piece of equipment] but they rarely use this with them.’’

Other relatives continued to be more positive about how their loved ones were supported to monitor and improve outcomes in relation to their health. One relative said, ‘‘[Family member] is well and healthy despite changes to how they need to be supported and I have the staff team to thank for this.’’

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Some people had number locks or stairgates on their bedroom doors to help stop other people entering their bedrooms. Whilst people had capacity assessments in place for these, we were not shown evidence this had been considered as the least restrictive option for people. There was no evidence discussions with people and their relatives or other professionals had taken place in relation to this. We asked for this evidence however it was not given to us.

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. Decisions had been made in people’s best interests where necessary. These capacity assessments and best interest decisions were of good detail. One person said, ‘‘[Staff] are very polite. They ask before they do.’’