Lillibet 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 inadequate. At this assessment the rating has remained inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of a legal regulation in relation to person centred care. People’s care plans did not contain the correct information about their support needs. People’s preferences, likes and dislikes were not always recorded or being considered. People were not being asked to feedback about their care and support in meaningful ways. Some people were not supported to engage in meaningful past times.

This service scored 36 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People were sometimes supported by staff who had not worked at the service before making person centred care difficult. For example, some people did not speak English as their first language. Staff members supporting them could not speak their preferred language and had not been supported to learn some phrases to help talk with them. This meant staff were unable to converse with people. Another person was visibly upset and showing how they were feeling by vocalising certain phrases. Staff supporting them did not realise this was happening and this led to the person becoming more upset. People continued to go for long periods of time without meaningful engagement from staff. Staff continued to not always record how people were feeling in care records. The provider and management team were not effectively reviewing care records to help ensure people were receiving care in line with their support needs and preferences.

There has been some improvements to people’s care plans since our last inspection. However, there remained a lack of information about people’s personal preferences and the way they would like to be supported in their care plans. People’s care plans for support needs such as living with dementia or health conditions continued to be more generic and lacking in person centred detail.

However, people and relatives told us they were satisfied with their support. One person said, ‘‘I think staff are my friends. I like them all.’’ A relative told us, ‘‘Our experience has been really positive. Staff are all kind friendly and very pleasant.’

There were shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People’s care plans contained variable information about people’s religious and cultural backgrounds, although this had improved since our last inspection. The majority of staff at the service had worked with people for some time which promoted continuity of care. However, some staff who were unfamiliar with the service were deployed to support people who they did not know, leading to poorer outcomes for them. Staff supported people to access the local community on occasion, however these opportunities were few and far between. Staff told us they would like more chances to support people with this. We could not be sure people were being supported with the correct care provision from external professionals in a timely manner. This is because care records were not always being completed or reviewed in an effective manner.

However, people and relatives gave us positive feedback about their relationships with the staff. One person said, ‘‘Staff have helped me lots and know me well.’’ A relative told us, ‘‘I have noticed that staff continuity has been much better recently. [Family member] seems to know everyone.’’

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People whose first language was not English were supported by staff who could not communicate with them in their preferred way. Staff were not supported to have a care plan that contained phrases that could be used to help communication with the person. Another person used hearing aids and a whiteboard to support their understanding however these were not being used by the staff team. Instead, staff members raised their voice and spoke loudly with the person.

Whist, forms of communication such as pictures and objects continued to be available , we did not see these used by the staff team to support people. People would have benefitted from using these consistently to help them communicate. People’s care plans identified that signs and certain phrases could be used to support them understand what was being communicated. However, the care plans continued to not be updated with sufficient detail about what these signs and phrases were or how staff should support people with them. We were not sent any evidence of information such as policies, care plans or meeting minutes being available in easy read or accessible formats.

Staff spoke with people in a calm and relaxed manner and told us what people’s body language meant. Relatives were kept up to date with information about the service and how their loved ones were being supported. One person said, ‘‘I like to talk about my book and [staff] do this with me.’’ A relative told us, ‘‘We are kept up to date with everything that is going on at the service.’’

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

There continued to be little evidence people and relatives were being asked for feedback about the service. There was no evidence how feedback was being used to identify and drive changes or improvements at the service. There continued to be little evidence people, or their relatives had been asked to be a part of discussions about people’s care plans and risk assessments. A relative said, ‘‘[Staff] don’t talk to me as much as they could. I am supposed to have a monthly call, but it never happens.’’

However, staff sat and listened to people through the day when they could. People who were able to do so attended meetings to discuss the service. Whilst there was no evidence or records, the provider and staff told us people were asked for feedback in 1 to 1 discussions. One person said, ‘‘[Staff] are very good listeners.’’ A relative told us, ‘‘I always get asked for my opinion whenever anything happens with [family member].’’

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. Daily records were not being effectively reviewed to see if people needed more support or if their needs had changed.

However, staff supported people to contact health professionals such as GP’s or speech and language therapists if necessary and supported them to attend appointments with these professionals. Professionals were positive about how the staff team worked with them to support people.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

Following our last inspection the provider had put plans in place to improve the experience people had at the service. However, there had not been significant improvements in multiple areas. People continued to be at risk of having poor outcomes in multiple areas of their support at this inspection as discussed throughout the report. As a result of sometimes going longer periods of time without staff interaction, people’s experiences at the service were sometimes not as positive as it could be. There continued to be little evidence to show how people were being supported to discuss their goals and ambitions and then achieve these. This put people at increased risk of having poorer outcomes at the service. There was a timetable of social engagement in place at the service, including reminiscing activities and outdoor opportunities although we observed this to not be what happened. One relative explained, ‘‘I do worry about how much time [family member] spends in their room. It is almost like they are locked away.’’

We observed some people to enjoy social pastimes on offer, for example playing ball games and board games or being supported to read books. Staff tried their best to engage with people in the communal areas of the home as far as possible. We saw this meant a lot to people. One person laughed and indicated to us how much they were enjoying playing games with staff. A relative said, ‘‘There is always something going on in the lounge and [family member] is given cognitive and tactile things to do by the staff team as far as possible.’’

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People had end of life plans in place if they chose to do so, and these were quite detailed and personalised. However, there was less evidence people had been supported to discuss plans for the future in other areas such as what they would like to spend their time doing at the service.

Staff told us how they would support people at the end of their life and the importance of doing this with dignity and respect. Relatives were positive about the experiences their loved ones had at this time. A relative said, ‘‘I want to give huge praise to [staff] who were superb and supported us allas a family when [family member] passed away, again with professionalism, but with the loving care that I recognise throughout the home. Nothing was too much trouble, and they kept us informed at every stage.’’