Prestige Nursing East Lancs

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 changed to outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 was exceptional at making 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.

We found different examples where the provider did so, 1 being as follows.

Staff supported a child whose complex health needs made family outings a challenge. Staff went out of their way to find out what the child and the family would like to do and how to achieve this safely. They did so in several ways including: having regular discussions with the family, offering practical reassurance regarding staff knowledge and ability to manage risks, reviewing emergency risk assessments to make sure family were fully onboard, developed checklists to ensure all essential equipment, medication, and emergency supplies were available before leaving the home. All these actions and more enabled the family to develop full confidence and build up a positive risk-taking approach. Eventually the child and family could spend quality time together and enjoy a day out, which was previously unachievable due to the complexities involved. Other positive outcomes included creating meaningful memories and increasing confidence in staff so that further family outings were co-ordinated. Feedback from the family members was overwhelmingly positive, and staff were committed to supporting all people in the same way, to achieve similar outcomes.

Where able to, people wrote their own care plans, and care plans contained a significant amount of information not just regarding health information, but also people’s social situations, and goals they would like to achieve. Support was regularly reviewed involving all relevant people, and 1 relative told us, “It really is a very person specific care package, and we are very grateful for all their hard work.”

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

For example, the provider noted an increase in demand to support people with Motor Neurone Disease (MND). They met this challenge by arranging bespoke training for staff and creating and maintaining links with MND specialists and teams. This meant staff had a better understanding of how to support people, and made sure referrals were made in a timely manner. Staff could identify at an early stage when people’s health changed, for example the need for a soft diet to reduce the risk of choking.

The learning and development manager spent time with people to observe their daily routines and gain important information. This meant staff were trained according to people’s specific needs, such as moving and handling techniques. This approach was replicated for other health conditions such as people who had experienced a brain or spinal injury. This increased staff confidence and in turn their ability to support people safely and with a view to helping them achieve their goals.

Staff advocated to make sure people received health funding where needed.

Staff worked alongside health professionals such as PEG nurses, (a PEG is when someone has a tube inserted directly into their stomach for food, fluid and medicines) ventilation teams and learning disability teams. This meant care was fully co-ordinated and joined up, with the right people involved with the right knowledge and skills.

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

Care plans could be adapted dependent to the person, for example for young people, care plans were worded in a child friendly manner. For people with complex needs, care plans contained photographs of items such as moving and handling equipment and feeding equipment to make guidance easier to understand. The provider was able to adapt written information into different formats if required, and some members of staff spoke different languages which made communication for some people who English was not their first language easier.

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.

There was an appropriate complaints policy and the registered manager collated concerns and compliments and passed these on to staff. People knew how to raise concerns, although the provider had not received any formal complaints. A person said, “I never have reason to ring the office, and I have never needed to complain. If I need anything I speak with the carers and they sort it out.”

The provider sought feedback from people in different ways such as surveys, telephone reviews and face to face reviews.

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

The service was flexible, and staff supported people to attend appointments or in an emergency. People said staff were reliable, and staff usually attended visits on time. There was an out of hours protocol and staff were able to gain advice and support from a manager at any point. Care plans considered people’s mobility needs and staff worked alongside professionals to make sure people had the right equipment to aid their mobility.

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.

Staff understood potential discrimination people they supported may face, for example when accessing healthcare.

Staff completed training on ‘stopping over medication of people with a learning disability and autism’ which is a national NHS England programme to stop the inappropriate prescribing of psychotropic medications. This meant staff could advocate on behalf of people, and were confident to do so, when decisions about medicines were being made.

Staff did the same with other types of medicines and clinical interventions. For example, staff identified when someone had a blocked catheter and required more urgent care than what was being offered. Staff made face to face visits and several telephone calls to try and resolve the situation. This was successful and prevented skin breakdown or further health issues.

For another person staff noticed issues with their pain relief medicines. Initial enquiries did not resolve this adequately and so staff challenged this further. Eventually the situation was resolved and the prescription was amended. This meant the person’s pain was managed safely and effectively, they experienced successful pain relief, which in turn reduced the level of distress the person experienced and overall improved the quality of their life.

For a further person, staff identified their feeding tube was leaking. When this was initially escalated to the PEG team, staff were told this can be normal and not to worry. However, staff recognised this was not normal for the person and advocated on their behalf for a proper review. During the review, health professionals agreed, leading to a change in clinical practice and the leakages reduced. This meant there was a reduced risk of skin damage, infections and other medical complications.

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

Prestige Nursing East Lancs received high praise regarding the provision of end-of-life care. Comments from relatives included, “Words cannot express our appreciation and gratitude. The professionalism and presence meant we were able to get some much-needed rest at night, knowing that our [relative] was in capable hands. The care was nothing short of a godsend. We received professional advice from the staff, which meant we could care for our [relative] well during the day.”

A further comment was, “We feel incredibly grateful that he had such caring and compassionate people around him. The ongoing care, support, patience and kindness staff showed meant more to us than words can ever express. Knowing that he was cared for and treated with kindness gave us comfort, especially during the difficult times. We will never forget the care, the time you spent, and the compassion showed to our family.”

A person receiving care at the time of the assessment told us staff had really listened to them, laughed and cried together, and gave them a “real boost”. The person added staff empathised and made them feel relaxed.

We saw several examples of compliments received and thank you cards during the assessment.

The provider was part of the hospice framework and so were commissioned to provide care for people who were in the final days of life. It also meant formal links were established with several hospices, and the team could access extra training including recognising when someone may be approaching the end of life, symptom management, avoiding unnecessary hospital admission, and spiritual care.