3L Care Limited

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 people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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’s care and treatment were effective. Care plans contained detailed information and demonstrated a good understanding of people’s complex neurological and behavioural needs. Diagnoses were clearly recorded and linked to practical guidance for staff on how to deliver care. Risk assessments were in place and reflected people’s needs, with clear steps identified to minimise risks such as choking and falls. People and relatives were involved in assessments and reviews. Their views were listened to, respected and reflected in day-to-day care. Professional partners were confident in the provider’s approach to assessing needs. One healthcare professional described staff as "very knowledgeable of the people being supported". Care plans were reviewed regularly, often monthly, and updated when there were changes in health or following incidents.  

The provider planned and delivered people’s care and treatment in line with current evidence-based guidance and best practice. Care plans included detailed, practical guidance for staff to support people safely. This included instructions on positioning during mealtimes, monitoring following meals, and managing risks associated with swallowing. Structured monitoring systems were in place for specific health conditions, including seizures, and were used to inform ongoing clinical review with specialist services. People’s moving and handling care plans gave clear, step-by-step instructions on how to position people safely, what equipment to use and what to consider if someone was in pain. Plans for PEG and gastrostomy care included detailed instructions. PEG and gastrostomy care means supporting someone who is fed through a tube directly into their stomach when they cannot eat or drink safely by mouth. Support for maintaining healthy skin showed input from physiotherapists, included structured repositioning routines, and made use of specialist equipment designed to reduce pressure and prevent skin damage. National guidance such as IDDSI (International Dysphagia Diet Standardisation Initiative) was followed for food and fluid textures, repositioning schedules, and use of specialist equipment, including airflow mattresses and heel protectors, were well documented. One professional partner told us, “Recommendations are always documented and provided in written reports for inclusion in care plans.” The provider recorded, shared and followed external professional advice. Staff used visual tools like whiteboards for activity planning, arranged healthcare appointments, and encouraged community access. 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Coordination between staff and external professionals had improved and was more structured and collaborative.  The provider worked well with specialist teams, including epilepsy services and hospice services to support people’s care. Care plans referred to input from Speech and Language Therapists (SALT), Occupational Therapists (OT), General Practitioner’s (GP) and epilepsy teams. This included attending hospital discharge planning meetings and best interest meetings to help ensure care remained consistent when someone moves between services. Professional partners described better communication under the current management team. One professional said, “The home manager will call or email with any concerns.” Some relatives described previous communication gaps, including delays in sharing important information and missed escalations before the current management team was in place. They told us this had improved. One relative said, “We are kept updated now. Before we had to ask.” Staff attended provider forums and external training to strengthen their knowledge and practice. Following past safeguarding concerns, learning was shared more widely across the service.  

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Care plans included guidance on nutrition, diabetes management and monitoring of conditions such as epilepsy. When someone’s health changed, for example, a new diagnosis, their care records were updated to reflect this. People’s care plans contained guidance for staff to recognise changes in people’s presentation, emotional state or distress, which may show a deterioration in their health or wellbeing. Where healthy eating was a goal, staff encouraged this. One person told us, “Dinner was 10/10.” The provider had a focus on improving people’s social, emotional and physical wellbeing and not just maintaining their clinical stability. Under the current leadership team, we saw opportunities for activity and community involvement had increased. People were supported to go out to places they enjoy such as salons, pubs and local amenities. Most relatives told us there has been a noticeable improvement in people’s overall wellbeing. In the past, they felt there was limited activity and over-reliance on medication. One relative said, “[Name] now goes out, it’s hugely improved [Name]’s mental and physical wellbeing.” Several relatives reported reduced hospital admissions, strengthened health oversight, improved mobility support and increased community access. A structured sleep programme had been implemented for one person to address excessive sedation.  One relative commented, “There is a glimmer of hope again.” 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or met both clinical expectations and the expectations of people themselves. Care plans were reviewed and updated regularly, however, some of the review notes were short and repetitive without showing analysis or reflection in higher risk areas. Although reviews were happening often, the quality and depth of those reviews varied. The provider had introduced systems to monitor risk and improve outcomes for people. People’s skills, life experience and strengths were discussed with them and those involved in their care, to understand how people’s life choices, goals, ambitions and outcomes could be planned and achieved.  The provider was conducting a piece of work to introduce a goal and wishes programme for people.

The provider did not always ensure consent to care and treatment was clearly and consistently recorded in line with the Mental Capacity Act (MCA) 2005. People were subject to a range of restrictive measures, including bed rails, lap straps, locked doors and supervision. While appropriate legal authorisations, including Deprivation of Liberty Safeguards (DoLS), were in place and monitored, the supporting documentation was not always consistent. We found some mental capacity assessments contained conflicting information. For example, records for the same person provided different accounts of their ability to understand and retain information. In some instances, documentation did not clearly demonstrate how decisions had been made, including why restrictions were necessary, proportionate and the least restrictive option available. This meant it was not always possible to be assured decision-making was consistently in line with legal requirements. However, staff demonstrated a good understanding of the principles of the Mental Capacity Act. One staff member said, “Never assume someone hasn’t got capacity.” We observed staff supporting people to make choices using appropriate communication methods, including visual aids and objects of reference. Best interest decisions were recorded, and relatives told us they were involved in review meetings. Leaders told us they had MCA champions within the staff team and used team meetings to support staff understanding.