Lilias Gillies House

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• 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

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 assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care and wellbeing with them.

We reviewed 3 care records during our assessment. Staff completed an assessment of the resident’s needs in a timely manner at, or soon after, admission. Detailed physical health needs were assessed by the resident’s GP or external agencies.

Staff mostly developed care plans that met the needs identified during assessment. Two out of 3 residents had personalised care plans to meet their identified needs. One resident did not have a care plan or risk management plan around non-compliance of their medicines. Care plans were reviewed every 3 months by the resident’s keyworker, the community social worker and the clinical psychotherapist.

Keeping safe care plans showed that residents and staff had discussed and recorded signs of deterioration and distress and coping strategies to help reduce the risk of harm occurring. However, 3 residents told us they did not have a copy of their care or recovery plans or did not know what their care and recovery plans were.

One out of 3 records had the views of the resident in their care plans. One record indicated involvement in the discussion, but no direct views were obtained.

Staff assessed the communication needs of resident and ensured that these were met. One resident had an autism passport and a sensory needs care plan detailing their required communication needs. They told us that agency staff did not understand their needs as well as the permanent staff did. One resident had a set of cards that they placed outside of their door to inform staff of their mood and current presentation. Red described feeling unsafe and may require support from staff and green showed that they felt safe.

The service did not always discuss people’s care and treatment with them, including what was important and mattered to them.

The aims and objectives of the service were to enable people experiencing high levels of mental distress, including psychosis, personality disorders and complex needs, to recover and achieve more of their potential in life through the provision of psychotherapy and psychologically informed therapeutic environments in residential communities. The service did not admit anyone that was detained under the Mental Health Act.

The service provided interventions that were primarily psychotherapy based and used a clinical treatment model based on psychologically informed environments (PIE) and trauma informed care principles. The five stages of their clinical model were engagement through developing daily task management, attachment through therapeutic relationships, containment through supportive environments, exploration through learning and autonomy through participating in community life. This was based on meeting the emotional and psychological needs of each resident.

This model was implemented through residents receiving one to one therapy and attending a weekly psychosocial group facilitated by the clinical psychotherapist. Residents and staff also attended a weekly community reflective group which was a space for both to reflect on the individual and group dynamics. Three residents were not currently taking part in the individual therapy treatment programme. Disengagement from therapy was anticipated and clinically understood within the model of the service and within the recovery plans agreed with residents.

A timetable showed that there were weekly activities available, such as art therapy and a walking group. Feedback from clients about activities was that they felt there was a lack of them or they wanted more on the evenings and weekend. One resident said the activity group set for 3pm every day did not always happen. One resident commented that weekends at the service could be lonely and isolating. We found lack of evidence of one-to-one meetings between the resident and their keyworker to discuss their care and treatment needs.

Staff ensured that residents had access to physical healthcare, including access to specialists when needed. We saw evidence of referral to physiotherapist for one resident and liaison with a specialised medicines clinic for another resident to ensure that regular physical health monitoring was completed.

The service did not always handover internal information effectively. Although there were examples of liaising with some external services, this could be further improved.

Staff attended daily handover meetings, including agency staff. We observed a morning handover meeting and saw that the running of this could be improved. Some staff arrived late so missed important information. Staff did not keep written records of the meeting, including actions required and who was responsible. Staff ensured that incidents from the previous day were discussed and these were repeated with the staff that had arrived late but there was no discussion of the current resident’s risks for all staff to be aware of. Managers had planned to improve the staff handover by implementing a new handover template document. This aimed to improve the discussion and recording of information during the staff handover meetings.

Records showed evidence of appointments being made with external services for residents such as GPs and drug and alcohol services. Residents were encouraged to attend their own appointments independently in line with the provider’s therapeutic model. For example, one resident attended external Dialectical Behavioural therapy (DBT) to help manage their emotions, improve their coping skills and try to reduce self-harm behaviours. However, there were specific instances where liaison with external services could have been more consistent and better documented.

The service supported people to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported residents to live healthier lives and maintain their independence in doing so. We saw an example of the service providing a health education session in December 2025 to provide information to residents on how to cook and eat healthy food.

Residents were responsible for cooking for the other residents in the service and planned a menu each week.

The service planned to ask an external agency that provides help with managing substance and alcohol abuse to speak to the residents around alcohol use.

The service promoted walking groups and told us they had recently hired a fitness therapist to help support residents in managing their physical fitness.

The service monitored and discussed resident progress through engagement, reflective practice and recovery plan reviews, but did not use formal outcome measurements in line with their policies. This had been identified as an area for improvement by the service.

We did not see evidence that the service used recognised rating scales to assess and recorded severity and outcomes for residents in the 3 records we looked at. The service2 treatment policy specified that the service is meant to use Health of the Nation Outcome Scores (Honos) and Adverse Childhood Experiences (ACE) scores in the assessment and induction period for residents and Clinical Outcomes in Routine Evaluation (CORE 34) and Questionnaire about the Process of Recovery (QPR) scores at three-monthly reviews for residents. Dialog Plus was also meant to be used during one-to-one key working sessions. Outcomes were also meant to be recorded as part of the PIE treatment model but we could not see any of these outcomes used in the records to monitor people’s care and treatment.

After our assessment, managers sent us an action plan outlining how the use of outcome measures would be improved. The action plan also identified that capturing feedback from residents could be further improved.

Outside of formal rating scales, there were a number of ways that staff monitored and discussed resident progress. This included daily engagement with residents, weekly team meetings, reflective practice and quarterly recovery plan reviews. Oversight of the number of therapy sessions attended were monitored in the monthly management meetings.

The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Staff took all practical steps to enable residents to make their own decisions. Due to the nature of the service being a community residential rehabilitation service, staff asked residents to consent to their care and treatment, and this was recorded in their records. Staff recognised that residents had the right to change their mind and respected their decisions to withdraw consent.

Staff maintained the confidentiality of information about residents.