Lilyrose Care Group Ltd - Cheshire/Derbyshire

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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

We assessed 2 quality statements in the effective key question and found areas of good practice and concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. People were positive over the care of staff, partnership working both internally and externally. External partners spoke positively over contact with the deputy manager and overall, the support provided to people. We saw evidence of feedback the provider took from people; this was also discussed in feedback from people. However, we did not see how feedback was used to support improvements nor how this was shared with staff.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us staff worked well together and overall, there was good communication with each other and with external professionals when required. Comments included, “They [staff] do things the way I want them done and that’s all I’m bothered about" and “Care and support is coordinated, everyone works well together and with me, other than one incident.”

The management team told us they were focused on building a more effective staff team. They described previous difficulties with staffing culture and recruitment. However, they told us the situation was now more stable and the service was in a much better place moving forward. Staff supervision and spot checks had not always been undertaken in line with the provider’s policy. However, the deputy manager told us they had been addressing this to make the improvements required since being in post and to monitor and support the staff team. Where required, staff made referrals for specialist support for people and worked with health and social care professionals, such as district nurses and GPs. A staff member told us, “A service user's catheter was blocked, and I noticed when I got there. I alerted the office immediately and contacted the family. The district nurse was called immediately.”

We received some feedback from a local authority in relation to a safeguarding concern identified during our assessment. A social worker had sought some feedback from people about their experience of the service. The feedback was varied. Some concerns were raised about new staff meeting all needs and some communication issues in relation to language barriers. Others were happy with the support provided. Partners told us that the deputy manager liaised and shared information with them.

There was evidence of the provider working with other services, this included district nurses, GP’s, opticians and dentists. Care plans were reviewed. However, they were not always updated in a timely manner to reflect changes in people’s needs. The service sought feedback from people. However, we did not see evidence of actions completed following feedback received. The provider had processes in place to ensure that people were supported with making relevant referrals when needed. People's needs were considered and assessed as soon as they started using the service. This was also discussed in team meeting minutes. The care staff worked collaboratively with other healthcare professionals to assess, plan and deliver people's care and treatment and to understand and meet people's needs.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received mixed feedback from people. Comments included, “Happy with the service overall, staff are trained” and “Managers do phone from time to time and check if everything is okay.” However, others told us, “Things would improve if we had the same staff and knew who was coming” and “Care is not necessarily coordinated and it’s not clear that all staff work well together.”

The deputy manager told us they had started to contact people by telephone on a weekly basis to gather feedback and monitor the service. Initial assessments were completed at the start of the service with people. Staff liaised with people and their families about any issues or changes. Staff told us they had access to care plans to guide them about people’s needs and preferences. Managers told us risk assessments were carried out and updated if there were any changes in people’s needs. However, we found examples where people’s current needs had changed and they had not been re-assessed or records updated. The deputy manager shared an example of support they had provided to a person who had been at end of life, whose condition had now improved. They adjusted their support accordingly as and when required.

The provider had processes in place to monitor people’s care and treatment. The management team reviewed care records to ensure the care and support provided was in line with plans. However, plans were not always reflective of people current care needs. This put people at risk of harm as staff were not fully aware of risks to people and how best to support them safely. We saw examples of questionnaires and quality assurance reviews sent out and completed with people to monitor their support and give feedback over their care and staff. This included ensuring they were happy with the service provided and were able to communicate any changes they needed.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.