Liberham Lodge

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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

Staff assessed people’s needs which ensured care supported good outcomes to people and involved them. Their care, support and treatment reflected these needs and any protected equality characteristics. People were at the centre of their care and staff worked well with other services. Leaders supported a culture of improvement, where understanding current outcomes and exploring best practice was part of everyday work. Staff demonstrated an understanding of the principles of the Mental Capacity Act 2005 (MCA). Throughout the site visit, inspectors observed staff supported people in the least restrictive way, asked for people’s consent and offered choices, at the same time, ensuring people were safe. Staff supported people to access other health and social care services when needed, so people could live healthier lives. People’s care was regularly reviewed and adjusted to ensure it brought best possible outcomes for their health and wellbeing.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care records included assessments of their needs which then formed the basis of their initial care plans. Assessments were person-centred and detailed different areas of possible care needs and risks which were explored with people and their representatives.

Staff and managers knew the process around assessing people’s needs before they moved in. The registered manager explained, “Myself and the management team will complete assessments to make sure we meet every individual need.”

People and their relatives told us their needs were assessed before they moved in and addressed in their care plans, so they received appropriate care in line with their needs and wishes. One relative said, “The staff are always there to help and are very good and helped her settle in. They made themselves available to her all the time.”

People and their relatives were very complimentary about the standard of care. One relative said, “The care provision is excellent.”

Staff were aware of any changes in national guidance and best practice as the provider had good communication and support channels. One staff member explained, “If any new nationwide government advice has been released our head office lets us know. We get sent all the information, I make sure I really go through it and understand it before I send it to my team. I’m always speaking to them, if anything new comes out we mention in staff meetings, we send to all team members, we mention in handover, and I walk around to remind [staff] and chat to them about it.”

Staff followed national best practice guidance when supporting people and used nationally recognised tools, such as Malnutrition Universal Screening Tool (MUST), skin integrity risk assessment tool or pain monitoring tools. Staff were also trained and aware of best practice in relation to supporting people living with dementia. People had ‘All about me’ in place which is a simple tool containing information about a person who may not be able to easily share information about their needs, wishes and preference with others. This tool helped staff to provide person-centred care and to be able to share basic information about the individual with other services supporting them.

People and their relatives told us staff worked well in the team and with other services. One relative said, “[Staff] always seem to share all necessary information between them.”

People’s care records and governance records we reviewed showed people were referred to other services when required and could also access a range of other support services. The home worked with a specialist service providing therapeutic activities to people living with physical and dementia related care needs.

Staff told us they worked well within the team which enabled them to recognise, for example when people did not feel well. One member of staff said, “We stick to the same floor, so we get to know our residents really well. We can tell when they are in pain.” Staff also said they had easy access to support from other professionals when needed, “We have a good relationship with the GP and the pharmacist. We have a weekly meeting with the GP [by phone] and they will visit if we feel a resident has to be physically seen. I think the relationship works well.”

The visiting healthcare and social care professionals were positive about how the service worked with them. One professional told us, “Before the start of any session, I am updated by the care staff on duty about any concerns relating to an individual’s general well-being to ensure the activity and their involvement are appropriately adapted.”

People’s care records confirmed people had access to their GP and regular medicines reviews. People were supported to access specialist healthcare services, chiropody or dental services when needed. Professionals working with the home shared positive feedback about how the services worked together. One visiting healthcare professional told us, “Communication between Liberham Lodge and myself is open, transparent, and timely. If I am required to provide emergency treatment, I will be notified immediately and requested when I will arrive. The staff will discuss what treatment I have provided and outcomes, follow ups.”

People and their relatives told us they could access healthcare services when needed and staff supported them to do so in a timely way. One person said, “Recently, as soon as I ask [staff] to book an appointment with a doctor, I see one straight away. It’s nice because I don’t need to worry about booking appointments myself.” A relative of a person told us how staff ensured their loved one accessed GP and diagnostic tests straight away when a health issue arose.

Staff knew which healthcare services they could access on behalf of people and how to do that effectively. One staff member explained, “Through these years our team was able to build strong relationship with other health professionals, NHS and the private health provider, especially with our surgery.”

Staff were focused on supporting people to be well and to live their life the way they wanted to. One staff member said, “Ensuring everyone’s individual needs are met in the best way possible. We are always trying to challenge ourselves in thinking of new and innovative ways to give people the best experience.”

People’s care records were regularly reviewed to include any changes in their needs and risks, feedback from them and their representatives and to monitor the effectiveness of their care. People’s achievements were celebrated, and people received support to improve their quality of life. For example, by enabling them to do what they wanted and liked to do or by providing them with additional help to improve their health.

People told us the care they received was good and it made them feel comfortable and safe. People also told us they felt they could do what they wanted, and staff respected them as individuals. People’s relatives described how the care provided by staff improved people’s mobility, quality of life, general health or mood.

Staff knew how to support people in a way which respected their decisions and supported them to make choices. One staff member said, “I check care plans. I discuss any care I’m giving with the resident and gain informed consent.” One of the senior staff members said, “We are on top of all the legal documents like the MCA (Mental Capacity Act related records) and the DoLS (Deprivation of Liberty Safeguards).”

The provider had clear policies and procedures in place around mental capacity, consent and restrictions on people’s liberty. People’s care and clinical records included mental capacity assessments addressing time and subject specific decisions when people lacked capacity to make them on their own. People’s representatives were involved in best interests’ decision making. Staff supported people in least restrictive ways. DoLS authorisations were closely monitored by the management team.

People told us they were asked for their choices and staff respected their decisions. One person said, “I made my own decision.”; when referring to the decision to move into the care home. Another person told us when asked if staff sought their consent for care, “Always, staff are very respectful like that.” Relatives echoed that saying, “[Staff] always ask how he wants to spend his time, whether he is okay with them helping him.”; ”She can make decisions, and the staff will help her. She is very much her own person and supported by staff.”