Cascade (Hurst House)

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity, and respect.

This is the first assessment for this service. This key question has been rated good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

This service scored 85 (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 always treated people with kindness, empathy, and compassion, and respected their privacy and dignity.

Our observations throughout the day were positive with staff treating people respectfully, confirming choices with them in a meaningful way and ensuring people were engaged but also had the space they needed. Each relative we spoke with confirmed that Hurst House had made a big impact in terms of providing stability, security and opportunity. One relative told us, “All the staff are lovely they have developed a lot. They are calmer now they use to be violent but not now.” Another relative spoke of previous incidents in the community which had impacted on their ability to do activities with them but suggested ‘they were now having a better life than them.’ And said ‘their behaviours were significantly improved, and they could benefit from new experiences. ‘Another relative described the gradual transition from children to adult services and how this was managed well and the progress they had seen. They described the staff as ‘Young and cool.’ And said their family member always seemed happy. Other relatives said people enjoyed visiting their parents but were eager to get back home which they took as a good sign.

We found management engaging and knowledgeable with a caring attitude for people they supported and staff to ensure their well-being was prioritised and regular observations of care helped ensure this was delivered to the highest standard. Circles of support were fostered and nurtured to ensure people had a sense of identity and belonging. Community engagement and links with people outside the service were facilitated.

Individual achievement folders and a ‘look what we did’ board highlighted how the service supported people to maximise their choice, control and independence.

New staffwould be introduced gradually and if it wasclear a person being supported preferred a particular staff member this would be respected. The expectation would be that staff could work with everyone and where they might be struggling to do so they would be supported to build a relationship with that person.

Staff provided a seamless service for people with clear planners and handover of information to ensure all staff knew important informationor what the plan for the day was. Involvement of families were key with people going to stay with relatives regularly but choosing to spend more time at the family home and relatives telling us when they visited the parents’ house, they were always keen to return. Family members described their relatives as safe and happy with significant reductions in them being distressed or anxious.

The environment enabled people to have privacy and space including space away from the staff supporting them. Private time was respected and although one person had a monitor for health and safety reasons this was not in their bedroom and there was a clear rationale and best interest decision in place. This person regularly pulled down their curtains, so staff had tried to ensure their privacy by introducing half curtains, the person was unable to tolerate blinds, so staff added a privacy screen to the window.

The provider treated people as individuals and made sure people’s care, support, and treatment met their needs and preferences. They considered people’s strengths, abilities, aspirations, culture, unique backgrounds, and protected characteristics.

People’s care plans were robust, and the cornerstone of the care they received. They helped ensure people received consistency and routines which helped keep people safe. Care documentation was cross referenced to ensure staff had all the information required and understood the potential risks if they did not deliver care and support in line with the person’s care plan.

Documents included people’s communication and sensory needs to help staff understand that some people might not like touch, or certain noises, materials etc and this was considered when supporting the person. If a strategy did not work staff were quick to review and adapt accordingly.

We observed staff and their interactions with people giving people praise and encouragement and using visual cues to help people understand their environments. For example, one person had difficulty moving from one activity to another so staff used a timer to indicate the end of each activity.

Whilst people had choice there was also the understanding that too much choice or over-stimulation could be detrimental to the individual so staff were clear about any potential triggers and actions they should take if they witnessed distressed behaviours. This included giving the person some space, swapping out one member of staff for another, or the use of safe holds or medication but this was often the last strategy.

A family member told us, “Staff send photographs of cinema trips, outings in the snow. The staff are good and knowledgeable. My relative is complex, but the staff get them and despite them being nonverbal they always make staff laugh.”

The provider promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment, and well-being. People were observed being supported by staff to remain independent and be in control of the care they received.

People had accommodation suited to their needs and had clear structure and routine. Any changes to their routine were carefully managed to promote people’s autonomy. Medicines were carefully monitored to observe any shift in the person’s presentation to judge the effectiveness of the medicines.

People were observed helping to manage and sort their laundry, be involved in food preparation and meal planning, assisting with cleaning, relaxing, completing skill development time and going out on planned activities. When we asked about the lack of regular structured evening activities, we were told this was due in part to the winter months when it was cold and people were active across the day. Staff mentioned people did a couple of regular evening activities and much more in the summer including local and planned trips and holidays, forest school and working on the allotment.

Each month the home had a theme they would focus on and support people to be involved with, the theme at the time of the inspection it was de-cluttering and recycling.

The provider listened to and understood people’s needs, views, and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern, or distress.

The provider gave staff clear guidance and training around how to support people, recognise changes in their needs and when to contact external healthcare professionals. The provider invested in their staff and by doing so they improved the outcomes for people using the service. Staff showed they had a good understanding of people’s needs and why the person was supported in the way that they were, reflecting their care plans.

An increase in positive communication, a decrease in medication and incidents showed effective positive behavioural strategies were working and meant people were supported in the least restrictive way. This was at a time when new activities were being carefully planned and introduced to improve people’s life experiences and opportunities.

The provider cared about and promoted the well-being of their staff and supported and enabled staff to always deliver person-centred care.

Within this service there were staff from different walks of lives, backgrounds, and cultures. The quality assurance manager told us when staff had entered the country on sponsorship, they were supported by a mentor to help them get established, for example help with housing, schooling and registering for a GP. Staff we spoke with were well established and praised the organisation for the opportunities and the training that had been provided particularly in terms of higher educational courses and internal promotions which supported their wellbeing and finance. Staff told us they enjoyed working at the service and enjoyed working with people they supported. They felt able to raise anything in which they described was an open culture.

When speaking with the registered manager she placed an emphasis on supporting and developing staff in the right way by good training and support and empowering them to take on additional responsibilities. Regular team meetings, annual appraisals, spot checks, observations of practice and supervision all helped to support and develop staff.

A staff member told us how they had moved from another country with no prior experience in care. They said, “Training is very goodtop notch. They are always asking about training needs, you can ask and they will arrange. I asked for NVQ 4 this was completed then asked to do NVQ 5, They look after staff and respond immediately which helped you grow in confidence and feels well supported.”

There was a human resources department which supported staff with employment rights and included access to well-being services and support should staff require them. Statistical data collated by the provider showed a large decline in days lost through sickness in the last year and any sickness trends and reasons for sick leave were monitored to help the provider target support where needed. Mental health support and training was available, and the organisation celebrated annual well-being days: such as world mental health and world autism days.

There was a detailed two stage recruitment process which considered the needs of people living at the service and potential staff were invited into the service so a second interview could observe potential applicants’ engagement and interaction with people and permanent staff helped to explore with people what questions they might wish to ask. The provider had various champion roles within the service, led by staff, including a dignity champion, dental health champion, and infection control champion. The skills and talents of the staff team were recognised and utilised, for example one of the teaching staff had an art degree and had created picture murals and supported people in developing art and exhibiting their works.