Cascade (Hurst House)

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated good. This meant people’s needs were met through good organisation and delivery.

This service scored 79 (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 made sure people were at the centre of their care and treatment choices, and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Family members told us of their relief in finding Hurst house and the stability this had given their family member particularly after some families said their earlier experiences of residential services and schooling had been poor. Hurst house staff had a willingness and commitment to get it right for people and to support them to develop positive relationships and opportunities for people’s development. People became more independent through improved communication tools and better self-regulation which helped them in terms of their interactions with others and the wider community. Family members said their relatives were happier, calmer, and living a full life. We observed good interactions and noted staff were really engaging with people and using distraction techniques when people were becoming more agitated.

Staff and people using the service created strong bonds and predictable routines. Skills development, independence, and self-awareness were promoted. Learning journals and the outcome star provided a visual and illustrative overview of tangible goals people had achieved such as cooking skills and travel training. People had been on holidays with each other and individuals had been on their own holidays with travels further afield planned. People were supported to decide on how to spend their time by having personal planners and routines. Each key worker would spend time with people to review what they liked and disliked and to plan time ahead to help ensure people’s needs were met in line with their needs and their care plans.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible, and supported choice and continuity.

Integrated health care was provided through close working partnerships between the service, the local GP surgery, nurse, pharmacist, and support from the learning disability team who had a range of services and access to a psychiatrist. People’s health was monitored and positive outcomes achieved through external and internal support such as the well-being lead and education team who promoted self-care and wellbeing.

Hospital admissions and health care appointments were supported by staff and staff had up to date guidance to support them in their decisions about when to refer a person to the GP. Health trackers provided a clear overview of people’s appointments and checks to monitor their health and medicines to ensure they remained safe and appropriate.

The provider supplied appropriate, accurate, and up-to-date information in formats that were tailored to individual needs.

Accessible documentation was available and routinely provided to people using the service. Lots of visual information was around the service and adapted to people's individual needs.

As part of the quality assurance process relatives feedback was collated and reviewed to help identify what service improvements were necessary. The electronic door sign in prompted all visitors to leave feedback about their visit and this was regularly analysed.

The staff who focused on skills development told us people have their own journals which showed their progression of learning and achievements. These could be downloaded and shared with families which included samples of work and photographs.

People’s care plans had detailed communication and positive behavioural plans telling staff how people communicated often through a mix of gesture, using pictures and symbols, Makaton, and phonics. Visual information helped support people make positive choices across their day.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Staff involved people in decisions about their care and told them what had changed as a result.

Where people could not verbalise their experiences, the staff had developed a 1-1 information board used to discuss people’s choices, needs, and emotions. This was then uploaded and shared with the manager and people’s families. Surveys to share experiences of the service were widely distributed and actions followed any identified suggestion or concern.

Staff communicated with people in meaningful ways through objects and reference, pictures, symbols, singing, and music. Staff supported people to explore emotions offering therapy workshops and drawing to help express themselves and staff were experienced in using in using Thrive (A trauma sensitive approach to emotional resilience.) The service had a clear established complaints procedure and complaint responses were thorough and showed evidence of learning which was communicated to all staff.

Staff had regular supervisions and team meetings, which provided an open forum for discussion. Staff told us that they felt able to raise concerns, have difficult conversations, and make suggestions.

The provider was exceptional at ensuring people could access the care, support, and treatment they needed when they needed it. They did so by removing barriers whenever possible which may have prevented people from accessing services before.

The provider understood barriers to health, social care and health care and implemented training, guidance and a collaborative approach to support staff to navigate their way through to ensure people got the care and support they needed. The weekly contact with the nurse helped ensure continuity of support and the learning disability team had a range of specialists at hand to complete assessments and provide services and guidance to staff when needed.

There was an emphasis on equality and diversity and creating a positive culture where everyone recognised each other’s strengths and rich diverse history. Staff completed equality and diversity training, person centred care and sexuality training. Staff recognised people’s human rights to express their sexuality and form relationships and gave people every opportunity to explore their feelings whilst protecting their rights and making safe choices.

At its core the provider had promoting health and well-being as a main strategy which in the long term may reduce the need for secondary health care. The staff were encouraging people to take control over their health by understanding the implications of their decisions.

The provider recognised the barriers and discrimination people had faced in accessing services and how this had impacted on people’s life changes. Through a programme of support which focused on developing life skills, people had progressed in many ways which was demonstrated through live case studies and proactive reviews of people’s care and development.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People were treated fairly and engaged in all aspects of their care and support. They were members of the household and wider community. Staff were also supported to develop themselves and feel part of a wider organisation with shared values and culture.

The provider remained accountable for the care provided and had established an open, honest culture where staff could acknowledge and learn from mistakes.

A family member told us, “In 3-4 years, we have only had a couple of concerns but there’s always been a reason, and our concerns were acted on instantly.”

Creating an inclusive culture meant all the staff we spoke with felt supported and able to identify and report and or speak out when required both internally but also externally where necessary.

Some families remained active care givers and worked in partnership with the staff and staff supported the continual development and understanding of those relationships.

Effective communication tools, quality assurance systems, and audits helped promote fairness and equality and ensure the safe provision of care and access to services when needed. Through the empowerment and development of staff they were able to advocate and defend the rights, needs, and best interests of the people they were supporting.

People were mostly supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their lives. Detailed transition plans were in place and care, and support was reviewed and adjusted in line with people’s needs and wishes.

Pictorial end of life plans were in place to help people explore what things were important to them and how staff might support people if their needs changed. Plans focused on people’s favourite things: places, people, colours etc to help ensure staff understood people’s preferences. This was supported by clear documentation about people’s preferred routines, and overview of their needs, likes, dislikes and social history. The well-being lead told us life story work was being developed, and staff were aware of important milestones and events in people’s lives. For example, the death of a close relative and its impact on the person’s mood and behaviour, and the long-term support people might require in exploring their feelings and emotions which was an integral part of their support.

Family members felt assured knowing that their relatives were settled and had a home of their own. The provider had a range of services including transitional services from children to adult services and were keen to adapt the range of accommodation and support they could provide in line with people’s needs and changing requirements.