Tottle Brook 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 Outstanding.

This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

This service scored 90 (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 was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

The ethos of Tottle Brook House was one of celebrating people’s strengths and acknowledging their achievements. For example, one person was being supported to self manage their medicines in future. We saw the plans in place for this transition, and a highly personalised medicines care plan, which detailed the person’s skills and understanding of this.

Staff actively demonstrated the core values of the service; kindness, empathy and dignity. Staff showed a genuine interest in peoples’ lives, we observed staff and people engaging in meaningful conversations during our visit. The service ensured they delivered care which fully reflected each person’s preferences and cultural needs. People were confident their privacy and independence was respected at all times.

Staff showed warmth, compassion, and a clear understanding of each person, and their needs. For example, staff spoke of how the mandatory training they had completed had enhanced their understanding of potential closed cultures and of ensuring they provided culturally appropriate care. The staff member explained, “I feel it has opened my eyes. You need to fully understand people's lives and history which impacts on this.”

The service had a welcoming, positive environment, and we heard lots of laughter and meaningful interactions during our visit. People were encouraged to retain and fully express their individuality and share their sense of humour with others. Our Expert by Experience was welcomed by people, who were happy to share their views and tell jokes.

People told us their support was provided at their own pace and they did not feel pressured to hurry. Staff promoted an ethos of support provision, where people were enabled to participate in their care. One person said, “I find the staff kind and caring and feel they respect my dignity and privacy.” We saw people were enabled to have privacy in their personal spaces, which they told us staff fully respected.

External teams who visit the service regularly gave positive feedback about the inclusive approach of the staff team. One professional visitor told us, “The care staff, managers, and providers are always courteous and respectful. They take time to listen to me, explain things clearly, and treat me with dignity. I’m always spoken to politely, and staff show genuine care and patience in their interactions.”

The management team ensured they continuously monitored and adapted their support provision. People were consistently supported to give feedback about all aspects of their support, environment, meals, staffing levels and activities. The registered manager had robust systems in place, for gathering and acting on feedback about respect and compassion, ensuring continuous improvement in this area.

The provider treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The provider took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People were respected and celebrated as individuals, with diverse and unique skills and stories to share. The ethos of Tottle Brook House was a strengths-based approach, which celebrated differences and acknowledged achievements. We observed staff practice being exceptionally patient, person centred and very responsive to individual needs. For example, one person lived with a fear of abandonment, arising from their life history. We saw staff were mindful of this, and had built up a positive, trusting relationship with the person. People gave positive feedback about the care, empathy and understanding shown by the staff team. One person said, “I have lived at this home for around 3 years and I find the staff are respectful, kind and caring.” Another person had a passion for music, and of playing this for others. We saw the person had a range of equipment in their personal space, to enable them to fulfil their wishes. Staff were engaged and supportive of the person’s passion for music, and we saw the positive impact this had for this person.

The service fully demonstrated that treating people as individuals was embedded in its culture and practice. This included staff having a clear and detailed knowledge about each person’s life, preferences, and values, which in turn shaped their planned support. People were fully respected as individuals, and were supported to achieve their goals. For example, each person had highly personalised care provision, which was directed by them, as a partner in their support planning. This was evident in the interactions between staff and people, the activities planned with people, and ensuring people were fully engaged in decision-making. Staff adapted their approach to ensure people were able to have fluidity in planning their day, rather than a rigid plan. The service supported people to regain and maintain their independence, make choices, and feel a sense of control over their lives.

Staff demonstrated how their training influenced the way they provided care and support. For example, one staff member explained, “I feel therapeutic intervention is the key to ensuring best outcomes for people. Supporting meaningful activity and occupation can aid better rest, sleep and can then have an impact on people expressing less distress behaviours.”

The provider was exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Promoting independence and choice for people were fully embedded in the culture and practice at Tottle Brook House. This included staff proactively encouraging people to make decisions about all aspects of their care, supporting them to take positive risks, and providing opportunities for individuals to maintain or develop skills which enhanced independence. Care planning fully reflected each persons’ goals and aspirations, which were fully included in daily practice. The service demonstrated they were adaptable and showed a flexibility in routines and staffing to accommodate people’s individual preferences. We saw this approach had achieved positive outcomes for people. The registered manager explained, “For people who were previously living in a more secure placement, we ensure more meaningful occupation is in place. For example, one person, within the space of 11 months, is now doing their own laundry, they have also purchased a hot plate. On a Sunday, the keyworker will go through a menu planner, using pictorial guides. They will review the menus together and purchase any required ingredients.” This person explained how this support for their independence had a real positive impact on their day. They said, “The home provides the food. I am given a menu to choose from, and they do encourage me to eat healthily, but I have the option to cook for myself with support from the staff.”

People were fully supported and encouraged to understand their individual diagnoses. For example, one person had a pictorial guide to help them understand their specific mental health needs. The plan gave information for staff on how to support them effectively. The actions included speaking with staff to discuss their feelings, going for a walk, yoga or having time on their own. The person had been fully involved in co-producing this plan, so felt confident this met their needs. They said, “I do feel the staff at the home are there to provide support, but at times I like to be on my own, which the staff do allow me. If I need staff, I would just go and find them.”

People had been consulted on their feelings around speaking with the CQC team, prior to us visiting. These easy read, pictorial guides were included in people’s care records. These documents allowed people to give their consent, and were able to be revisited, should a person change their mind once we had arrived.

The provider was exceptional in how they 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.

People were supported by a staff team who fully understood their anxieties, triggers and distress. Each person had personalised strategies in place, to anticipate and prevent issues before they arise. For example, one person was observed exhibiting distress during our visit, and the staff promptly attended, to reduce their anxiety, redirect the person, and allow them the space to discuss their feelings. Staff showed sensitivity and an active listening approach. For example, where a person had changed in their presentation, and had begun to decline meals and medicines, the staff team responded to this promptly. The registered manager explained how this had been urgently reviewed with the relevant health professionals involved with this person, with a plan made to reduce the risk of a relapse in their mental health and prevent any subsequent inpatient admission.

Documentation in care plans showed Antecedent, Behaviours, Consequences (ABC) charts were used effectively, to review peoples identified care needs, and ensure referrals were made for any changes in peoples’ presentation. External partners gave positive feedback about the service incorporating and following their guidance, to ensure improved outcomes for people. A visiting health professional explained, “The service effectively coordinates and collaborates with our agency. Information about people’s care and treatment is shared appropriately and in line with confidentiality requirements. Whenever information has been requested by our team, it has been provided promptly and appropriately. Care staff also follow the recommended guidance to ensure consistent and person-centred support.”

The provider always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centred care.

The staff team were respected for their knowledge and experience, and encouraged to progress within the service and learn new skills. The registered manager explained how they were supported in transitioning into their new role, by the provider. The area manager was a regular visitor to the service and provided peer support for the management and staff team.

A visiting professional gave positive feedback about the skills and knowledge shown by the staff team. They told us, “Staff in all levels of roles and experience appear happy and supported in their jobs and feel respected and valued by a well led management team. The team have achieved great things with some complex service users that have had multiple placement breakdowns in the past.”