Tottle Brook House

On this page

• 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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated Good.This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The provider always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Assessments of people's needs were holistic and comprehensive. The staff team used current guidance from The National Institute for Health and Care Excellence (NICE). NICE provides national guidance and advice to improve health and social care. This ensured the service was using evidence-based techniques to support the delivery of high-quality care and support. Care plans were developed and regularly reviewed for each identified need people had and staff had clear guidance on how to meet those needs.

People were fully engaged in developing their care plans, which were highly personalised and reflective of their identified needs. One person said, “I do have a copy of my care plan and have an easy read copy in my personal folder.” People were encouraged to progress and their achievements were recognised. People we spoke with told us they had plans and goals in their care plans, which had been set by them and agreed with the staff team. One person said, “I have spoken with the manager about walking to the local shop with staff following shortly behind me, hopefully if all goes well, they would consider supporting me to go on my own.”

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

We found that staff worked with the person and those external teams involved with them, to ensure a safe transition which met their identified needs. One visiting professional explained, “The approach of Tottle Brook House was evident from the first time the staff team met my service user and began shadowing their previous support team.” The registered manager explained how essential this practice was, to ensure people were supported with changes which may be triggering for them.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once, by sharing their assessment of needs when people moved between different services.

People's health care needs were met by the positive partnerships established with health and social care professionals. If people experienced a change in their mental health or needed emergency healthcare, staff acted quickly to arrange this. One person said, “I have meetings with the staff team and other healthcare professionals involved in my care to discuss how I am getting on.” This meant people received joined up care that fully involved them where possible and ensured a high level of continuity.

We received positive feedback from all external partners who we contacted for their opinions of Tottle Brook House. One visiting professional told us, “The service communicates information effectively. Important details about individuals are shared appropriately, so people only need to tell their story once. When a person’s needs change, I am informed promptly, which helps ensure that the right support is provided without delay. The staff are very good at keeping everyone updated and maintaining clear communication.” Another visiting professional told us, “I have been very impressed with their attention to detail and ensuring information sharing. This ensures well planned and well led transitions and getting their whole team of staff on board and educated in care plans, positive behavioural support (PBS), strategies, history and risk management. We completed staff training prior to one person moving to the service and the engagement in the sessions was great, with all staff asking relevant questions and acting and thinking in a solution focused, positive manner. All staff showed great care, empathy and knowledge around Learning Disabilities, Autism, challenging behaviour and physical health needs.”

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were able to lead healthier lives and enhance their wellbeing because the registered manager and staff were dedicated and proactive in supporting them to do this. The registered manager embraced the view that people should be provided with access to information for them to promote their own wellbeing, and for staff to support this where people were unable to make complex decisions. One visiting professional explained how the service supported a person to stay healthy, they told us, “I have a client I see at the service who is being supported with their weight management and has a healthy eating plan.”

Information on staying healthy was provided for people through discussion or easy read information boards displayed throughout the home. We found staff to have a clear understanding of each person living at the service, in relation to their specific health needs.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

People's care plans were person focussed and fully reflected their voice and views on the care they received. On the day of our visit, we could see that people received support with day to day tasks at times which they preferred. These preferences were mirrored in people's day to day activity planners which included each element of a person's day. Staff listened to people's needs and supported them to make decisions in ways that suited them. For example, records reflected that one person required specific periods of quiet, calm time to help them comprehend their day. We observed staff supporting the person with understanding this in order to decide how their day would run.

Visting professionals gave exceptionally positive feedback about the highly personalised approach at Tottle Brook House. One told us, “They totally respect the residents and are always looking for ways to enhance care. They are always forthcoming with appropriate information and I feel we work together as part of a multi-disciplinary team, to get the best outcome for residents. The staff team are always friendly, compassionate and professional.” Another visiting professional explained how the service always contacted them for support with best interest meetings. These meetings were held to ensure any decision making was inclusive, and reflective of people’s choices.

The provider always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

The provider showed embedded, positive practices were in place, which supported people to be fully involved in decisions about their care and treatment. Where people were subject to restrictions, for example by having 2 staff supporting them, we saw this had been discussed with people and their advocates. People had care plans detailing this enhanced support need, and their feelings were fully considered.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When people lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and the least restrictive as possible. Mental capacity assessments were carried out where needed, to establish if people making decisions affecting their lives had the capacity to do so. Decisions made for people identified as lacking capacity to make specific decisions, followed the best interest process. We saw that people had been supported to make choices with involvement from independent advocates, and appropriate health and social care teams. Where restrictions were in place, there were easy read plans for people in their care records, so people could understand these. The registered manager had ensured that applications to the local authority for Deprivation of Liberty Safeguards (DoLS) were applied for in a timely manner.

People explained how they were fully involved in decision making processes and their wishes and feelings were respected. One person said, “The staff always ask for my consent before providing any personal support.” A visiting professional told us, “I feel they strive for excellence and I note that they know their residents very well and they try to guide people without taking away their autonomy.” We observed staff during our visit, allowing people to fully express themselves. If people required redirection, due to them becoming distressed, this was done in an understanding, empathetic way by staff.