Tottle Brook 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 Outstanding.

This meant services were exceptionally tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (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 making 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.

Support plans were exceptionally person centred and individualised, each area covered different areas in a person's life to support their overall well-being. We saw these plans were reviewed regularly with the person and their family, advocates and any health professionals involved in their care. Each care and support plan contained a highly personalised, realistic plan of what people would like to achieve. For example, one person wished to become more independent with accessing the community and doing their own shopping. We saw the plan in place for this had detailed goals for the person, to enable them to achieve their goals. Details of peoples wishes and dreams for life were clearly documented and discussed. The service used innovative ways to enrich people's lives through activities and social events that enhanced their quality of life. We saw that people were encouraged to be active participants in the local community and to enjoy fulfilling lives, which focussed on positive outcomes. These had been tailored to people’s individual skills and qualities. Where people had previously lived in a more secure environment, we saw detailed plans in place to support them to transition to a community setting. For example, one person said, “I am able to access the community with the things I enjoy, like shopping, going to the cinema, bowling and the pantomime at Christmas.”

Each person had their own activity and support planner, that was effectively tailored to people's needs and choices. One person said, “I have a copy of my care plan. My relative is involved in my care, I speak with them regularly, not every day now, but some days for hours.”

Staff took great pride and were passionate in providing care, support and meaningful activity to provide a high standard of life quality for people. The registered manager was motivated to innovate and use new ideas and initiatives to maintain excellent care for people. People were encouraged to work alongside the staff team, to acquire skills in cooking and housekeeping. This in turn, supported an increase in life experience and provided meaningful activity and occupation, whilst promoting independence. A visiting health professional told us, “I have always been very impressed with the home. The staff get to know the residents very well and will make sure that the residents get the therapeutic intervention that is helpful for each individual.”

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

People had highly detailed and personalised hospital passports in place, for use with any planned admissions or emergency events. These documents ensured people’s care and support needs could be met if they were away from the service. The service ensured that people were supported to understand and effectively communicate with other healthcare professionals. This included the use of social stories and preparation visits with other agencies, in order to feel supported for any appointments. This multi-agency approach ensured the best possible outcomes for people.

Visiting professionals gave positive feedback about the way the service worked in partnership with them, to achieve positive outcomes or transitions for people. One professional visitor said, “The service do refer to us in a timely manner. I find them all very thorough to be honest. I feel I have great continuity with the management team and this helps when doing a monthly assessment for our patients. I feel their heart is in the role and they are always striving for the best outcome for the patients.”

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Where people had additional communication needs, we saw the provider had ensured this was provided in an individual way, which each person could understand. For example, using pictorial guides or objects of reference. This ensured people were able to fully participate in all aspects of their care and support.

Easy read signage was in place throughout the building, and all care plan documents had easy read formats where required. We saw personal safety care plans which were exceptionally detailed and showed the service had involved people in discussion around any possible impacts to them. The service regularly sought the views of people about their care experiences. This was carried out by the use of accessible feedback forms, and regular one to one meetings with people and relatives or advocates.

Visiting professionals spoke positively about the accessibility of information, where people may have additional communication needs. One visiting professional told us, “The senior leadership team supporting Tottle Brook House have been great on this and staff have made really accessible resources. These were provided well before my client moved in and were shared with the multi-disciplinary team involved with the person, to get feedback and ensure social stories were correct.” Another visiting professional told us, “Staff communicate with people using their preferred methods and adapt their approach to meet individual needs, for example, using picture books.”

Protected characteristics under the Equality Act 2010 were fully considered. For example, people were asked about any religious or cultural needs they had so those needs could be fully met. We saw religious festivals were celebrated by the service, with people involved in planning parties and deciding who they wanted to attend. The provider ethos of fully respecting protected characteristics was displayed in the communal spaces. This detailed the fundamental importance of respecting peoples’ race and ethnicity, sexual orientation, neurodiversity, disabilities and family backgrounds.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

People were fully involved as partners in their care. People all told us that they felt listened to, and their opinions were valued. The complaints procedure was accessible to people, with visual guidance on how to raise any concerns displayed in reception, and at various locations around the service.

There were easy read contact details displayed across the service, for Advocacy services, CQC and the Adult Safeguarding team, along with other important information and people were supported to understand how they could access these if needed.

There was a robust complaints policy and procedure available in formats suitable for people to understand. This was given to people and relatives as part of their service user guide.

People who used the service told us they felt able to raise any concerns with the manager or staff and felt assured they would be dealt with. Where people had raised any concerns, we saw this had been clearly documented, reviewed, and outcomes discussed and shared with people to help them understand these. One person said, “I have never needed to raise any concerns and I am happy with the support they provide me with."

The provider always ensured that people could access the care, support and treatment they needed when they needed it.

Records showed people's oral health, weights, (along with blood pressure, and other clinical observations) were recorded regularly and any areas of concern shared promptly. These observations gave a good indication of the overall health of people using the service. People had been supported to attend dentist appointments, vaccinations, breast screening, cervical screening and well man checks. The care plans for these detailed any anxiety people may have around these external appointments, and how they wished to be supported by the staff team.

Visting professionals gave positive feedback about the support provided for people, one gave feedback, “The service works closely with our agency to identify any changes in people’s health and to prevent deterioration. Staff communicate regularly with us and promptly share any concerns or updates about a person’s condition. They monitor individuals closely, report early signs of changes, and follow up on any recommendations made by healthcare professionals. This collaborative approach helps ensure that people receive timely support and appropriate interventions."

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

The outcomes for people using the service truly reflected the principles and values of 'Right support, right care, right culture', promoting choice, independence, control, and inclusion. People and their families were recognised as the true experts in their own lives, with an emphasis on what they could achieve first, followed by any support they required.

People told us, staff made a conscious effort to seek out and listen to their experiences and aspirations for their care plans. Staff consistently championed people’s rights and upheld equality and diversity with respect.’

The whole staff team showed an in depth practical knowledge in meeting the needs of people living at the service, but they continued to look for and achieve further improvements in their knowledge and skill sets. The registered manager's expected standards were exceptionally high, and staff were committed in achieving these.

Throughout the service we saw ample evidence of the wide range of activities that people had participated in. People had been supported to vote in the most recent election; we saw evidence of this in their individual care plans. The staff team had worked hard to ensure that people would be able to learn and develop understanding around having their voice heard, and to make informed choices about who and what they were voting for. We saw that the staff team had invested time and support to ensure people were enabled to enact their democratic rights.

People were given support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

People were supported and involved in making decisions and plans about their preferences for end of life care. Although nobody living at the service was receiving end of life care at the time of our inspection.

Where appropriate, people had been supported to make decisions about how they would wish staff to support them when they neared the end of their life. These discussions had been developed into exceptionally detailed and meaningful care plans, which included people’s personal preferences. These included details about people’s faith (or wish for a humanitarian service), clothing, music and the people they wished to be involved and/or informed about their death and their views on remaining in the service or going into hospital.

Staff were skilled and experienced in end of life care and understood people's needs. Staff had undertaken additional training in providing palliative care and bereavement support. The service had access to a supportive community palliative care team, should this be required.