Tottle Brook House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated Good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

The service was led by an experienced, motivated and committed registered manager, supported by a staff team who strived to deliver the best person-centred care they could. The service understood the importance of ensuring effective collaboration with people and external partners, to ensure a fully wrap-around approach to support. The registered manager's vision and values were exhibited by the whole staff team. The management team ensured they had robust auditing and reviewing processes in place, to ensure continual improvement of the service. This approach was delivered by the commitment of the whole team and the results seen by people living at Tottle Brook House, and those external teams who were involved in their care and treatment. One visiting professional told us, “Tottle Brook House is an excellent service that is very well led.”

The leadership in the service was very forward thinking and proactive in their approach to people's health and wellbeing. We saw many effective interventions that had resulted in significant and positive outcomes for people. One such example was shared by a person who explained how the service had supported them to reconnect with their relatives. They said, “After being apart for many years, we have built our relationship over a period of time. I also have been able to see other relatives I have not seen for a while. I do visit my relative as much as possible, and I do like visiting them at home, as it helps me reconnect with them.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

The registered manager ensured the staff team were enabled to provide the highest quality care for people, by ensuring the whole staff team were involved in detailed daily flash meetings. Discussion centred around each person, their current presentation, any arising issues and their activities planned for the day. Staff training needs and planned sessions were discussed, to ensure staff felt confident in their skills and knowledge. For example, on the date of our visit, some staff were attending ‘breakaway training’, which supports staff to safely support people at times they are showing distress. This process allows staff to build their confidence and communication skills.

The management and staff team were fully supported by the provider to continuously learn and develop new skills, which then directly impacted on positive outcomes for people.

The provider was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.

The service operated an open door policy, which ensured people and those who were important to them, could share their views and be heard. Staff understood the freedom to speak up policy in place for the provider, and their responsibility to follow this. This reduced the risk of any potential closed culture at the service.

There were opportunities for people who used the service and their representatives to share their views about the quality of the service provided. People told us there were regular meetings at the service that the management team and staff attended. Surveys were completed regularly, with people, relatives, staff and other stakeholders to gather feedback about the quality of the service provided. Where any ideas for improvement were shared, we saw the service had a, ‘you said, we did’, board on display, detailing recent changes made within the service. For example, the provision of a ‘continental style breakfast’ and a massage chair, which was delivered on the date of our visit.

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.

The service celebrated and championed their diverse workforce. The provider employed staff from the local area as well as from overseas. The staff team were from varied backgrounds and cultures, and this was reflected in the skills and experience they brought to their roles. One staff member said, “I have a vast experience in mental health services, both forensic and community based. I am really happy with the registered manager; they have really thrown themselves into their role.”

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The registered manager understood their responsibility to notify all relevant agencies, including the Care Quality Commission, when issues had arisen. The registered manager sought advice when issues had occurred. There were clear governance processes in place. This gave the registered manager clear oversight of the service, ensuring appropriate actions were taken to prevent recurrence.

The registered manager had an overarching governance system to ensure that good quality care and support was provided, as part of their approach to continuous improvement. This was monitored by the provider who also undertook regular quality assurance visits to the service. The results of these audits were provided to the registered manager and reviewed with the provider's regional manager. We saw that any actions identified were taken in a timely way.

The registered manager fully understood their regulatory responsibilities and duty of candour. For example, where incidents had occurred, there were robust debrief processes in place. This allowed staff to share their views on what had worked well, or what they feel could be improved.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

The registered manager and staff team understood the importance of engaging with external partners, to ensure a fully person-centred approach. The staff team showed initiative in supporting people who may have previously lived in a more secure location. They understood the challenges this can present, as people transition, and offered a wrap-around, therapeutic approach. Staff understood the importance of supporting people to make choices about their daily lives. Where people had been unable to make important choices, records contained evidence to show that staff had followed best interest procedures to agree appropriate actions with professionals, relatives and advocates on behalf of the person.

One visiting professional told us, “I have read the clients’ care plans and case notes, and they are well documented and clearly written. The information is detailed, accurate, and shared with me when requested, which helps ensure consistent and informed support.” Another visiting professional gave their views of the service, they told us, “My overall thoughts of the staff team, are of them being knowledgeable, caring and skilled and only wanting the best for each resident.”

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice.

The Registered Manager showed transparency, knowledge and integrity and led the service by example. The related skills and experience they brought from their previous roles, showed in the ethos of the service. For example, the staff team were skilled and experienced in the specific needs of the service user group. They ensured peoples physical and emotional wellbeing was fully considered, along with individual mental health support needs. The service took a fully holistic approach to individualised care and support.

The registered manager showed a clear and sustained commitment to learning and continual improvement of the service. The registered manager had robust systems in place, for reviewing performance, identifying trends, and acting on lessons learned in a timely and transparent way. Staff were actively involved in shaping improvements, and given opportunities to contribute ideas and new ways of working. Innovation was evident through creative solutions which responded to challenges and improved experiences for people, supported by leadership that values experimentation and continuous development.

The service implemented best practice guidance across all areas of peoples identified needs. For example, they used the Lester tool, which was developed to provide a clinical framework for the assessment and management of people’s physical health and cardio-metabolic risks. The tool aims to integrate physical and mental healthcare with lifestyle advice and support. We saw each person had an individually tailored plan in place, linked to this assessment tool. Visiting professionals told us the service followed a holistic approach to wellness and improving health outcomes for people.

A visiting professional told us, “Overall, I believe the service continuously strives to improve and provide excellent care.”