Foxland Grange

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 under this provider. The key question has been rated outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There was a process in place to ensure people’s needs were assessed. The assessments we reviewed considered people’s individual risks, needs and preferences. Relatives and those important to people were involved with the process.

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.

Without exception, each person’s care and support was evidence based and a variety of tools were used to ensure their needs were considered and met.

The home used the ‘Flower of Need’, which they told us was based on a person-centred approach to dementia care, to help staff understand the whole person rather than focusing solely on their diagnosis. This considers five key psychological needs: comfort, identity, occupation, inclusion and attachment. A staff member said, “These principles help us recognise the importance of emotional security, personal identity, meaningful engagement, belonging and maintaining connections with others.” By using this approach, staff supported people to have positive outcomes that related to their cultural, health and wellbeing needs. This had resulted in positive outcomes for people including identifying and supporting people with their culture and identifying previous hobbies and skills that were important to people so they could reconnect with these.

Staff also used a communication tool which supported them to recognise each person’s unique communication, emotional needs, preferences and responses to their environment. This was especially important for people living with advanced dementia or people who had difficulty communicating verbally. By observing what brings comfort, happiness, distress or withdrawal, staff could better understand each person and tailor their support accordingly. Observations were completed using this tool and were recorded monthly for people. Using this tool enabled staff to identify and act upon areas of individual need, which resulted in positive outcomes for people which included, supporting people through grief, alleviating pain and general improved mood.

There was a system in place which used evidence-based tools to assess people’s health needs. The staff used a variety of clinical tools which included tools to monitor risks, such as; falls, pressure risks and communication needs. Staff were aware of these assessments and the outcomes to ensure they delivered the correct care that people needed.

The provider demonstrated consistently strong and joined up working across staff teams and external services. Thorough assessments and effective information sharing supported smooth transitions, reduced the need for people to repeat their story and ensured care remained coordinated and responsive.

Partnership working with the local District Nursing team was proactive, sustained and highly effective. Monthly multidisciplinary reviews of caseloads and people’s individual needs strengthened professional relationships, maintained responsive care plans and created a more integrated pathway between the home and NHS services. This resulted in continuity of care during short term stays, timely access to more intensive nursing support when people’s needs increased and improved clinical monitoring and symptom management.

Joint working also delivered wider and lasting benefits. District Nurses supported targeted training in areas such as minor skin injury management, enabling nursing staff to provide safe first line care, avoid unnecessary referrals and deliver faster treatment. This resulted in better use of community healthcare resources as the Foxland Grange nursing staff took on some nursing tasks for people with residential care needs that traditionally would need to have been referred to the District Nursing team.

In another example, staff worked persistently with wheelchair services and a person who used the service to overcome barriers that had kept them in bed for over a year. Before the person moved into the home a suitable wheelchair had not been able to be sourced for the person. Through patient, person-centred and coordinated support, the person obtained a suitable wheelchair, left their room and accessed the outdoors, significantly improving their choice, independence and wellbeing.

Daily handovers and huddles, regular reviews, staff meetings and supervision enabled staff to identify and act promptly on changes in people’s needs. Staff knew people exceptionally well and described an open culture in which they were encouraged to share even minor concerns without fear of criticism, helping to prevent deterioration and secure the right support. One staff member said, “If we identify something isn’t quite right with someone, we can share it. Sometimes it can be nothing, but no one ever criticises you for saying it or sharing it, quite the opposite, they prefer us to get it wrong than miss something.”

Visiting professionals spoke positively about the home and reported no concerns. One professional told us, “I am happy to come here, there are never any concerns, and we all get on well.”

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.

Staff responded promptly to people’s health needs. For example, 1 person was admitted following repeated episodes of uncontrolled blood sugars, which had resulted in hospital admissions and distressing moves between care settings. Staff completed a comprehensive assessment, involving the person, their family and specialist diabetes services, and introduced clear, individualised guidance so the nursing team could respond immediately to changes in their condition. Regular monitoring, specialist oversight and consistent support improved the management of the person’s diabetes while promoting their independence and respecting their choices. Staff reported that severe episodes had reduced, and the person had not required a hospital admission since moving to the service, demonstrating that their ongoing health needs were met effectively.

Another person was admitted to the home following a significant period of poor nutrition, reduced ability to manage daily living tasks and increasing social isolation. Staff and partner agencies worked at the person’s pace over a sustained period to build trust and agree achievable goals. This consistent approach led to significant and lasting improvements: the person was supported to work towards their goals and gained and maintained a healthy weight, became mobile and active, improved their personal hygiene and self-care, and experienced reduced depressive symptoms. A friend described them as having a, “new lease of life”, demonstrating a marked improvement in health, independence and social wellbeing.

Another person was admitted with a painful pressure ulcer that had severely restricted their mobility and quality of life. Staff immediately implemented a comprehensive plan, including specialist pressure relieving equipment, consensual repositioning and close monitoring. They worked proactively with Tissue Viability Nurses, the GP and other healthcare professionals, reviewing and adapting evidence based treatment as the wound changed. After 6 months of coordinated and consistent care, the ulcer had significantly improved; the person was able to spend time out of bed and resume socialising with friends. This progress was directly observed during our site visit and showed how skilled, collaborative support achieved an exceptional improvement in the person’s health and quality of life.

Staff recognised that a deterioration in a person’s continence needs was affecting the person’s physical health, confidence and quality of life. In response, staff acted proactively with the person’s consent and in close partnership with the Continence Service to access the equipment required to meet this person’s long term continence needs. A personalised intervention plan was introduced that reduced the risks of infection and trauma, and led to significant improvements in physical comfort, emotional wellbeing and overall quality of life. This demonstrated exceptional support to achieve better health outcomes without compromising the person’s independence or preferred routines.

The provider systematically monitored and reviewed people’s care through audits, reflective practice and regular evaluation. This drove continuous improvement and ensured outcomes and reflected what mattered most to each person.

Outcomes were exceptional and highly personalised. For example, following the death of 1 person’s wife, staff recognised their grief and helped them rediscover purpose through a shared passion for gardening. Despite mobility limitations, the person independently cared for the home’s gardens, planted a memorial tree and won an award for growing the tallest sunflower. This sustained achievement provided a therapeutic outlet and significantly improved their independence, self-esteem, dignity and confidence.

The staff delivered accredited sensory programmes for people living with dementia, with weekly sessions and documented outcomes. Records showed reduced agitation, greater calm and relaxation, and increased communication among people who were non-verbal. Individual responses included a person recalling family and childhood memories and another person recreating piano playing movements from when they used to play the piano. Staff described these meaningful responses as, “golden moments”. The provider used this evidence to refine support, maintain and develop people’s skills, and improve their quality of life.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Capacity assessments and best interest decisions were in place when needed to ensure the Mental Capacity Act 2005 was applied. Staff were able to demonstrate an understanding in this area including the importance of gaining consent from people. They had also received training in this area and were aware of the processes to follow.