Foxland Grange

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

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

This service scored 89 (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.

The staff team showed an exceptional commitment to person centred care. Detailed, individualised care plans and risk assessments reflected each person’s needs, preferences, interests and what mattered most to them. People, and those important to them where appropriate, were fully involved in decisions and supported to achieve meaningful outcomes. Staff used their exceptional knowledge of people to create innovative opportunities that enhanced identity, confidence and wellbeing.

Retired teachers were supported to plan regular intergenerational activities with a local primary school. With 1 describing the experience as, “boosting their confidence”. With staff support, the retired teachers organised an Easter egg hunt, Easter arts and crafts session (which the children made and gave to the people), and in return people gave ‘life advice’ slips to the children. We saw photographs of this event which were displayed around the home. The registered manager told us, “Intergenerational relationships are mutually beneficial, enriching the lives of both the elderly and children while promoting healthier communities.” This was now a regular event at the home which the retired teachers with support from staff planned and arrange.

A former head teacher was supported to revisit the school they previously worked in, where they renewed valued connections and became a pen pal to pupils. The person had said, “Coming back here, feeling the atmosphere of the school and seeing the interaction of the children with the teachers has filled me with confidence and joy, the support for the children is still at the forefront of everyone’s minds. It has been just wonderful to have such a lovely welcome, I feel like a celebrity.”

Staff also helped a person who had become socially withdrawn to rediscover their identity as an artist and poet, develop a personal studio space, exhibit work at a local art gallery and re-engage with writing and community projects. In taking part in this, they said they had found old written work they had completed and intended on getting in touch with their old publisher. The person commented “I’m waking up thinking of rhyming words.” These outcomes demonstrated that personalised care was embedded in practice and enabled people to lead fulfilling lives that reflected their histories, strengths and aspirations.

Staff worked with people and their families in a person-centred way to ensure everything was individual to each person. Staff knew people and their needs exceptionally well and could demonstrate an understanding of each person they spoke about. We saw this when staff interacted with people.

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.

Evidence showed an exceptional standard of care provision, integration and continuity. The provider had an in depth understanding of people’s diverse and changing needs and worked effectively with families and health professionals to deliver flexible, joined up care. People consistently received support from staff who knew them well, understood their histories and relationships, and continued to offer meaningful choice even when communication became limited. With 1 relative telling us, “I am impressed by the way the whole team mobilise to make sure that my relations care is personal to her. At all times they talk with her about what she wants and needs from day to day. Even now when she rarely communicates verbally the staff involve her and give her choices. This is made even better by the staff arrangements. Whenever possible my relations daily care is provided by the same staff who know her really well. This history is important as initially my relation came into Foxland Grange with her husband (now deceased). Her carers know and understand the importance of these memories and have also built strong relationships with me and the wider family group.”

When 1 person’s Alzheimer’s disease progressed and their cognition, nutrition and weight deteriorated, staff identified the changes promptly, introduced weekly monitoring and prioritised the person at multidisciplinary clinical reviews. Recognising that the assisted living environment could no longer meet their needs, staff worked with the family to plan a gradual transition to the home’s dementia focused unit. Familiarisation visits, shared meals and continuity of monitoring helped the person adjust safely while maintaining relationships, independence and social engagement. The move resulted in clear improvements in nutritional intake, weight, wellbeing and quality of life, demonstrating highly coordinated care that adapted seamlessly as their needs changed.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Detailed communication care plans were in place to show how people chose to communicate and how information should be made available to them. Some people used assisted technology to communicate, and others used cue cards and visual prompts. We saw staff using this equipment to support people to make choices, for example at lunch time.

The registered manager confirmed information was provided to people in a format or language they could understand if requested.

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.

There was a clear commitment to listening to and involving people. People and relatives were consistently involved in decisions, felt heard and described prompt, attentive responses when they raised concerns. A relative told us, “On the occasions when we have had any concerns, senior staff responded very promptly and kept in touch until any issues are dealt with. The attention to detail is outstanding.”

Feedback was actively sought through reviews and resident council meetings, with clear opportunities for people to influence the service. A Resident Ambassador role had been co-developed around a person’s strengths: they welcomed new residents, supported others to express their views, engaged with relatives and contributed to recruiting care and kitchen staff.

The service also acted creatively on people’s aspirations through a ‘wish tree’, enabling highly personalised experiences such as attending the theatre or a football match, spending time with family cooking and pets, and for 1 person they returned to sailing which was an activity they previously enjoyed.

Leaders monitored feedback, compliments and complaints, responded quickly to concerns and ensured advocacy was available, demonstrating that people’s voices shaped both their individual support and the wider service. The registered manager was able to explain the action they would take if concerns were raised and told us this was in line with the complaints procedure that was in place. A unit manager explained to us the benefit of responding to concerns quickly. People had access to an advocate if needed. The service promoted advocacy and information would be available for people if they needed this.

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

There were processes in place that the registered manager could consider if concerns or changes in people’s needs arose. They had links with external agencies that they could engage with to raise concerns and make referrals if needed.

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

Staff showed an exceptional commitment to equity in experiences and outcomes. Staff proactively identified people at risk of inequality and used detailed knowledge of their histories, cultures, beliefs and changing needs to provide highly personalised support. For 1 person whose faith provided comfort, staff worked with their family and a local faith community to arrange accessible reflection sessions within the home. As the person’s dementia progressed, staff recognised that these visits were no longer beneficial and, with the family, adapted the support. Staff now read their faith newsletter to the person individually, using and recording non-verbal responses to ensure the connection remained meaningful.

Equality training further enabled staff to identify and remove barriers, support positive outcomes and provide people with opportunities comparable to those available outside a care setting, including holidays. This demonstrated that equity was embedded in practice and support was continually adapted so each person could experience inclusion, dignity and meaningful outcomes.

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

Professionals spoke positively about the support people received at the end of their lives. One professional said, “The reminisce side of the home I would say are outstanding. They deliver exceptional care led by [unit managers name]. [Staff names] there seniors absolutely shine in end-of-life care. The patients are so well cared for. The relatives cannot sing their praises enough when I go in. There is always evidence of mouth care, tidy rooms, recent personal care, relatives being offered care and support. We get offered drinks which goes a long way in the line of work we do and the difficult conversations we are having in palliative and end of life care.”

End of life care plans were in place for people when needed, they had been completed with people and those important to them, when they wished to. These had considered people’s choices and preferences during this time.