Tolson Grange

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 60 (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 did not always respect people’s privacy and dignity. Staff treated people and colleagues from other organisations with kindness and respect.

Staff did not always demonstrate an understanding of the importance of meeting people’s dignity needs. For example, we met a person walking along the corridor with their trousers, which were clearly too large, around their ankles. This situation compromised the person’s dignity. No staff were present in the immediate vicinity, so we supported the person to pull their trousers up.

When we raised this with a member of staff, they said that night staff had assisted the person with dressing. However, given that this occurred around lunchtime, this response did not demonstrate sufficient awareness of the need for ongoing support to maintain people’s dignity throughout the day.

On another occasion we observed a person throwing their chewed-up food in the direction of another person who was eating their meal. Some of the chewed food had landed on the other person’s plate. Staff commented on this but took no action to intervene. This demonstrated a lack of understanding of the dignity of both people involved.

Some care plans did consider people’s dignity needs. For example, one person’s care plan talked about how staff needed to offer support and reassurance to manage the person’s anxieties around incontinence.

People told us they were supported with care and kindness. One person said, “Staff are 10 out of 10.” Staff treated visitors with kindness. A relative told us, “They are welcoming, friendly and pleasant, can’t fault them.” During our visit the service was celebrating International Nurses Day and provided gift packages for visiting health professionals.

When we arrived for one of our visits, we were discreetly informed that a person had died and was still in the home. A sensitively worded notice had been placed in the entrance hall to inform people of this along with two small flameless candles. This gesture demonstrated a compassionate and respectful approach to the person who had died and their family.

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

When people came to live at the service, they and their families were asked to complete ‘life story so far’ documents. These documents helped staff to get to know and understand the person. A member of staff told us how they used the information provided as talking points with people.

Care plans had been developed to reflect people’s cultural needs and what actions staff needed to take to make sure they were met. For example, one person’s care plan talked about their faith and how they may wish to observe key dates. Staff knew people well and engaged them in conversations relevant to their interests and lifestyles.

The service had gained accreditation from the Veteran Friendly Framework which meant that veterans or spouses of veterans received visits from members of the armed forces. Veterans and their spouses were recognised by the service with a poppy sticker on their bedroom door.

The provider promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Care plans reflected people’s abilities and preferences about how they wished to retain as much independence as possible. One person had recently chosen to move rooms so they could have direct access to the garden which they enjoyed. However, a member of staff told us there were probably situations when staff did not take time to encourage people to be independent.

People were positive about being supported to follow their own routines and make choices but were mixed in their responses about having access to meaningful activities. One person said, “A man with a guitar came recently; nothing else activity wise. I like to get out into the garden; I can do that myself.” Another person told us they didn’t need activities and relative told us, “There are no activities [person] would enjoy. I take [person] outside when I visit.”

A person was engaged by the provider to support activity planning and visited the home once a month. During these visits, they led sing-along sessions and spent time with people who preferred to remain in their rooms. They also planned to support staff with organising outings, building community links, and increasing access to activities within the home. In addition, local groups including church groups, a choir, a nursery, and a mobile library visited the service. People had enjoyed a visit to a ‘dementia showing’ at a local cinema.

Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

On 2 days we observed a person throwing chewed food in the direction of other people sitting at the dining table. On one occasion the food had landed in a person’s drink and on the second, the food was landing in another person’s meal. On neither occasion did staff offer any support to any of the people affected by this until prompted by the inspector. On another occasion a person was expressing severe pain, becoming distressed and asking for their pain relief. Staff told the person they would have to wait as the senior member of staff had to wait for another senior to co-sign for administration of their medicine. This caused the person further distress.

People told us that generally staff came quickly when they pressed their buzzer and said staff were usually available to them as they needed. However, one person told us they would use their phone to call the home if staff had not responded to the call bell within 10 minutes. They said staff responded when they did this.

The provider did not always promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us that morale was low because they did not feel supported, and the staff team was depleted because people had left. One staff member told us, “I think there is a staff morale issue, about 80% of staff are looking to leave. Some of the long-standing staff are looking to leave because there is no consistency. It is the rotas that are an issue.” Another member of staff told us, “It is a problem about the rota. We want a 2-week rolling rota so we can plan life out of work”. Staff spoke about worrying that they would be punished, and one said, “It feels like no matter how hard you work you never get a thank you.”

Some staff felt supported by the management team and said they could approach them whenever they needed to. Staff felt their training was useful to their roles.