Tolson Grange

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.At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 61 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care plans varied in the detail they provided. Some included good detail about the person’s needs and how they would like their care and support to be delivered whilst others lacked specific detail. For example, a person with known issues around eating did not have a care plan in place to address this. A care plan for a person assessed as being at very high risk of skin damage and required careful repositioning said the person was to be repositioned ‘as often as needed’ rather than giving clear direction in line with the assessment of risk to the person.

Reviews of care plans did not always reflect the involvement of the person or, where appropriate, their family and did not always reflect if the care plan had been fully reviewed to see if it was still effective.

Staff did not always reflect a person-centred approach to care. For example, one staff member told us, “I would toilet them before lunch. I like to know they are getting done well before dinner, so they are not sat in a wet pad.” Another member of staff told us care was not always person centred because they were often rushing.

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

Staff worked pro-actively with families to promote continuity of care for people. Relatives told us they were involved in reviews of people’s care although documentation to evidence this was not always in place.

There were good links with the local community which meant people benefited from contact with church groups, choirs and children from a local nursery.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Only one of the people we spoke with told us they had knowledge of their care plan, they told us it had been read to them and they had signed it. Care plan development and reviews did not always evidence involvement of the person or, where appropriate, their family and there was no record of people being informed how to access their electronic care records or be offered a paper copy. The registered manager told us they would produce documentation in other formats or languages as required.

People and their relatives were kept informed about what was happening in the home. Meeting minutes showed how people were informed of such as staff changes, planned decoration and upcoming activities.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

People were given opportunities to have their say about the service. This included use of satisfaction surveys and regular meetings. People and their relatives told us they would feel comfortable to go to any member of the management team if they had any issues.

Complaints were managed well and we saw a number of compliments about the service from people and their relatives.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

There was a risk that safe systems of care could be compromised because people were not supported to attend healthcare appointments. Minutes from a recent meeting showed senior staff had been informed that hospital appointments might need to be cancelled if family members were unable to provide support and no staff were available. Whilst the registered manager said that no appointments had been missed due to a lack of available support, staff told us that some appointments had been missed or cancelled as a result of poor planning and organisation.

This was addressed by the provider who put in place a reflective learning process for staff.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff told us they thought people who were unable to speak up for themselves or did not have representatives to do that for them, were at risk of not receiving the same outcomes as people with involved families or advocates. One staff member told us that if family were involved, “then the managers are on it but not as proactive with others who don’t have family to advocate for them.” Another said, “Some people have advocates in place. It is always a problem when people don’t have families. They will get forgotten about.”

Not all of the people living at the service had direct access to outside space. We discussed with the manager about how people who had the most difficulty in asking to go outside were the people without direct access. The manager said they would give thought to how this might be resolved. Some relatives told us their loved ones only got to go outside when they took them.

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.

People’s preferences and decisions in relation to emergency care and treatment, including resuscitation were clearly documented. End of life care plans were in place with some including very good detail about people’s wishes. One person told us about a member of staff’s dedication and care in supporting a person at the end of their life.