Heywoods 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 inadequate. This meant services were not planned or delivered in ways that met people’s needs. The service was in breach of legal regulation in relation to person-centred care.

This service scored 32 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. We found the provider had not developed appropriate care planning, risk management or specialist support arrangements for a person who regularly exposed themselves in communal areas. The provider had not fully considered the person's privacy and dignity, nor the impact of this behaviour on other people living in the home. This demonstrated a lack of person-centred planning and review to ensure care met the needs of everyone affected. Staff knew people well and relatives described positive examples of personalised support and understanding of people's preferences and routines. However, personalised care planning was not always translated into effective practice.

There were shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity. Records showed that referrals to specialist services were not always actively followed up, and recommendations from healthcare professionals were not consistently implemented, reviewed or reflected within care planning documentation. We also found limited evidence of regular multi-agency reviews of people's placements and support arrangements, with the most recent placement review on file for a person dating back to 2019. As a result, the provider could not consistently demonstrate that people's changing needs were being reviewed and coordinated effectively across health and social care services.
 

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The provider did not always ensure people, relatives and representatives received accurate, up-to-date information about the service and the care they provided. Relatives described mixed experiences of communication and involvement. Some told us they had not recently been involved in care reviews and were unable to recall discussions about important decisions affecting their family members, including Mental Capacity Act processes. The provider had also failed to display its Care Quality Commission rating within the service as required. However, we saw positive examples of accessible information, including personalised "About Me" documents, photographs, pictorial information and Makaton symbols which supported people to understand information and express their preferences.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. We found that involvement in formal reviews and structured opportunities to provide feedback was inconsistent. Several relatives were unable to recall recent care reviews, and the service was unable to demonstrate a consistent approach to gathering feedback from people and their families. Relatives generally described staff as approachable and willing to listen. One relative said, "They always say tell us if there's anything you're not happy with," whilst another described communication as "good both ways." One person told us, “We choose what we want to watch on TV.”

The provider did not make sure that people could access the care, support and treatment they needed when they needed it. We could not see that a specialist instruction to adjust one person's prescribed medication had been implemented, and recommendations contained within a psychiatry review had not been progressed. We also found referrals and follow-up actions were not consistently monitored to completion. Relatives generally told us staff sought medical advice when concerns arose and kept them informed about significant health issues. However, we found examples where clinical recommendations and treatment plans had not been acted on within appropriate timescales. As a result, the provider could not demonstrate that people always received timely access to the care and treatment needed to support their health and wellbeing.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. We found one person with treatment-resistant schizophrenia and a history of command auditory hallucinations spent significant periods isolated in their bedroom, with limited evidence of structured mental health monitoring, proactive engagement or escalation when concerns arose. Despite having some of the most complex assessed needs within the service, records did not demonstrate how the provider was evaluating their experiences, outcomes or wellbeing to ensure they received equitable access to support and opportunities compared with others living in the home. Relatives consistently described staff as knowing people well and understanding their individual personalities, communication needs and routines. However, this knowledge was not always translated into proactive care planning, monitoring or intervention.

People were not 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. We found limited evidence of anticipatory care planning, end-of-life discussions, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) reviews where relevant, or plans to support people through significant changes in health, support needs or life circumstances. This limited the provider's ability to demonstrate that people, their families and relevant professionals were being supported to make informed decisions about the future at the earliest opportunity.