Archived: Nutbush Cottage

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

People’s care records were not person centred and lacked details regarding people’s life histories, preferences and needs. Guidance from professionals regarding people’s communication needs were not always followed which meant people opportunities to contribute and make choices regarding their care was not maximised. People did not have the opportunities to go out as much as they wished and were not supported to do the range of things they enjoyed. Staff demonstrated a poor understanding of how to support people in a person-centred way. During our assessment of this key question, we found concerns around people not receiving person centred, specific to their needs and wishes. This was a breach of regulation. You can find more details of our concerns in the evidence category findings below.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives/representatives told us they felt people’s care could be more person centred. Comments included, “[Person] does go out but would like to go out more.” And, “Staff are always with [person], they let [person] guide the way. There is very little meaningful engagement, mainly following [person] around. When observing people’s experience, we found there was a lack of engagement and things for people to do. Staff walked around people’s home rather than looking to engage them in conversation or doing something together. This felt like staff were supervising the service rather than meaningfully supporting people.

Staff told us they were focused on providing person-centred care. The registered manager said, “I think it’s getting there but there is still work to do.” Despite these comments we found concerns from previous inspections were still being repeated. This included the language which was used in records such as staff referring to a person going ‘for a walk around the compound’ when describing the person walking in the garden. And referring to the action staff should take if the person was ‘refusing to calm down’. This demonstrated a lack of understanding regarding a personalised and dignified approach.

We observed that for some people there had been an increase in them going out, this was not the case for everyone and was still not in line with their assessed needs. One person had been assessed as needing staff to support them in going out for 2 hours each day. Records showed the number of times they went out had increased with regular swimming sessions and buggy rides. However, the person did not go out daily and was regularly out for less than an hour. People’s activity plans were not followed with evening activities rarely taking place. There was limited evidence of people having the opportunity to go to the pub, cinema, eat out or go dancing which were all things people enjoyed. One person had declined to attend groups they had previously enjoyed. There was no record of the reason for this being explored. The groups had mainly been replaced with supporting the person to go for walks down the road where they lived. There was no evidence of how people were empowered to develop new interests. There was no evidence of how community relationships were being developed or how people were being supported to be part of their local area.

Due to the high use of agency staff and team changes, staff told us they felt people did not always receive good continuity of care. One staff member told us, “We need more staff who are regular and who know the people. Especially [person’s name] needs regular staff. I have to keep explaining and explaining to new staff.” The registered manager also told us that a stable staff team was required at Nutbush Cottage. They told us, “I need to sort my staffing out, they keep taking them away from me.” Despite these comments both the staff member and registered manager felt that due to a core of a few staff, people always had someone they could go to for support.

Feedback from partners in relation to continuity of care varied. One professional commented, “There are always different staff now which makes me worry about continuity.” A second commented, “It’s difficult to comment on consistency but from the feedback I receive from the management team there is some degree of continuity.”

Despite assurances from the registered manager that agency staff used were very regular and knew people well we found this was not the case. A review of rotas for May and June 2024 showed with 9 different agency staff were used to cover 19 day shifts. This meant there was a risk people would not receive continuity of care from staff who knew them well.

We did not receive any direct feedback from people or their relatives in relation to this area. However, we found information was not always provided to people in and accessible format and in line with their assessed needs. Although staff took pictures of people to demonstrate things they had done, these were not used to enhance communication going forward and were not used to develop communication aids. This meant people did not routinely receive information in a way they were able to understand.

Staff were unable to describe how to use communication systems recommended for 2 people living at Nutbush Cottage. They told us they had not received training in this and were not aware of the recommendations. One staff member told us, “We know them so well we know what they like and dislike.” This demonstrated a lack of understanding regarding people’s need to communicate on a wider level. We asked the registered manager about recommendations made for one person in November 2023 by the Speech and Language Therapy team (SaLT). They told us they were unaware of the report and recommendations.

Processes were not in place to ensure information was provided to people in an accessible format and people’s communication plans were followed. Guidance from the SaLT team regarding one person’s communication recommended the use of photographs, social stories and the Now and Next communication system. This system is designed to minimise anxiety and prepare people for the transition from one activity to the next. Despite this guidance being shared over 6 months prior to this assessment this had not been implemented. A second person’s care plan continued to refer to SaLT guidance issued over 3 years ago. This had not been implemented and no update had been requested. We observed the pictorial communication aids for individual activity planners displayed contained very small pictures and symbols which was not in line with people’s needs.

Whilst steps had had been taken to involve one person in their care and the running of their home, this had not been put in place for others living at Nutbush Cottage. One person told us, “They do discuss things with me. The manager that is.” We found systems to involve people with more complex communication needs were not effective.

The registered manager told us they were aware the compliance manager had started to use a different system for involving people in their home to make this more personalised. They told us they had not seen the information until our inspection. Following a review of meeting minutes they told us, “I can’t see what the point of that is.”

The most recent residents’ meetings were recorded as a 1-1 with meetings and entitled ‘Summer Plans’. The conversation related to the garden, being outside, and having barbecues. The record was a transcript of the conversation with the staff member asking questions and the response from individuals recorded. On numerous occasions people did not responded or on some occasions their responses did not appear to be linked with the question. Despite this indicating people had not fully understood the discussion, the staff member drew conclusions from the meetings regarding what people wished to do. The meeting minutes did not reflect that any photos or other communication aids were used during the conversations. There was no discussion regarding if people would like to make plans for the summer doing things outside of their home.

Staff told us people’s needs were considered in terms of access to services and external resources and adaptations in the home were in line with people’s needs. The registered manager told us that prior to looking at opportunities for people they would ensure they reviewed risks regarding accessibility. The registered manager told us, “Before we started using the swimming pool they went to look at it to make sure it was suitable, and we planned what the best day to go was.”

Partners told us they felt relevant adaptations had been considered to meet people’s needs. Comments reflected on the investment of a garden office which had helped to reduce people’s anxiety as there were less people in the house.

People’s home had the adaptations required to support them. There was a ramp fitted externally and a downstairs wet room which meant those with sensory and mobility needs had easy access.

We did not receive any direct feedback in relation to this. Although people did not raise concerns with us directly, other evidence showed the service had not always ensured people’s wellbeing and care was being looked at in a way which empowered and enabled them to develop and make choices.

The provider told us they felt people’s needs were being met more holistically and improvements had been made to the way people received their support. They told us, “I think service users are very settled. I can’t say it’s 100% good, staff need to start thinking outside the box.” Near the conclusion of our assessment the registered manager told us that having reviewed documentation and discussed observations during the inspection they understood that a lot more input into the service was required. They told us, “I honestly believed it was going in the right direction but there is so much to do here. It’s going to take time to build this team and get everything sorted.”

The provider had failed to embed systems to maximise the effectiveness of people’s care and treatment. This meant people’s needs continued not to be met in a holistic way and that people’s individuality was not always respected.

The provider had initiated discussions with relatives regarding planning for people’s wishes at the end of their life. However, due to people’s younger ages relatives had recorded they did not wish to have this conversation at this point. The provider told us they felt it was important to give people the opportunity to discuss their wishes and would continue to do this going forward as the need arose.