Hydon Hill - Care Home with Nursing Physical Disabilities

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

Although people told us staff were kind and caring towards them, people were at risk of receiving institutionalised practices. People received varied outcomes around choice and control of their care. This seemed particularly poor for people with a learning disability. This meant the service was not meeting the principles of RSRCRC as the model of care did not maximise people's choice, control and independence and the care was not person-centred .

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We observed people’s care was fitted around the routine of staff. During our assessment, at 5.45pm 28 of the 37 people living at Hydon Hill were in bed. By 8pm this had increased to 33 people. Staff told us this was because people needed to stretch out after being in their wheelchair. We did not see reference to this as a specific need within care plans we viewed. Staff told us the same people were supported to bed prior to the end of their shift each evening. Furthermore, staff supported the same six people with their morning personal care prior to their shift finishing at 7.00 am. This did not demonstrate a personalised approach where people were supported to make choices daily. People did not have access to food for long periods during the night. Staff told us breakfast was served between 8.30am and 9am, and supper between 4pm and 5pm. Whilst some people were able to keep snacks in their room, for others this meant they may not eat for over 16 hours a day. Staff told us there was no access to food for people during the night as the kitchen was locked. The registered manager confirmed this was the case due to catering being provided by contract caterers who were reluctant to leave food out overnight. Staff told us people may occasionally request a yogurt but did not normally say they were hungry. This did not take into account if people were unable to verbally express if they were hungry. This demonstrated a lack of flexibility and consideration regarding people’ needs and wishes regarding their access to food. Practices within the home did not always reflect a dignified approach to people’ care. We observed staff using two commodes stacked with different sized pads, replacement catheter bags were draped over one handle at the back of the commode and a yellow clinical waste bag over the other. The commodes were left outside people’s rooms whilst people were supported. This was an undignified and institutionalised way in which to provide people’s care.

Individual staff showed kindness in their approach to people although the system within the service meant people did not always have a positive experience as reported in other quality statements of this report. People told us they received kind and compassionate care. One person told us, “Staff are very good. They are all very friendly. Staff always check on me.” Another person said, “Staff are lovely. I really like it here.” Relatives also confirmed this, with one telling us “Staff are kind and caring.”

We received positive feedback from health care professionals in relation to how caring staff were towards people using the service. One health care professional told us “The staff that I have interacted with appear to know the resident well and are caring.” Another health care professional fed back the service was “caring and giving a good quality of care for the residents.”

However, staff did not demonstrate an understanding of ensuring dignity when supporting people with their personal care. Language and terminology used by staff was not always dignified or respectful. Night staff told us they checked people’s continence and personal care needs three times during the night. They described this as completing ‘pad rounds’. Another said “Others (people) are prepared by the day staff” in relation to people receiving personal care in the morning. Staff demonstrated an awareness of ensuring people’s care was provided in private. A staff member told us “If I was hoisting someone, I would ensure the sling was closed so they were not exposed. I am always asking people what they would like and explaining everything I am doing. I would always close someone’s door if I was providing personal care.”

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

There was mixed feedback in relation to what activities were available for people. For those people with a learning disability their experience appeared poor. One person told us, “There is always something going on.” Another person told us “There are activities, but not necessarily what I want to do. When I first came, we used to do a crossword every morning, but that stopped.” When we asked the person if they had requested for it to be restarted they said, Yes, I’ve suggested it, but it just doesn’t happen. I have been so pleased to have [staff member] as he’s good to talk to and so interesting. Most people here are non-verbal.” A relative told us “[My loved one] rings me twice in the evening. We have the same conversation. It’s because she’s bored and there’s nothing for her to do.” They don’t go out enough because of drivers.” Another relative said “I have seen him go for a walk with staff during the summer. Other than that he is generally in his room waiting for me.” Relatives also fed back that people were encouraged to be independent where possible. One relative told us, “Hydon bring [my loved one] to [my home town] so we can go to the theatre together. They’ve even given her her own key as she takes the post to the letterbox for them and lets herself back in”

Activities for people within the home were not always in line with people’s preferences. One to one records for people with a learning disability living at the service showed the main activities offered were around crafts and games which were not listed on people’s preferred activities. People were not supported to go out regularly and did not have the opportunity to do things they enjoyed. One person’s support plan stated, ‘It is important I access the community as I love going out and this is important as I am unable to tell you.’ Despite these wishes, one-to-one records for the person for the 4-month period between September 2023 and December 2023 showed they had only been out on four occasions. Systems were not in place to support people in planning their day/what they wanted to do. Whilst there were three staff in activities all worked during the day with no evening support available and minimal support at weekends. We asked staff if people went out in the evening. They told us this was not possible as people needed to have ‘bed rest’ and that drivers finished at 5pm. The registered manager confirmed this was the case. Consideration had not been given to how people could be supported in a more flexible way which meant their choices and opportunities of doing things in the evening were restricted. This went against the principles of RSRCRC Although care plans highlighted what people enjoyed doing there was limited planned activities around this.

Staff were not aware of the principles of personalised care, meaning that activities provided should be personal and meaningful to each person. One staff member told us “We adapt everything so everyone can take part. (Person-centred care) is where you understand the individual and tailor to their needs. So where you give things to a 4 year old, some people (at Hydon Hill) wouldn’t be able to do that. So we help them do the parts they can.” The registered manager did also not demonstrate a personalised approach to people going out. They said “The location makes things difficult to get them out. By the time you’ve loaded them and got to Guildford that’s an hour gone. It’s not like we can just go out to get a coffee or go to the shop.” This meant people were not supported to have choices on how they spent there time to ensure their care was meaningful to them. However, staff also told us they wanted to continue to support people in developing their independence. One staff member said, “We try to push people do things themselves like eating or in activities. If you encourage people and they achieve they are much happier.”

We did not look at Responding to people’s immediate needs during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.