Hydon Hill - Care Home with Nursing Physical Disabilities

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Processes in place as well as the ethos, values, and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. Leaders showed a lack of understanding on how to meet the RSRCRC principles. Quality governance systems were not effective in their use. Staff felt confident in being able to speak up if necessary, and felt supported in their roles.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Management systems were not designed to give people an equal voice when raising concerns which meant there was a risk of closed cultures developing. The registered manager told us that any complaints raised by families or professionals were recorded on the electronic system which could be viewed by senior managers in the organisation. Complaints received from those living at Hydon Hill were reviewed in house and were consequently not seen by the senior leadership team. On 28 November 2023 a person raised a concern that a staff member had hoisted them alone during the night when it should require two members of staff for safety reasons. A supervision was held with the member of staff who denied this was the case. The complaint record determined no moving and handling guidelines were breached. There was no evidence of other staff members on the shift being spoken to or of feedback being given to the person. People were not fully involved in the running of their home. Residents’ meetings took place regularly although did not take into account the different communication needs of those attending. Minutes were typed with no pictorial aids or easy to read versions available. Despite a number of people attending meetings not being able to vocalise their opinions, minutes recorded that everyone felt safe and that everyone knew how to raise a concern. There was no evidence of how people who were unable to express their opinions verbally were supported to take an active part in the meetings or receive minutes in a more accessible format such as by using visual aids or easy read.

Staff felt supported in their roles and said they felt able to speak up. One staff member told us, “I feel very supported. I feel the home is run well.” Another staff member said “I feel supported. I have no problems with [the clinical lead] or [the registered manager].” They went on to say they felt they could speak up in the meetings and that everything was discussed. Staff also spoke about people fondly and were caring in their day to day interactions. However, staff did not always demonstrate a positive personalised approach. Staff talked about people collectively in many instances using they and them and speaking about the care people required as tasks such as pads rounds and getting them done when describing supporting people to get up in the mornings.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff commented on the improvements made since the clinical lead had been in post. They felt more aware of people’s health needs and felt processes for recording were more robust. We received mixed feedback from leaders on the governance systems in place for the service. The registered manager told us “We have a service improvement plan. We work through it and I think we’re getting there. It feels much calmer and safer.” However, the nominated individual informed us they had identified concerns in relation to the quality governance processes. A new audit system was starting on the day of our site visit. They stated the new stage in the process was to employ a team of ‘fixers’ who could support services to make improvements. They told us the audits were in on-going development. Whilst the need for change had been recognised this still raises concerns regarding how current concerns would be managed. As described earlier in this report, we identified several areas of the service where the principles of RSRCRC for people with learning disabilities and autism were not being met. When we asked the Registered Manager for her feedback on our findings, they said, “To be honest I don’t see how we will ever be able to meet it. Again, it’s the location and the style of building. They all have their 8 hours 1-1. We just need to work out how we can make adjustments so they can do more cooking like they do in Willows.” This demonstrated a lack of understanding of the guidance in seeking to ensure people were able to live an ordinary life. At the end of our assessment, the nominated individual stated they would suspend admissions for people with a learning disability until they had addressed these concerns. They clarified this would be if people’s primary need was a learning disability. If they felt the persons primary need was their physical or nursing need they may consider admission. This again demonstrated a lack of understanding of the guidance.

Quality governance systems were not effective in their use. The provider's audit from 17 May 2023 identified areas for improvement which we also found during our assessment. However, it did not state what was done to follow up on the issues identified, and as we identified during our assessment, action had not always been taken to rectify these issues. For example, the audit found "There are communal activities but when I spoke to customers, they said they did not want to always do art and puzzles therefore they spent time in their rooms. I sampled three [care plans] and could not evidence any meaningful goals having been set or actioned.” There was no information what action would be taken to rectify these issues and we found that they still remained during our assessment. The registered manager's audit was completed on a regular basis. However, it had not identified the issues we found during our onsite assessment. For example, the manager's audit on medicine management in November 2023 found no issues and an internal rating of 'Good' was given. They did not identify the issues we found on site, such as PRN protocols not always being in place and poor stock management.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.