Archived: Nutbush Cottage

On this page

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

Although we observed occasions when staff demonstrated a caring approach to people, there was a culture of staff focusing on tasks rather than individuals. This created an institutionalised feel where staff appeared to be working in people’s home rather than supporting them in a meaningful way. Staff did not receive supervision to support and monitor their performance which meant there was little chance for learning and mentoring. During our assessment of this key question we found concerns around people not always being supported in a respectful, caring and dignified way. This was a breach of regulation. You can find more details of our concerns in the evidence category findings below.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they felt staff approached people with kindness. One relative said, “From what I have seen staff are always kind." Whilst people did not raise concerns with us directly, other evidence showed people had not always been treated in a caring and dignified way.

Permanent staff spoke of people with affection and told us they wanted to care for them well. One staff member told us, “I try to do my best to make [person]happy.” However, we found the approach of staff to people’s anxiety could be dismissive. Staff used phrases such as, “They are just wanting attention.” And “They are doing it from mischief. I think they enjoy it.” They did not recognise people were communicating their distress or need for support.

One professional told us, “To some extent I feel staff treat [person] well.” They went on to describe how staff did not always encourage the person or respond to their concerns. Another professional told us there were times when they felt people’s emotional wellbeing was not being responded to when they appeared distressed. They fed back on instances of people’s privacy was not respected including where another person was present whilst staff were speaking about someone else’s care and staff taking a professional into someone’s room without knocking or checking with the person it was okay to go in.

We observed staff did not always treat people with honesty, kindness and respect. We heard staff repeatedly telling one person they would be going to see their family member the following day. When staff told the person this they sought further reassurance this was the case and staff repeatedly confirmed this to them. We asked staff about the arrangement for the person seeing their family the following day. Staff told us they us this was not the case but the person liked talking about their family. We asked if they would be upset when they realised they would not be meeting their loved ones. Two staff member told us, “They will have forgotten by then.” This showed a lack of respect for the persons emotional needs.

Relatives/representatives told us whilst a number of permanent staff knew people’s needs well this was not consistent across the staff team due to the use of agency staff and changes made to the team. We found for the majority of people their care followed the same set routine each day rather than staff exploring what was important to them as individuals. For example, we found the majority of people were supported to shower and get changed into their night clothes before 7pm each evening. This created an institutionalised feel to the care people were receiving.

The provider told us their aim for the service was for each person to be treated as an individual and to be supported to flourish. Staff told us they felt they had made changes to how people were supported, and people now received personalised support. Despite these comments we found staff did not always demonstrate an understanding of how to support people as individuals. When speaking to staff about people’s needs they frequently referred to people living at Nutbush Cottage as a collective group rather than speaking about people as individuals.

Staff were observed to spend the majority of their time focussed on tasks rather than on the individual. One staff member was supporting people to have a shower in the early evening. When asking people if they would like a shower, the staff member moved around the house wearing their PPE gloves and giving repeated prompts. For one person who initially refused, this meant the staff member was moving around their home for 20 minutes wearing gloves and ‘prompting’ repeatedly. Whilst the staff embers tone was pleasant, their emphasis was to complete a task rather than supporting the persons wishes to have their shower later.

Processes in place did not support staff in identifying the need to change their approach and support people in a more person-centred way. There was a lack of observation and feedback regarding how staff approached people. Whilst training had been completed in relation to providing personalised care, this had not been followed up to ensure staff were aware of how this training should impact the way they supported people on a day-to-day basis.

People did not always have choice and control over things which impacted their day to day lives such as who supported them, menu planning or going shopping for food. People were supported to maintain links with their family members. This included staff supporting people to travel to their family homes regularly or planning to meet up with relatives. This clearly meant a lot to people and their loved ones.

Staff told us they encouraged people to be as independent as possible and ensured choices were offered to people. One staff member told us, “I know what they like and what they don’t like but I still show them choices.” A second staff member told us, “We help them with the laundry and in the kitchen, with cleaning the table.” However, when we asked staff to show us how this was achieved in practice staff were not able to do so. For example, we asked staff to show us how people chose their food. Staff said they showed people pictures from the internet but when asked to demonstrate, they were unable to access the laptop easily to do so.

We observed the support people received during this assessment over 3 visits ranging from early morning to evening. Whilst one person had things they liked to do independently, we did not observe other people were supported to take an active role in their support. Staff were observed to do all the cooking, cleaning, laundry and collected people’s clothes and toiletries prior to supporting people with showering. We observed people were asked what drinks they would prefer although the majority of people were not supported to make them with staff. During our third visit people were having a takeaway for dinner. We observed each person was called from the table to take their dinner from the takeaway box and place it on a plate. This was done in an instructional way with several staff overseeing the process rather than making this into a social occasion.

Processes to enable people’s independence, choice and control were not embedded into practice. People’s care plans did not contain any assessment of their independent living skills. Guidance for staff in how to support people in developing skills was basic and did not achieve positive outcomes for people. Records showed that staff completed shopping and made choices for people without their input. For example, despite people enjoying the process of shopping, records and receipts showed staff often bought people’s toiletries in bulk without them being present.

People, relatives/representatives told us that in general staff responded to people’s immediate needs. One person told us, “I can generally get support if I ask for anything, but I might need to wait a little while. I know staff sometimes have to deal with other people first as their needs are higher than mine.” A relative told us, “It’s difficult to say when we’re not there. I think with the permanent staff yes, but I worry about the agency.”

Staff told us they felt responding to people’s needs was their priority. One staff told us, “Whatever they want we do for them, shower, food, drinks going out. Everything, we do it for them.” A second staff member told us, “We look after them well, we know what they like.” However, we found this was not always the case in practice.

We observed staff followed routines such as supporting people with meals, drinks personal care etc. When people made requests outside of these routines these were generally met, although the timeliness and importance to people was not always recognised. We observed one person repeatedly request a cup of tea when staff were completing records. They told the person they would do this in a minute on 6 occasions before making them a drink. On another occasion the person was showing signs of anxiety. Two staff both asked the person if they would like to listen to their favourite music as this was known to help them calm down. However, despite offering this neither staff member found the music channel for the person for 20 minutes.

The majority of staff told us they felt supported in their role although we were also made aware of concerns regarding them not always feeling listened to. Despite assurances at our last inspection a more effective supervision system would be implemented, we found this had not been completed. When asked about the meetings which had been held with individual staff, the registered manager reviewed the forms and told us, “I have no idea what these are supposed to be.” The provider told us they felt supervisions may not be being completed as the managers did not always fully understand the subject so lacked confidence in discussing this with staff. This demonstrated a lack of regard for staff well-being and enablement, and a lack of training and support for managers.

Staff did not receive effective supervision to support them in their wellbeing and development. There was no evidence that supervisions looking at staff performance, training, concerns and objectives had been completed with care staff since our last inspection in November 2023. The only record of individual staff meetings were reminders of guidance such as infection control, safeguarding and accidents and incidents. This meant there was no systematic approach to supporting individual staff members in relation to their personal and development needs.