Nyton House

On this page

• 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

The service was exceptionally well-led, with the registered manager and provider deeply dedicated to delivering the highest quality care and placing people at the heart of every decision regarding their support. They cultivated an incredibly positive culture, ensuring the staff team wholeheartedly embraced their roles, consistently prioritised individuals' needs and preferences. Both the registered manager and provider demonstrated exceptional expertise in their roles, supported by outstanding systems to monitor service quality and implement improvements whenever necessary. Their leadership inspires a shared passion among the entire team to stay informed about best practices and continuously strive for excellence. The provider’s commitment to exceptional care has earned recognition from numerous professionals and partners for their remarkable approach to supporting individuals.

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

Staff were motivated by and proud of the service. There was a strong organisational commitment and action towards ensuring that there were high levels of satisfaction and constructive engagement with all staff. One staff member said, “It is lovely to have such an enthusiastic management team to work for." One senior leader said, “We make sure there is something that everybody can do every day and feel they are achieving and valued.” Preventative action was quickly taken and embedded in response to any workforce inequality issues. For example, when moving and handling issues were highlighted for one staff member, leaders ensured that all staff maintained the high standard expected. One staff member said, “We all had moving and handling training refreshers recently as an audit showed a few people needed support in that area. Rather than make it obvious and retrain just them they trained everyone again which I though was a nice approach.” Equality and diversity and human rights approaches were embedded in everything the organisation does and understood by all staff. Preventative action was quickly taken and embedded in response to any workforce inequality issues which we have detailed in this well-led section.

The home fostered an exceptionally positive culture, with both residents and staff highlighting the service's outstanding and unique leadership. They praised the emphasis on vision, values, and people, which were central to the service's approach. These principles were wholeheartedly embraced by the registered manager and the staff team, leading to remarkable outcomes for residents, as detailed throughout this report. Staff and leaders cultivated a compassionate, collaborative, and responsive culture that encouraged trust and understanding between staff and residents while focusing on continuous learning and improvement. The leadership upheld a shared vision and strategic approach, driving a culture of excellence through innovative practices in areas such as tailored dementia and disability environments, clinical outcomes, staff development and well-being, and the integration of advanced technology and best practices. Leaders ensured that staff were well-informed, actively involved in improvements, and seamlessly integrated new initiatives into their work. One staff member shared, “The culture at Nyton is such that everyone is fully supportive when improvements are needed.” The vision, strategy and culture were co-produced with partners. They closely reflected the challenges and met the needs of people who used the service and wider communities. Leaders viewed partnerships and engagement with local communities and initiatives and integrated these into people’s engagement and activities. Challenges that leaders identified, such as supporting dementia care, people’s mobility and clinical needs were met with collaborative working with external professionals. One partner said, “I cannot speak more highly of (the registered manager and Directors) dedication, vision, and commitment to excellence in care. They stand out as leaders.”

Leaders embodied the vision and values, and discussions with staff showed that they worked to embed these with everyone who worked at the home. There was a robust framework to ensure equal opportunities for access and benefit from these for all staff, especially those with protected characteristics. We have detailed this in the workforce equality section of this report. One member of staff said, “Management is so supportive. They are out of this world.” Another member of staff said, “It is lovely to have such an enthusiastic management team to work for."

Leaders had exceptional understanding of staff and people’s needs and the context behind their care experiences. These were central to their methods of leading an inclusive and highly effective organisation. Leaders identified risks to peoples support and where the development and improvement of the home could enhance people’s experiences. The approach to continuous improvement was proactive and preventative through the introduction of technology and innovation and by ensuring a highly trained and motivated workforce was in place. The registered manager was highly visible in their role, engaged with people consistently and with compassion and had exceptional understanding of their needs. We observed this throughout the inspection. One person said, “The managements excellent. She is a hands-on administrator. She wouldn’t ask staff to do anything she wouldn’t do herself.” Another person said of the leadership, “They know me. I couldn’t find a better place.” Leaders had high levels of credibility. They consistently did what they say they would and communicated in transparent ways. We have detailed in this report the development of an open and transparent culture that allowed staff and people to challenge and change practice, to suggest improvements and become involved in the running of the home.

The registered manager and Director were proud of the work they had invested into ensuring staff and people felt comfortable to address any comments, suggestions and challenges they had with care in the home. Leaders commented on the professional and direct way that staff did this and provided examples of this approach, which we have detailed within this quality statement. Leadership spoke of how freedom to speak up had been embedded within the home and how they had received constructive feedback received from new staff members regarding moving and handling processes. The director said, “Freedom to speak up is where we are strong.” People and staff told us they felt incredibly confident to speak up about any improvements they felt could be made to the service or if they had concerns that needed addressing. Without exception, staff and people said these were listened to and acted upon without prejudice. One person said, “If I wanted to say something, I would, I wouldn’t wait for a meeting.” Another person commented, “I like to know what’s going on. You can speak up, make comments. I don’t think anyone said anything critical about the home, no one raised any real objections.” One stakeholder said, “They sit down when there's a problem, and (the registered manager) is good for giving that space to people.”

Leaders promoted an open and transparent culture where staff had the freedom and confidence to speak up. There was an inclusive environment where staff were encouraged to raise viewpoints on the delivery of care, management practices and suggest improvements. One instance involved open and transparent communication from a staff member directly to senior leaders highlighting the staffing challenges on a particular unit. The staff member felt confident in requesting open discussions about the issue which was respected. In response, leadership conducted a thorough review and analysis, ultimately increasing staffing levels to address the issue. The provider said, “We have trained our staff on toxic workplace traits and how to manage difficult conversations respectfully.” Constructive challenge was welcomed from people, staff and stakeholders, and we saw consistently high levels of engagement where staff had questioned practices such as health record completion, and communication between staff. Lessons were identified and acted on quickly. Management met with the staff member where processes were explained and adjusted accordingly. Processes were in place for staff to relay their views on the home. Staff accessed an employee engagement survey that allowed for feedback on their role and give opinions on how people were supported. The provider said, “We have an amazing 'open door policy' to address concerns raised by staff members relating to workplace or resident concerns. Enabling choice is key to ensuring the dignity and autonomy of our service users.”

The registered manager and director knew how important the staff team were to the success of the service and to the quality-of-care people received. Without exception, staff told us they worked in an equitable workplace that supported their needs professionally and personally. Staff we spoke to were highly motivated and attributed the approach of the leadership in fostering an inclusive team. One staff member said, “I feel very well supported.” Leaders worked collaboratively with staff, partners and people who use services to monitor, review and improve the culture of the organisation in relation to equality, diversity and inclusion. The home had been recognised by the local authority as a Great Care Employee and as a Disability Confident Committed employer. This recognised the provider as an employer who was committed to inclusion and diversity, and one that improved employee morale and commitment by demonstrating fair treatment in the workplace. These achievements were reflected in the feedback we received. Leaders understood power dynamics and discrimination risks. There were robust polices that promoted workplace equality, inclusion and diversity best-practice and staff at all levels are accountable for preventing bullying and harassment. There was meaningful and creative engagement collaboration between leaders and staff to listen promote and respect all staff voices. Ways of doing this were monitored and owned by everyone. In one instance, the actions of one staff member potentially impacted another's personal and cultural needs. This was addressed in a positive and proactive manner. The staff member involved engaged in constructive discussions about their behaviour, with a focus on teamwork and inclusivity. Additionally, they attended a course on positivity to further develop their understanding and approach.

Diversity was championed as integral to a positive, inclusive, and high-performing workforce. There were robust polices that promoted workplace equality, inclusion and diversity best-practice. Staff had access to personalised support that acknowledged the diverse needs of the workforce, offering both proactive and reactive measures. For example, one staff member who was undergoing a protected characteristic change received sensitive, tailored support that included meaningful and proactive adjustments to their working pattern. As a result of these leadership adjustments and ongoing support, the staff member's performance and wellbeing improved considerably. The provider had a rigorous recruitment and training programme that ensured they employed staff who held up the values of the service. In consultation with staff, training in LGBTQA+, ageism, CALM mental health training, and positive workplace was provided to promote inclusivity and understanding. The provider said, “We provide enhanced forum and discussion training at the discretion of our staff. Our recruitment strategy reflects our commitment to skills-based recruitment, which can be demonstrated by the improved diversity in age, race, gender reassignment, and sexual orientation.”

Leaders and managers drove an awareness of positive accountability, and shared responsibility with staff to ensure oversight of people’s care. Leaders used teams of senior staff to oversee different areas of quality monitoring, this included areas such as maintaining the environment, staffing levels and training, people’s engagement and medicines. This combined approach was used effectively by staff to give the provider an excellent oversight of the service. Performance management processes were effective, reviewed regularly, and reflected best practice. Leaders told us that these allowed for new and innovative ideas and best practice technology to be tested and used in the home. These included advanced pressure area equipment, an electronic pain assessment system and the light detection and sensor system to improve falls monitoring that we have detailed in the Learning and Improvement section of Well-led. Staff told us that leaders were conscientious in ensuring that people’s needs in different houses were met by matching staff whose approaches, skills and strengths me their needs and maximised their support. One staff member said, “That is my skill. I suppose that’s why I work in the main house as it allows me to be me with people I support. That was a good thing when I started. They matched my skills to the unit.” The registered manager said, “Some people are suited in different areas. Some are more assertive. You need to be proactive and not wait for triggers, Staff are very good at that."

People at Nyton House benefited from an exceptional leadership team who made people at the centre of the work they did. The provider had a clear vision of the direction and standards they wished to see at the home and had implemented effective and robust quality assurance systems that led to the delivery of demonstrable improvements. For example, leaders conducted comprehensive audits of the strategies and approach to those people with conditions who exhibited behaviours that challenged. This meant strategies were continually developed to support people and reduce their anxieties. Deterioration was identified in one person living with dementia. With the full consent of the individual and their family, a series of tailored adjustments in the persons environment were trialed to address the behavior, particularly during mealtimes, when the challenges were most pronounced. This change allowed for a more controlled environment, fostering a sense of comfort and security. As a result, there was a significant improvement in the person’s overall wellbeing, including more restful sleep, which has been recognized as an essential factor in the positive health outcomes for people living with dementia. There were robust systems for capturing data to provide excellent quality information for relevant data. These requirements were consistently met. For example, analysis of risks to people’s nutrition and hydration, together with consistent use of clinically based tools and best practice, ensured that risks were monitored to a high standard. We saw evidence of detailed actions and positive outcomes taken as a result.

People’s experiences had been greatly enhanced by the providers work with external partners in care. The providers use of technology and drive to seek best practice input from a wide range of specialists meant that outcomes were continuously improving, including areas such as receiving a more rapid input from local GP’s, falls monitoring and supporting the identification of pain from those who were unable to convey their needs. One person said, “They (Staff) go out of their way to get me the health support I need.” People praised the support staff gave them to access healthcare services and ensure that they received specialist input for health conditions they lived with.

Leaders spoke passionately about the need to invest in developing diverse networks at local and national levels. Partnerships supported leaders to identify innovative ways of working and priorities. A senior leader said, “Our approach is to fully engage in continually improving through collaboration with suppliers, healthcare practitioners and community leaders.”

Partners and stakeholders that we spoke to were unanimous in their praise of the staff’s approach to improving care and collaborative working. One professional said, “I have been able to build a strong, professional rapport with Nyton House staff and I always leave at the end of my reviews feeling the residents there are receiving a high quality of care daily.” Professionals told us that staff were diligent in identifying risks and maximising the specialist support that they offered. One professional said, “Nyton House is a home which shows a lot of professionalism and dedication to person - centred care. Nyton House are excellent at identifying risk and reaching out for support when required and always appear to put resident safety first.” Another professional said, “Nyton House appear to be very keen to know our service's thoughts when working with their residents and always follow up on plans set out by our team, to ensure safety and effective mental health support is provided.” The director stated that this was, “a testament to our approach and commitment to improvement.”

Leaders and staff strived for excellence through collaboration and shared practice. This included building and maintaining credible, safe and effective data sharing across the system. For example, leadership agreed to the CEO of the company that provided the home’s electronic medicines administration records system to stay on site for a week to understand fully how their system was deployed in a care home, the challenges staff face as users and to share information on how to improve outcomes for those at the home. Leaders worked with partners who provided innovative technology to trial adjustments and make improvements to the technology to enhance outcomes for people. For example, leadership worked with company providing the laser sensor falls equipment to improve accuracy and efficiency in the system to monitor people’s mobility. Staff worked with the home’s electronic care system provider to integrate the homes own data to improve responses to people’s support. Staff and leaders work in partnership with key organisations to support care provision and joined-up care. The service has a systematic approach to working with other organisations to improve care outcomes. Collaborating with multi-disciplinary teams to undertake ward rounds of the home, specialist referrals were made to specialist therapists, speech and language, mental health teams, dementia care teams and DOLS. Staff worked with the NHS end of life care hub to support effective end of life care, while arrangements were in place for oral, hearing and sight specialists to provide on-site assessments for those people who found it difficult to attend appointments in the community. The home was working in partnership with the hospitals Trusted Assessors Team, an initiative driven by the NHS to help reduce the number of delayed discharges to the home.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. Minutes of staff meetings showed the leadership sharing information on the results of quality assurance audits as well as innovative technology being introduced to the home and what actions staff could do to ensure that it was used effectively used. One professional said, “They are always looking to improve and don’t mind investing in infrastructure. Very good at looking at people’s individual needs, what they need, solutions to this.” Staff were fully supportive of the providers approach to innovative and continuous improvement. Staff embraced the technology used and the developments that the home has implemented in the past few years. Leadership introduced specialist training courses in areas that were of particular interest to staff and which staff had requested. One staff member said, “The culture at Nyton is such that everyone is fully supportive when improvements are needed.”

Leaders and staff had an exceptional understanding and drive to make improvements happen. This was supported by developing strong external relationships and research into advanced evidence-based practices and technology. For example, leaders had invested in an electronic pain assessment system that supported staff to recognise and assess indicators of pain in those people who lived with dementia or could not reliably report pain. The technology provided an assessment of movement, facial expressions, behaviour and activity to support staff to determine what actions and support to provide. One person said, “They do everything well. If something needed improving, they would do something about it.” Leaders had recognised the impact and risk of mobility and falls, and had invested in a light detection and sensor system in people’s rooms which was linked to the homes call bell system. This allowed staff to be alerted to potential risk of falls and falls by alerting them when a person was self-transferring for example or fallen. The director said, “We have made a significant financial and time investment in this project as we believe in better-supporting independence, fall response and utilising mobility data to inform decision-making.” One professional said that the home had made, “Investments in advanced digital tools that enhance operational efficiency and prioritise resident outcomes.” They had a “commitment to class-leading solutions emphasises their forward-thinking approach to optimising care. They have raised level of well-being by introducing advanced approaches to dementia care.”