Creative Support - The Houghtons

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good. This meant the service was consistently managed and well-led.People, relatives and staff all told us the service was caring, supportive, and distinctive. People said the staff went the ‘extra mile’ to make sure they received the care they needed and wanted.There were effective systems in place to monitor and improve people’s quality of care and continue to develop the service. Staff worked in full partnership with other services to meet people’s holistic needs. The provider had an effective audit and governance system in place to provide oversight of service quality. Action was taken promptly where required to improve the quality and safety of the service and changes were made swiftly and robustly to ensure people's changing needs could be met. Staff felt well supported in their role and there was a positive culture at all levels.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. We found that staff were motivated and proud of the service and they had a good understanding of the provider’s values and the vision of the organisation.

There was an extremely positive and open culture that ensured people were at the centre of everything the service did. Staff spoke very highly of the culture within the service and the wider organisation, drawing comparisons with others they had worked within and describing it as the best. The provider had introduced a monthly staff bulletin called Creative Connect. This provided staff with updates on all policies, any new innovations or new practices and social care legislation changes, as well as how staff could access wellbeing support. There were monthly team meetings with a clear agenda and staff were asked for their feedback and input.

The service had effective systems in place to ensure everybody understood and promoted the service’s vision, values and strategic goals. Minutes from meetings, showed that discussions had been held in respect of dignity, respect, human rights, inclusiveness, equality and non-discrimination. We saw these areas were continually monitored and there were effective processes in place to address any issues or shortfalls, quickly and appropriately. Staff recruitment focused on ensuring staff demonstrated empathy, a person-centred approach and values fitting for their roles. The managers set out clear professional boundaries and expectations for staff and reinforced these through training, supervision and quality monitoring.

There was a person-centred culture that put people and families at the heart of the service. For example, 2 people using the service were supported to arrange a “We Care” panel. This was where the national nominations for care awards were reviewed by people using the service and the winners are chosen. The registered manager ensured that families were empowered to have a voice to drive positive changes, and improving open cultures. For example, families wanted the communal rooms to be decorated, so the provider liaised with the housing provider and people using the service to arrange for decorating to take place, with people using the service deciding on the colour scheme. There was a person-centred culture that put people at the heart of the service. Easy read policies were co-developed with people and 1 person had recently reviewed the Safeguarding policy and looked at what changes were needed to make it more user friendly.

The provider regularly reviewed the vision and values of the service and the organisation. The registered manager attended the ‘We Care’ Conference, quarterly registered manager conferences, closed culture training workshops and campaigns. There were leadership conferences that were held annually, and the provider had a ‘CODE RED’ poster in the main office in the service where staff could report concerns anonymously. This information was cascaded in social care governance meetings held locally with services to share incident learning and innovative changes. There were also local care conferences for staff and regular team meetings to ensure managers and staff teams understand and believed in the shared vision, strategy and culture.

The provider monitored the performance of shared vision, strategy and culture by completing observations of staff. People using thr service were supported to get involved with observations of staff and were able to provide feedback of the support they received on a regular basis.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Staff spoke positively about their role and enjoyment of working and supporting people. They told us it was a rewarding role and spoke of their commitment to supporting people to manage their wellbeing, and to provide opportunities for people to have new experiences. A staff member told us, “We want to make sure we can people give the best life they can live.” Another told us, “Since the appointment of a new [registered manager], the home has been a happier and safer place for residents and staff. Everything has improved.”

Staff said the registered manager was an exceptionally kind, caring and compassionate person. One staff member told us, “The manager is very very very kind. They help us and support us all the time. We are lucky.” We saw that the registered manager often went over and above their roles to ensure people received the care they needed. For example, when there was no one to drive 1 person for their swimming session the registered manager would come in on their day off to support them.

The provider was committed to continually motivating the staff team and recognising their dedication to their role. For example, the provider organised WE Care Awards to recognise staff who embodied their values of Welcoming, Empowering, Compassionate, Aspirational, Respectful, and Effective care and support. They also celebrated International Women's Day by highlighting the work of women in the organisation.

Staff had access to an employee handbook that provided them with information and support in relation to numerous benefits that included a staff welfare fund, the 'We Care Awards and Creative People appreciation awards, a staff prize draw, other discretionary leave, a domestic abuse policy, menopause policy, life assurance/death in service benefit and retirement award.The provider actively promoted and enabled staff to deliver exceptional care,spend quality time with people, take their own initiative to benefit individualsand be compassionate care givers. We saw evidence that the provider createdopportunities outside of their contractual obligations to support people'swell-being.

Staff had various meetings and communications to keep them updated, andensured they felt included. Everyone told us they were confident in themanagement of the service and that it was well managed. Themanagement team were knowledgeable about people’s individual care needs,the running of the service and their priorities for maintaining care quality anddeveloping the service.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff and managers acted with openness, honesty and transparency. Staff told us they felt comfortable raising concerns and had a good understanding on how to escalate risk to ensure people’s safety. One staff member told us, “We have a very caring and open culture here. We are encouraged to speak up and we can do so without worry of repercussions.”

We saw that 1 person wanted to have Wi-Fi in their bedroom and had requested this from the person who had responsibility to look after their money. This had not been provided and the person was unhappy about the situation. Senior management supported the person to consider their options explaining that they had the right to raise a safeguarding concern. The person agreed and wanted to raise a concern as they felt their wishes were not being listened to. The person was fully involved with the referral to safeguarding and felt empowered. With the support of staff encouraging the person to speak up they were provided with WI-Fi. This meant the person felt empowered and supported to have their voice heard, and has reduces financial costs as well as gaining confidence.

We saw processes in place to provide staff with the opportunity to raise concerns and provide feedback. For example, the provider had a ‘code red’ policy which was an anonymous, early intervention process designed to prevent safeguarding issues and promote an open culture of individual responsibility. This allowed staff to raise concerns with an independent person when they felt uncomfortable or unsure about their duty of care. In addition, there was feedback in staff meetings from incidents so that lessons could be learned for continuous improvement.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. This was achieved by embracing and valuing differences, such as those related to gender, race, ethnicity, age, disability and professional backgrounds. For example, staff were supported to observe diverse holidays where possible and embraced various cultural perspectives and traditions. One staff member said, “Our manager is very understanding and approachable. They understand what is important to the staff and they know how to support them.” Another commented. “The manager has an open-door policy that means we can approach them at any time. They do care about the staff and the staff wellbeing.”

The provider had numerous initiatives to support staff with inclusion and equality in the workforce. For example, there were equality, diversity and inclusion groups and leads. We saw a LGBTQ and equality policy and a supporting staff through gender transition policy. The provider completed a race pay and gender pay gap analysis ensuring that all staff received fair pay. Anti racism and cultural awareness training was provided for managers. There were promotions of various events such as local and national pride, black history month and supporting staff through Ramadan and a celebration of Diwali. In recognising the value of a diverse work force the provider supported staff to ensure their cultural needs were met by approving longer than usual holidays to allow them to visit family in their home countries.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. Staff described supervision and appraisal as regular and supportive, with staff praising the high level of support they received from the registered manager. One staff member told us, “The [manager] has been like a breath of fresh air. They have made a big difference all ready and introduced improvements which has been a big benefit to everyone. They are a very good role model to us all.”

A well-established staff team and clear communication meant that all staff understood their roles and effectively contributed to the open team ethos. Staff felt valued and listened to and they told us that if there were any issues, they were quickly sorted out. The provider had a system of robust checks in place to monitor the quality of the service. This included regular internal audits in areas such as accidents and incidents, the environment, risk management plans, staff training, staff supervision, reviews of people's goals and required support plans. Actions plans were put in place to address any areas that needed further improvements. For example, following a robust review of accidents and incidents we saw that the provider had created a vehicle observation of practice to ensure staff were competent with all vehicles in use, created further photographic guides for staff guidance and had introduced written daily equipment checks for all moving and positioning equipment.

Best practice was shared throughout the team, identifying what had worked well for each person, or what had not worked well. Risk assessments addressed people's diverse needs and risk management plans were proportionate and centred around the needs of the person.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The management and staff team had built good working relationships with health professionals and supported people to see them if they needed this support. They also supported people to go in to the community to follow their interests. One person told us, “We go out a lot and do things we enjoy.”

One person who lived out of county was due to transition from children’s services to adult services. Due to excellent partnership working staff were able to review their referral and support the person to move to the Houghtons. The person had a range of very complex health needs, and 2 comprehensive assessments were undertaken before they moved to the Houghton's. Staff were required to travel to complete the assessments and they worked collaboratively with the staff at the service where the person was residing, family, local authorities and other healthcare services. Staff required specific training to meet the needs of the person who had very complex health and medical needs. Creative Support has its own academy, and they sourced information to create the training as they had not had a need for this previously. It was evident that good communication was needed throughout the persons move to ensure the transition from 1 service to another was as smooth as possible for them. Learning had been continuous throughout the transition period by working with other health care professionals such as occupational therapists, physiotherapists, the dietitian and Speech and Language Therapist (SALT). Working collaboratively with other healthcare professionals had ensured a smooth transition, closer family bonds as the persons family lived closer, and had improved their quality of life because they had a bespoke fully trained staff team dedicated to meeting the person’s complex needs.

The registered manager told us that multi-disciplinary meetings were organised if there were any concerns about a person’s care or well-being. People experienced positive outcomes because staff understood their needs and worked collaboratively with other organisations. For example, we saw that 1 person was being supported with a life limiting condition and staff worked collaboratively and received training from health professionals around specific areas of the persons care needs to ensure they could support the person safely.

The Houghton’s management team has built strong partnership working with health and social care professionals. This includes attending care forums, learning disability partnership boards, and local council meetings, regular meetings with health care professionals and social care governance meetings to network and learn ideas.

Feedback from partners indicated the staff and leaders at the service actively engaged with external health services to promote the wellbeing of the people using the service.

The staff worked in partnership with other professionals to ensure people received holistic and joined up support which met their needs. They supported people to access a range of services and had effective systems of communication with healthcare teams. There were clear avenues of communication with other health professionals such as the occupational therapist, dietitian, and epilepsy experts. All staff training was in line with the recommendations of Skills for Care and records conformed these were all up to date. Following a robust review of accidents and incidents staff training had been updated to ensure safer working practices and this had included working collaboratively with other health and social care professionals to ensure best practice recommendations were implemented and embedded into staff practice.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. Staff told us learning from concerns and incidents was a key contributor to continuous improvement and meant the service continued to change and adapt the support provided and reduce the risk of further re-occurrence. One staff member told us, “When something goes wrong it's taken very seriously, its looked at to see what went wrong and if any changes need to be made. This is always shared with staff in meetings, so we are all singing from the same song book.”

Following a very robust review of accidents and incidents, we saw that the provider focused on continuous learning, innovation, and improvement across the organisation. As a result, people were having their needs met by staff that were better trained and following improved practices to ensure people received safer care, prompt action was taken to ensure equipment was suitable and that when changes were needed, these were made swiftly to meet peoples changing needs. The extensive review had embedded a culture of learning, evidence-based practice, and transparency, ensuring such a robust approach to learning. Following the review the registered manager commented, “The impact of the learning from this incident has been clear. The staff team at the Houghton’s are more proficient in [moving and positioning] practices and have the confidence they need to support our service users well. The staff observations mean that I am confident in the skill set of my team, and I am sure now that if an incident were to occur, I would know just how to respond. The is also the impact of us being so open and transparent and using the incidents as leaning opportunities. This means the staff aren’t afraid to tell us if things need improving which is the best way to be. The duty of candour approach with families has also helped me build real trust with them and I will carry on doing that. The fact there has been no [moving and positioning] incidents gives me confidence of the massive impact of these changes on those who live at our service”

Staff feedback included comments such as, “I feel I have improved knowledge when completing moving and handling tasks.” A relative commented, “The manager is honest and open, they share incidents and how they make improvements, it is better now.”

There were robust processes in place to ensure that learning happened when things went wrong, and best practice guidance was sought and shared. For example, 1person had a fall whilst being supported swimming by 2 staff. There was another accident in the home a few days later when a person fell from a shower chair. At the same time as this incident, there was another incident elsewhere which involved a person in a wheelchair whilst in a vehicle. The provider completed a review to look at the incidents and a wider review of the way staff managed moving and positioning within Creative Support.

The review found there was no fault with the equipment at the swimming pool and so staff may have used incorrect procedures. The shower chair had a fault, the strap was missing a fastener at the back which inconsistent daily checks of the equipment had failed to identify. Senior staff held a reconstruction with the staff to understand what had happened and filmed this for future use and training. As a result of this cluster of incidents, the provider commissioned a private occupational therapist to visit the service to review all of the providers moving and handling practice. They observe staff practice, checked all equipment condition and storage and looked at paperwork. Immediate and service level actions were taken as a result of the review that included the purchase of a new shower chair, a letter of candour was sent to people and relatives, refresher training for all staff, photographic guides were provided for all staff for use of equipment, al registered managers are undertaking their Level 3 health and safety training and train the trainer moving and handling training and an improved register of all equipment was implemented in the service, including service dates and review dates confirming it was all good working order.

Following this robust review there were service wide recommendations that included some bedrails in service which should be removed. As a result, a central log of all bedrails in Creative Support was implemented and a new bedrail risk assessment put in place. The provider created a vehicle observation of practice to ensure staff were competent with all vehicles in use in the services, created further photographic guides to ensure staff were clear about the correct procedures to follow, reviewed all paperwork and made changes and enhancements to procedures, and managers attended further training in relation to moving and positioning.

As a result of the review the provider established a moving and positioning working group which continued to meet monthly to ensure all of the actions above, were embedded corporately. A moving and positioning conference is due to be held in 2025 to ensure the actions above are embedded company wide. The impact of this comprehensive review has included people are having their needs met by better trained staff, better storage of equipment ensured that people’s space was maximised and safe, prompt action was taken to ensure equipment was suitable and that when changes were are needed, they are made in a timely way to meet changing needs, risks to people were managed safely reducing risk and the review of bedrails has meant that the least restrictive options are in place in people’s homes. In addition, the review and subsequent actions had embedded a culture of learning, evidence based practice and transparency.