Aston 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

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 inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to good governance.

This service scored 36 (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 did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

Although the provider expressed a commitment to delivering high ‑quality care, and staff understood the importance of doing so, this had not been effectively implemented or embedded within the culture of the service. Inconsistencies within the management team meant the service’s vision and values had not been clearly communicated or discussed with staff, resulting in a lack of shared direction. Systems and processes to support shared learning and embed a clear vision and strategy across the service was not robust or effective to drive improvements. Lessons learnt was not always learnt following serious incidents.

Due to concerns we found relating to staffing, training, and managing risks, we could not be assured staff worked effectively to support people.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

The service was manged by the Nominated Individual who was keen to learn and develop the service to deliver person-centred care. There were elements of the service which required leaders to develop their skills in recognising where improvements were needed. The provider had not ensured they provided leaders with the skills to recognise where improvements were required to ensure the best outcomes for people.

Staff were not always provided with training and development opportunities to enable them to meet people’s needs effectively.

Despite this, the staff, people and their relatives felt the leaders were present and supportive. One person told us, “[Nominated Individual] is switched on and cares about the whole house and they are hard working.” Another person said, “[Nominated Individual] is a great asset to Aston House.”

Staff did not always feel they could speak up and that their voice would be heard.

The provider had a policy to support staff to speak up. This included information on when and how staff could raise concerns. However, an anonymous staff member whistleblowing was received before the visit, and some staff reported that the registered provided did not always respond to issues raised with them.

People were confident they could speak up if they needed to and felt they could always rely on the management team to listen. Management was open, transparent and responsive throughout the inspection process once issues were brought to their attention.

Staff did not always feel they could speak up and that their voice would be heard.

Some staff did not feel they received sufficient training to perform their roles effectively. Additionally, staff did not always feel that team meetings provided adequate opportunities to discuss issues related to people’s care and the support they received from the service.

The provider’s recruitment policies and procedures helped ensure staff experienced equitable treatment. Staff had received training in relation to Equality, Diversity and Inclusion and told us they felt respected and valued at work. Staff were valued and treated equally and fairly. They said the registered manager was supportive and reported feeling respected, valued, and listened to.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Although audits had been completed, the issues were not always identified, and those identified by the acting manager had not always been appropriately addressed. For example, the acting manager asked staff during the January team meeting to print out PEEPs and to place them in the grab bag. During our visit we saw only 2 people’s PEEPs were in the grab bag in the office. The provider’s audits had not identified the concerns we noted during this inspection in relation to, PRN protocols, mental capacity assessments, care plans, risk assessments and staffing.

Care plans, risk assessments and observation charts were not always accurate, contemporaneous or reflective of people’s current needs. There was a lack of assurance regarding leaders’ ability to carry out effective audits and governance processes.

Due to low staffing roles, responsibilities were not clear. The acting manager told us, they had to completed tasks which were normally completed by senior staff, and senior staff had to complete tasks normally performed by support workers or cleaners.

All of these concerns meant governance systems were not effective and exposed people to the risk of harm.

The provider did not understand their duty to collaborate and work in partnership, so serviceswork seamlessly for people. They did not share information and learning with partners orcollaborate for improvement.

The registered provider did not consistently contact other healthcare professionals to obtain information regarding people’s significant past, and significant risks to their health and wellbeing.

The provider had been working with partner agencies to support improvements within the home. This included commissioning a mock inspection by an independent care consultant. While the mock inspection identified several areas requiring improvement, it did not highlight the wider concerns we found during this inspection. This meant some significant risks and shortfalls remained unidentified and unaddressed.

People and relatives confirmed referrals had been made to health and social care professionals to gain support about people’s needs.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

There were no processes in place to review any lessons learned or any changes in practice to see if they worked well or not.When things went wrong, good practice was not reviewed and embedded. For example, we saw there was no reflection upon what went wrong, and what led to a serious incident which triggered this inspection.

The provider did not have robust and effective systems or plans to monitor and improve the quality and safety of the service. Systems to review and learn from care records, documentation and medicines management were not effective. The provider had not identified staff were not consistently keeping accurate, contemporaneous records of people’s care and support. This limited the service’s ability to learn from practice, monitor quality or implement improvements based on reliable information.