Cross 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 good. 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 ensure the delivery of high-quality care.

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

This service scored 32 (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. It was clear the management team and staff were passionate and caring about the care and support they offer, and the work they have done with people. They verbally explained a vision of wanting to achieve a good quality service that people could be proud of. However, we found there was no clear written strategy on how to achieve this vision and ensure regulations were met. The provider had a statement of purpose but did not have processes or system in place to ensure they offered safe care and support in line with their statement. For example, the provider failed to identify the concerns we found during this assessment, which meant people did not always have positive outcomes.

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. We were not assured the management team were competent to identify risks and concerns. Managers had not been provided with suitable training to carry out their roles and responsibilities. The provider and managers at all levels, consistently failed to identify concerns and risks. All audits completed which included care plan, medicines and environmental audits showed a 100% compliance score. Restrictive practices were accepted and went unchallenged with no consideration given to the impact this had on the lives of the people involved. The systems and processes to monitor quality and safety were ineffective, and ongoing issues with poor management oversight of the service had impacted on the quality of care people received. There had been a long-standing management team in place at Cross House who expressed their compassion to support people with complex health support needs. However, we were not assured the management team were capable to effectively manage the service and they did not have a good understanding of the Health and Social Care regulations.

Staff spoke positively about the management team and felt they were capable and inclusive leaders. One staff member told us, “We have a WhatsApp group and can raise any concerns, and they are dealt with quickly. We have staff meetings and include in any changes.” The provider has told us, all managers would complete management training, and they had recruited a new manager with CQC experience and knowledge.” A relative told us, “I’ve noticed that Headzpace management rarely visited [person]. Their lack of regular oversight may have contributed to the neglect and inappropriate behaviour I’ve observed. It appears some staff have taken advantage of this lack of supervision and failed to carry out their duties properly, which is unacceptable.”

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice. We found there were ineffective systems and processes in place to review incidents and accidents with the focus to improve people’s outcomes. This meant people were at continued risk of reoccurring incidents of harm. For example, where physical or chemical restraint was used the management team failed to review these episodes to ensure the safest and least restrictive techniques had been used. There was no evidence of learning from these episodes. Records demonstrated staff had not been involved in reflecting after incidents and had not considered what could be done to avoid the need for its use in similar circumstances. This meant staff failed to monitor and manage the use of restrictive practice which placed people at risk.

Furthermore, the provider and registered manager had failed to learn lessons from previous CQC visits. Improvements that had been made were not embedded which was evident as we continued to find the same concerns during this assessment. This meant people continued to receive unsafe care. We were not assured the duty of candour was always followed. Duty of candour is where the provider is to be open and honest when things go wrong. We found incident records failed to demonstrate if duty of candour was considered.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff worked 3-day shifts with no break away from the people they supported. The provider failed to ensure adequate processes and systems were in place for the staff team to have a break and they worked an unsafe number of hours. Staff felt they were treated fairly and the management respected them by including them in any discussions and valued their input.

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. The service was not well-led. The registered manager and provider did not have the skills and knowledge to perform their roles and lacked understanding of risk management and regulatory requirements. For example, we found notifiable incidents had not been shared with CQC and/or the Local Authority. The management and staff were not competent to ensure information was accurate, properly analysed and reviewed by a registered manager who could understand its significance and take action to protect people from harm or potential abuse. Governance processes were not always effective in helping to review staff practice, keep people safe, protect people's rights and provide good quality care and support. The systems in place to ensure good governance were insufficient in identifying the risks found during this assessment and to assess, monitor and improve the quality and safety of the services being provided to people. A number of audits had been completed which covered care plans, medicines, health and safety and infection control. However, these audits were tick box checks and did not identify any issues with the service. This meant people were at continued risk of poor care.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement. People’s care plans were not always up to date, detailed and accurate, therefore it was unclear whether partnership working was always fully supporting safe care. The provider failed to ensure people had access to appropriate health care such as dietician referrals, opticians, dentists or annual health checks. Furthermore, the provider failed to share safeguarding incidents with the Local Authority and CQC. A lack of oversight and monitoring at the service impacted the effectiveness of collaborative working and sharing of information, as learning and quality improvement did not routinely take place.

Staff did support people to access the community when possible, such as parks, swimming and college. The registered manager and provider engaged positively with the CQC throughout the assessment, welcomed feedback, and wanted to make the necessary improvements to the quality of care.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice. We found there were ineffective systems and processes in place to review incidents and accidents with the focus to improve people’s outcomes. This meant people were at continued risk of reoccurring incidents of harm. For example, where physical or chemical restraint was used the management team failed to review these episodes to ensure the safest and least restrictive techniques had been used. There was no evidence of learning from these episodes. Records demonstrated staff had not been involved in reflecting after incidents and had not considered what could be done to avoid the need for its use in similar circumstances. This meant staff failed to monitor and manage the use of restrictive practice which placed people at risk.

Furthermore, the provider and registered manager had failed to learn lessons from previous CQC visits. Improvements that had been made were not embedded which was evident as we continued to find the same concerns during this assessment. This meant people continued to receive unsafe care. We were not assured the duty of candour was always followed. Duty of candour is where the provider is to be open and honest when things go wrong. We found incident records failed to demonstrate if duty of candour was considered.