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 inadequate. At this assessment the rating has remained 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 safeguarding and continued breach in good governance at the service.

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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. Whilst the director was passionate about their vision and culture of providing people with outstanding care; we continued to find there was not a clear detailed strategy on how to achieve the vision and to ensure regulations were met. There was a culture of noncompliance with the CQC and commissioners. This meant people did to 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 to lead effectively. Whilst all managers we spoke to during this assessment were compassionate and additional management training had been completed; we found the management team were not experienced in managing services for adults with complex needs. Managers did not always have the knowledge or competencies to identify risks or improvements. The director acknowledged there was gaps in the managements’ understanding and, whilst they had systems in place, managers continued to fail to identify concerns such as medicines not being managed safely. This meant the service was not well-led. The director told us they were obtaining additional training to upskill managers and improve their knowledge around CQC regulations, and best practice guidance.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not report safety events. Whilst staff told us they felt they could speak up, we were not assured they could be due to our findings at this assessment regarding incidents not reported to appropriate professionals. Records showed duty of candour was not always reviewed if needed after an incident for the provider to speak up when things went wrong. Furthermore, polices and records such as service user guide and safeguarding policies did not detail who staff or people could contact if they wanted to raise concerns externally. This meant we were not assured there was not a closed culture.

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. Staff felt they were treated fairly and the management respected them by including them in any discussions and valued their input. One staff member said, “we’re a strong team. We communicate openly, share responsibilities, and support each other so the care stays consistent and safe.” Staff completed equality, diversity and inclusion training.

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

There was no CQC registered manager at the time of our assessment. A manager had applied during our assessment. Management structure and oversight systems, such as auditing, were ineffective in identifying concerns and risks to ensure safe care. Whilst there were multiple managers in place and audits completed, they were ineffective in identifying the concerns we found such, unsafe medicine management, not following the Mental Capacity Act or ensuring people living with a learning disability had a detailed health plan in line with good practice guidance. Records completed, such as audits, showed a lack of understanding of legal frameworks and regulations. There was no system in place to analyse information to identify trends and patterns to make improvements. For example, accidents, incidents and near misses were not analysed by managers. We also found, the provider was not open or transparent in its communications with commissioners or the CQC, in line with the requirement to promote openness and accountability for example as not reporting incidents to CQC or the local safeguarding team. This meant there was a continued risk of repeated incidents. We found multiple policies in place that did not meet best practice guidance. This did not meet right support, right care and right culture guidance; polices and procedures were not in line with current best practice.

A business continuity plan was in place but failed to provided information on what to do in an emergency and what plans were in place if people needed to be moved locations. This meant the service continued to be in breach of good governance. The provider had told us they have sourced policies externally and were in the process at the time of our assessment personalising them to their service and sharing with staff.

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. The provider continued to fail to ensure people had access to appropriate health care such as opticians, dentists or annual health checks. Furthermore, the provider failed to share safeguarding incidents with the Local Authority and CQC. This meant there was ineffective partnership working. We receive mix feedback from professionals regarding the lack of collaborate partnership working as stated in the effective section of this report, meaning professionals continued to have concerns in relation to people’s care.

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. This assessment identified there was ineffective systems of governance and managers failed to identify shortfalls in care. The provider failed to learn from the last CQC assessment. There was not a focus on continuous learning, innovation and improvement across the organisation and local system.

The provider had not met the warning notice that was served to them for regulation 17 good governance. This meant the learning and improvement processes were ineffective.