Aurem Care (The Red 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 outstanding. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

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

This service scored 61 (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 always have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

Leaders had a very traditional, hands-on approach that was compassionate, yet people would benefit from there being a more, respectful, person-centred care model. One person told us, “It used to be a care home. It feels different. It’s not the old staff that used to be here.”

The registered manager told us that after the inspection, they spoke to staff about some of the infantilising terms they were using and care they were providing. However, the fact that staff behaved in this way in front of the inspectors indicated a culture of care that has normalised poor practice. We noted a sign in the sluice referring to people’s continence aids as ‘potties’. There were also 2 desks either side of the main lounge where we observed staff frequently sat and worked. People may feel they are being watched in their own living space. Privacy is central to dignified care, and having staff doing administrative work in a living area interferes with people’s personal space.

However, there was a service improvement plan in place to track developments and ensure the required measures were taken to maintain the service to a high quality, safe standard. Where people and relatives had shared their views, we saw the management team had responded appropriately. One relative fed back, “The family atmosphere allied to professional medical care are the key strengths in my opinion.” One external professional fed back, “The manager, is clearly dedicated to creating the best possible environment for both residents and staff.”

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

While the registered manager and leaders were deeply committed and well-intentioned, their methods did not always reflect current best practices in care. Leaders had not identified all the issues that we found during the inspection. However, they were dedicated to improving the skills, knowledge, experience and credibility of the leadership team to lead effectively. They were responsive and proactive in addressing issues we raised.

Staff were positive about the management team and the support they received. One member of staff told us, “[Registered manager] is out and about on the floor and knows us. She is approachable and friendly.” Another said, “[Registered manager] is a very good manager. She is on top of everything.”

The Provider had not always ensured staff would feel comfortable about speaking up. For example, all of the communal spaces had CCTV cameras, and we noted a sign up saying, ‘Warning CCTV.’ A sign being written in this way can signal a culture of distrust.

We also identified that CCTV cameras were present in the staff room, registered managers office and the administrator’s office. This was not conducive to ensuring staff had a safe space where they could speak freely. When asked about this, the registered manager told us that if staff wanted to speak confidentially, they could go to the garden where there were no cameras. However, in the workplace, employees have a right to privacy, especially in non-working areas like staff rooms. A member of staff told us, “They [cameras] are for the residents and any incidents. I wasn’t told about them when I started, but I saw them.”

We have since been advised by the provider that the cameras in these rooms have been removed. However, this should have been considered prior to our visit.

Staff however did say that if they had a concern that they would raise this. The registered manager told us, “If they [staff] wanted to come and talk to me at any time, they will come and talk to me. And if they need any support, it could be professional, related to their work. It could be personal. They always come and talk to me and we support each other.”

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.

The service celebrated and championed their diverse workforce. The provider employed staff from the local area as well as from overseas. The staff team were from varied backgrounds and cultures, and this was reflected in the skills and experience they brought to their roles.

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. Quality management systems at the service were not always effective. Information was not always used by the leadership team effectively to monitor and improve the quality of care. For example, staff were using electronic care plans to record information. However, staff were not accurately completing the care records for example around bowel movements and fluid intake. These left gaps in care planning and daily records, leaving leaders unable to accurately audit care outcomes and review these promptly. Completing the care accurately would mean reports could be drawn from the care system to review the care. Instead, the registered manager and senior care staff relied more on observations and speaking to people and staff to ensure this oversight as care records made by staff would not always be an accurate reflection of care being provided. The registered manager told us, “I don't switch off to be honest, always working around.”

Information was not always being used effectively to monitor and improve the quality of care. The providers audits were not always identifying the concerns we identified including medicine, environmental, infection control and the recording of care. Where the provider’s auditing processes had not identified these shortfalls observed during our inspection, the leaders ensured they responded promptly and used the inspection feedback to drive improvement.

However, the registered manager told us they felt very supported by the provider’s leadership team. They said, “I can contact them and ask them if I need help.”

After the assessment, the provider sent us an plan of all the actions they had already taken, and future plans to make and sustain improvements. This included around the monitoring of clinical risks, the deployment of staff, external activities and improvements around the maintenance of the property.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners or collaborate for improvement.

The service had a positive approach to partnership working, ensuring they worked collaboratively with external partners. People had access to therapeutic support, from the Tissue Viability Nurse, GP and the Speech and Language Therapist who visited regularly. One external professional fed back, “I have noticed from my patients' experience that referrals to multidisciplinary teams have been made in a timely manner which highlights the person-centred approach and also individualised care.”

Links with the local community were well developed. Community partners supported activities within the home, including gardening and wellbeing opportunities, which people were observed to enjoy.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

We saw learning from incidents was routinely shared amongst the staff team to ensure care quality could be improved. Where we identified a concern with the administration of medicines, the registered manager updated us the following day with evidence they had undertaken a group supervision with staff. Reflective practice was used as an effective tool to inform and consistently improve care quality. One external professional fed back, “I have delivered training sessions on dementia and dementia care to staff, residents, and families, and it is evident that ongoing training is valued within the home. This is reflected in practice, with staff appropriately utilising non pharmacological approaches to manage behavioural and psychological symptoms.”

Leaders were committed to ensuring future development to enable high quality standards of care. They gave their full assurance to their set timescales for improvements and ensured they were accountable. We will review their actions taken at our next assessment.