The Moreton Centre

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 remained 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.

There was a negative culture within the service and a potential to become a closed culture as staff did not feel supported to raise concerns and did not feel listened to. This was in relation to the staff, not the people using the service.

Staff told us that they had raised concerns about the equipment and environment, these had not been addressed. We raised these concerns with the provider who took swift action to address the matter, however these new processes needed time to embed in practice to become a transparent and positive culture.

Quality assurance processes were not always effective in identifying or addressing issues. Some of the concerns we found during our site visit had either not been noticed, or action had not been swiftly taken to address them.

Staff worked well with partner agencies to achieve good outcomes for people. The registered manager had a good understanding of regulatory processes.

This service scored 50 (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.

The culture at The Moreton Centre was difficult to assess because of the mixed feedback and indications of a possible closed culture. A closed culture is a poor culture that has a potential to impact on positive outcomes for people if not addressed. It was clear that at this time, there was a lack of transparency and openness between the management and staff team which had created an uneasy working environment. The service aimed to give people consistently good quality care in line with the organisations vision. However, poor communication between management, staff, people, families, and some health professionals had created barriers.

We received mixed feedback regarding the leadership in the home, some staff we spoke with were positive regarding the culture and the vision of the service, whilst others were less positive. Feedback included, “The management is supportive, it’s a good place to work.” However, we were also told, “There have been changes, some good but there is a lot of worry also, we don’t know what is happening, don’t know what the future is for the home,” “Things are not right at the moment, we don’t get feedback, we raise concerns, and nothing happens, it’s all very sad, but I don’t feel listened to.” We were also told, “We do our best, the staff team are committed to the residents, we make sure they are happy and supported, but it’s not always a happy place to work anymore, lots of undercurrents and things are swept under the carpet.”

Feedback from visitors was also mixed. We were told, “The staff are really very nice doing a hard job,” and “I’m not sure, staff are very good, but something has changed, it’s not being well maintained, I have reported things that need attention, but it’s not been done.” These issues have now been resolved.

We have spoken to the provider and new senior management about the concerns of developing a closed culture and they would be addressing this through meetings to facilitate open communication and take action as required.

The management team and staff understood and supported people’s cultural and spiritual needs. People were treated equally, and their individual needs considered when completing care plans in line with their preferences.

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.

Whilst the management team had the knowledge and skills to lead the service, these skills were not always used compassionately and were not consistently inclusive. Some staff told how they had been subjected to bullying behaviour and felt excluded from the wider staff team.

Processes were in place to promote an inclusive environment and compassionate leadership, but these were not being followed. We discussed our concerns with the provider, and they told us about changes they were implementing to address these concerns. The resolution of these issues needed time to be fully implemented and embed into practice.

Staff were not always confident or free to speak up. Staff told us they would raise concerns that were related to people and their care to ensure safety. However, they would not raise other concerns to the management team as they felt unsupported.

The registered manager told us they had an open-door policy where staff could talk to them at any time. There were staff meetings and supervision. However, due to the lack of support and trust reported by the staff team, these were not always effective. During the inspection the provider told us about new measures that had been implemented to support staff and regain their trust and confidence.

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.

Some staff have come forward about their experience of discriminatory behaviour and how their differences were not supported and confidences broken. Staff did not always feel comfortable in approaching the management team to discuss any individual needs they may have, due to no action having been taken when they have raised concerns.

There was an Equality, Diversity and Inclusion Policy and an Equal Opportunities policy. Whilst the Equality, Diversity and Inclusion Policy was followed in relation to people, the Equal Opportunities policy was not always followed in relation to staff. We discussed these concerns with the senior management team. They told us they had a zero-tolerance policy and attitude towards bullying and discriminatory behaviour. They had started to implement changes to resolve these issues, in the 3 weeks they had been in position. However, it would take time for these to be fully embedded into everyday practice.

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.

The registered manager demonstrated a good understanding of the regulatory requirements. They told us they had robust oversight over accidents and incidents, and they analysed and reviewed audits each month and action taken to address shortfalls. Not all the issues found during our site visits, such as environmental risk and infection control risks, had been identified or addressed.

There was a quality assurance framework in place however, this had not identified the shortfalls and concerns we found. Where shortfalls had been identified, action to resolve these had not always been taken in a timely way. There was a lack of oversight in certain areas, for example, in regard to management of distressed behaviours and the use of medication to manage these behaviours. This was because the documentation completed by staff did not always reflect the use of de-escalation techniques and the effect of these techniques before administering medication. Daily notes did not fully reflect what people did each day especially for those people of working age. Audits were not always effective in identifying issues, for example, when laundry equipment was not working for up to six months.

These issues were acted on and resolved during the assessment process.

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.

Families and staff told us that appropriate health and social care professionals were contacted appropriately when required. One visitor said, “My ‘loved one’ sees someone from the doctors surgery when they need to, they also see a chiropodist, they are on the ball here.”

Staff and leaders told us they worked in partnership with key organisations to support care provision, service development and joined-up care. Staff worked with various external agencies including, GPs, community mental health teams, Tissue viability nurses, social workers, and local authorities. Staff told us how they would contact relevant external professionals to meet people’s needs. The staff team told of how they made referrals and we saw information in care plans to reflect this.

We received feedback from three health professionals. Overall, the feedback was positive and they told us that the staff appeared to be knowledgeable about people’s needs. One health professional said that the communication from staff could be improved, especially regarding recent changes to their health. This was shared with the management team. During the assessment process further feedback from the health professional said communication had improved.

The staff team told us they were proactive in building relationships with other organisations and into the local community to improve outcomes for people. However, there was work to be done to ensure younger people were enabled to access services and clubs that would give them the opportunity to mix and make friends of their own age.

Discussions with the management team and staff demonstrated they recognised the importance of learning lessons and continuous improvement to ensure people received care and support that was safe and effective.

Safeguarding concerns, complaints, accidents, incidents and near misses were recorded however, there was minimal evidence of review, and root cause analysis. Therefore, emerging themes were not always being identified and preventative action taken to reduce the risk of reoccurrence. We received mixed feedback from staff about how well they were supported to learn and develop. Some staff told us of support they received, through supervision and training, whilst others said their induction had not been robust and they felt unprepared to work as part of the team. During the assessment, senior members of the management team confirmed they had identified areas to improve and were reviewing their service development plan to ensure it included all relevant areas and more clearly evidenced priorities for driving improvement.