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.

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

This service scored 54 (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.

At the last inspection the culture at The Moreton Centre had been 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 still a lack of transparency and openness between the management and staff team which had continued to create an uneasy working environment. We have continued to receive anonymous concerns regarding the culture up to and during our assessment process. The service aimed to give people consistently good quality care in line with the organisations vision. However, communication between management, staff, and families, had created barriers.

There was mixed feedback regarding the leadership in the home, some staff we spoke with were positive, “Yes, the management is supportive, changes though keep happening.” However, we were also told, “Staff are scared to speak up, the latest changes to how we work has made us uneasy, being moved around and 1-1 increased in timing,” “We raise concerns about equipment and the environment, but nothing happens, we don’t feel listened to.” We were also told, “There is favouritism shown and that is not right.”

Feedback from visitors was positive. We were told, “Actually, things are really better now, no complaints” and “Staff are very good, but not as happy here as it was.”

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. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders at both service and provider level had not demonstrated sufficiently effective oversight, leadership or governance to ensure the service was operating safely and in accordance with people's needs. Several areas of risk to people's health, safety and wellbeing had not been identified, assessed or managed effectively through existing monitoring arrangements. For example, during the inspection we identified equipment in use that was not safe for people and that had not been subject to an appropriate risk assessment, alongside other environmental concerns such as doors not being able to close that had remained unresolved despite presenting potential risks to people using the service. We also saw that 1-1 support was not always being undertaken in a way that was effective for people and may be interpreted as restrictive. Staff voice was not being heard when concerns had been raised regarding 1-1 support and staffing levels. We were not assured that all incidents and falls had been accurately recorded and analysed to prevent further re-occurrences. Staff gave us examples of people who were at risk of repeated falls which we tracked and found no reflection on the overview of falls provided.

These issues had not been recognised or escalated through routine audits, management checks or provider oversight, which indicated a weakness in governance systems and risk management processes. The concerns identified during the inspection were not isolated and were reflective of wider shortcomings found across multiple key areas, including care planning, and the application of legal frameworks.

This meant that there was reduced assurances that people were being protected from avoidable harm and that the service was being managed in a way that promoted safe, high-quality and person-centred care.

People did not always feel they could speak up and that their voice would be heard. Staff meetings had been held but there no follow up recorded of actions taken or who attended the meetings. This meant that actions discussed were not always followed up to reassure people and staff they were being listened to.

Supervision meetings were scheduled to take place regularly, but the supervision matrix evidenced that supervisions had been inconsistent with some staff having not had a 1 to 1 meeting with a manager for 6 months. The registered manager had also not had a recent supervision since becoming the manager. There was evidence of the previous two managers on the overview of supervision spreadsheet but not many completed by the new management team. This had impacted on staff being able to raise concerns in a structured safe way.

The provider did not always promote an inclusive and equitable workplace culture. Some staff told us they did not always feel they were treated fairly and felt that favouritism had occurred. This had the potential to impact staff confidence in the fairness and consistency of decision-making.

While many staff told us they enjoyed working at the service and described the management team as approachable, supportive and willing to listen to their views, not all staff shared this experience. Staff generally felt unable to seek advice, raise concerns and discuss issues affecting their role; this feedback indicated that the provider did not always demonstrate a culture that fully promoted equality, fairness and inclusion for all staff members. This was discussed with the registered manager and would be addressed by ensuring regular supervisions, offering more individual and team meetings.

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.

Whilst there were audits and systems in place to govern the oversight of the service, these had not identified and/or addressed some of the issues we found on inspection. For example,

supervision was not fully up to date and showed gaps. Not all accidents and incidents and lessons learned were documented with an outcome or actions taken. This put people at avoidable risk of repeated accidents and incidents within the service. There were also some care plans with misinformation in, which could have caused confusion. We could not evidence that staff who undertook 1-1 with people had the necessary training, directions and support to undertake this role and we did observe some poor practices during the inspection process. Not all care plans had been updated in full regarding peoples’ mobility and mental health.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. Staff engaged effectively with external professionals and followed their recommendations.

People were supported to access medical services when needed, and staff worked closely with GPs, specialist nurses and other healthcare professionals to ensure people’s health needs were met promptly. Information was shared appropriately, enabling external professionals to understand people’s needs and provide consistent care. There was some concern about decision to access beds being used for people that might not be appropriate for the service. The registered manager confirmed that she had highlighted her concerns and would not be accepting these short term admissions.

The provider did not consistently promote continuous learning, innovation and improvement across the organisation and local system.

The management team spoke passionately about using continuous learning to improve the service and shared plans for further improvement. However, systems and processes did not always support these plans effectively. Learning from incidents and accidents was not sufficiently robust or consistently put into practice, including action to ensure people wore safe, appropriate footwear and rooms were free from trip hazards. We were therefore not assured that all incidents and falls had been accurately recorded and analysed to reduce the risk of recurrence. Staff identified people at risk of repeated falls, but these risks were not reflected in the falls overview provided. Although we identified shortfalls during the assessment, the provider responded and took action in key areas requiring improvement.