GHC Nursing Home

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 good governance at the service.

This service scored 46 (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. Staff, people and relatives were not always aware of what the providers’ vision and strategy was. We found no written guidance regarding their shared direction and culture. We found a lack of shared direction and culture across the whole staff team to drive the required improvements to ensure people living at the care home received, safe and person-centred care. Systems in place to ensure that the culture of the service was positive were not effective. Care records and feedback from staff demonstrated that care people received was task and staff driven. For example, a staff member told us showers were only offered after so many days since the last shower.

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. For example, a stakeholder had raised some concerns about the service, specifically about the lack of oversight and a lack of quality control at the service in November 2024; the provider was working through an improvement plan where actions were completed. However, during our assessment, we continued to find similar concerns of risk. People continued to receive a service that was not well-led. The provider did not understand their role, or regulatory requirements, and lacked effective oversight of the service. Issues we found at the last inspection continued to be found at this assessment. This meant people continued to be at risk of receiving unsafe care and treatment. The failure to embed the required improvements meant people were at continued risk of poor care. There was no registered manager in post at the time of our assessment. During our visit a new manager had started the day before our visit who demonstrated they were experienced and skilled. The provider and the new manager demonstrate compassion about driving the necessary improvements from our findings. They were receptive to our feedback and acted, they acknowledged the improvements required and demonstrated a commitment to people to improve the safety of the service.

The provider had policies and procedures in place however we were not assured that these would be followed. Most of the staff team were reluctant to speak to us. There had been many management changes in the 6 months prior to this assessment with no current Registered Manager in post at the time of the assessment. However, the service did have a new manager who stated that they were in the process of applying to become the Registered Manager. There was no system and process in place to allow people to speak up. We reviewed staff meeting minutes and one to one supervision records, these did not demonstrate whistleblowing was discussed during meetings. This was a missed opportunity to empower staff to speak up. Relatives told us they felt confident to raise concerns. One relative told us, “Yes, I would say very easy to speak to. No problem in raising a concern if I had one.”

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 management team understood the importance of having a fair and inclusive workplace for all staff to work in.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance, and outcomes, or share this securely with others when appropriate. During the assessment we found the provider did not have effective systems and processes in place to assess and monitor the care being provided. Systems to audit the quality of care and safety were not always effective in identifying and addressing areas of concerns, risk, or improvements. For example, we found processes and systems to review the quality of care people were receiving were ineffective. We were also not assured all staff were competent with safeguarding, moving and handling and risk management. This placed people at risk of harm. There was a lack of management oversight of staff competency to ensure staff understood their training. The management failed to identify issues regarding staff competency. The failure to identify areas of concern and failure to act to address issues places service users at risk of receiving unsafe care and support. Furthermore, we found poor oversight of staffing levels, care planning, risk assessment record keeping and person-centred care. The care plan audits and reviews failed to identify missing information, contradicting information and information that was not reflective of people’s care and support needs when changes had been made. The provider did not always openly share changes within the service when a management change had occurred. During our assessment relatives told us they were not aware the previous manager had left. One relative told us, “No, no communication from the care home regarding the change of Manager.”

Whilst the provider understood their duty to collaborate and work in partnership, so services worked together for people, the management team did not always share information and learning with partners or collaborate for improvement. We found shortfalls of the oversight of incidents and accidents. We found reportable incidents had not always been reported to the CQC and/or the local authorities safeguarding team where required. This meant people were placed at risk of harm/and or abuse due to poor reporting of safeguarding incidents. We found the management team had a strong and effective partnership working with health professionals such as GP’s and the pharmacy.

The provider had not made the necessary improvements in the service since our last assessment, to ensure people using the service received safe care at all times. This did not demonstrate a learning culture within the service at provider and management level. We were not assured the provider had robust systems to independently identify risks and poor outcomes and address them. We found that there was not an effective or robust learning culture and processes. Incidents and accidents were not reviewed to identify clear patterns and trends and information was not effectively shared with the whole staff team to learn from. The provider had little oversight of systems and process in place. During the assessment we identified training issues for example, one person was led by the hand by a staff member however, this person could walk independently. The Integrated Care Board (ICB) had previously identified concerns and risks, which mostly remained at the time of assessment. This meant there were missed opportunities to drive service improvement and improve the safety and quality of care.

The culture of the home and oversight processes in place to monitor the service failed to identify concerns and unsafe care. This showed that learning and improvement had not been embraced by the provider or embedded into the service.