Compton House Christian 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 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.

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 and leaders did not always ensure that the direction and culture of the home was shared and delivered consistently between leaders and staff.

Feedback received by CQC, that was confirmed by leaders, showed that the home had experienced previous internal management changes that had impacted both the leadership of the home and the trust with staff. Changes were being made to the structure of the management team and with delegation of governance tasks across the senior team so that they had oversight over specific departments, together with a change in care systems. Feedback we received highlighted concerns over how these changes had been managed and implemented, which had impacted the oversight of the home and the culture of the senior team.

Evidence and some feedback suggested that much work had been done to address the culture and leadership approach in the home. However, it was acknowledged by leaders and observed by the inspection team that further work was required to embed this and ensure a proactive work environment for staff. Leaders were taking steps to review and improve the culture of the organisation. The management team acknowledged that they had worked hard to change this. Some staff felt that the culture of the home was moving in the right direction but required more work. Other staff we spoke to were positive about the impact and drive the new management team had had and told us that they felt management were taking the home in the right direction. One leader said, “I feel like staff have settled. The management system is more settled and approachable now.”

Leaders demonstrated a focused and positive approach to ensure people received good quality care. Values were evident within the service through staff meetings and care planning. Staff completed Equality and Diversity as part of their core training and completion compliance was high. Ethnicity, religion, and sexual orientation were captured within people's care plans. Managers and staff understood the diverse needs of the people they supported.

Leaders did not always make themselves visible to people living at Compton House Christian Nursing Home.

Some people expressed a wish for the leadership team to be more visible around the home and to be more accessible to them. One person said, “They haven't got time to stand and talk. They could be a little more proactive.” Other comments included, “I met (registered manager) once, didn’t see him for long enough. He's friendly enough but when you do see him, he just says hello and moves on” and “I don’t know what he does in the background, but he doesn’t do enough in the foreground. I don’t see him very much. He will say hello and how are you. The place needs something a bit more than that.” The deputy manager stated that they were working hard on establishing a strong leadership structure but acknowledged that they could increase visibility around the home. The deputy manager said, “A lot of (people) feel they would want more visibility from management.”

Leaders were alert to examples of poor culture that had previously impacted the running of the home, some of which still persisted. This was an area that they were working hard to redress to ensure that it did not impact the quality of people’s care or have a detrimental impact on staff.

However, some people praised the running of the home, and that leadership and staff created an environment that facilitated their care needs. Leaders were knowledgeable about issues and priorities for the quality of services. The registered manager and deputy manager had a good knowledge of people’s needs and demonstrated a focus in ensuring that people received good quality care. One person said of those that supported them, “They are very considerate. They really want to know how you are.” Another person said, “They have listened to what I wanted done.”

Some staff told us how the home had improved and stabilised under the direction of both the registered manager and deputy manager. There was positive feedback from staff about the approach of the management team, with one staff member describing them as “firm but fair”.

The leadership team encouraged an open service and office where staff could raise any issues about care and their roles. Staff were able to raise concerns directly with them. The leadership team carried out consistent and regular supervisions with staff to ensure that their views and feedback were heard.

The provider had a policy in place guiding staff on raising concerns, detailing pathways to speak up freely and for whistleblowing. This provided assurances for staff on the protection and support they will receive should they need to raise concerns. Staff told us there were regular team meetings where they could speak about concerns and put forward suggestions for improvement.

The service valued diversity in their workforce and the leadership team was clear on the approach to staff inclusion and equality, with a workforce of staff who came from diverse backgrounds. Staff had received Equality and Diversity Training as part of their training within the service.

The provider and leaders ensured equality of opportunity and experience for the workforce was in place, for example, adjustments to work patterns to accommodate religious events or needs. The deputy manager said, “We have staff from different cultures and nationalities, a very broad spectrum on the staff. Everyone works together, nobody sees the differences. I will always work to make sure people are on a level playing field.” One staff member protected by these characteristics said, “So for me, it's like a real home. I feel it’s like home.”

The provider ensured that protected characteristics of those they supported were also considered as part of this approach. Care planning captured how these diverse needs and characteristics impacted their care needs and what adjustments were needed to support them.

Governance and accountability processes were not always reliable or effective. Governance frameworks were not always robust or consistently applied, leading to shortfalls in oversight of some areas.

There were a number of quality assurance systems, audits and processes in place to monitor the quality of care provided. However, changes in systems, management team and structure, together with the drive to improve the culture of the home, had meant that some areas of governance and quality assurance had not been fully embedded and effective, and we were not yet able to see the full impact. For example, the deputy manager was in the process of updating and creating some policies and procedures. These are crucial as they provide a framework for consistent and ethical practices, outlining how staff should handle various situations and activities. We highlighted the need for the provider to ensure that background recruitment checks are regularly updated although the policy and procedure did not reflect this. The deputy manager told us that this was needed.

The management team were aware of the areas of governance that needed to be embedded to be fully effective. Areas such as food quality had been identified by the management team were being addressed. Feedback from some people was positive, while others questioned the current standard. One person indicated that the modified diet they received to support with choking risks was ‘bland’ and felt this was due to the approach to the modification. One leader said, “We are acutely aware of some of the nutrition issues.” The decision to commence admissions again of people living with dementia had highlighted that an increased approach and more developed framework of training was needed to fully support this. We have detailed this in the Safe section of the report.

The registered manager said, “We are going in the right way. It's been a difficult period. We’ve been working through a lot of things. Things are heading in the correct direction. Quality assurance needs work. We started last August, and we have switched from one system to another, an obstacle to consistency.”

The leadership team had implemented a staffing and management structure that they felt was more balanced and increased working between care and clinical staff, while giving the wider management team more responsibility and oversight over their own teams. Staff feedback was positive on these changes.

Quality assurance systems were in place to maintain oversight of peoples support and improve care delivery. Audits we viewed had been completed consistently and effectively. The registered manager said, “I have introduced a new platform for integrating care documents, care notes and medicines administration. I'm proud to say we are well satisfied with the new platform. Now we have a more creative and explicit way of recording evidence for the quality assurance.” While the registered manager was confident in the effectiveness of the new systems and processes, he acknowledged that there had been some initial resistance from staff but that staff were becoming more proficient with them.

The Registered Manager understood their regulatory responsibilities. A review of statutory notifications completed prior to on-site assessment confirmed that they complied with the process for reporting to local authorities. Management ensured that they, and care staff, understood their responsibilities relating to people's information, records and confidentiality. As part of their induction and training, all staff had completed General Data Protection Regulation (GDPR) training. Secure electronic systems were used so that staff could access information they needed to support people effectively.

The provider understood their duty to collaborate and work in partnership. Appropriate referrals for specialist services and health support were made where relevant and needed.

People were supported by a variety of health and social care professionals to ensure their needs were met and made referrals to the health professionals when required.The provider shared information to ensure effective joined up working. One professional said, “I always feel the staff know the patients really well and are very caring and engaged.”

Leaders and staff worked with the local authority and social workers to ensure that they had all the information they needed to facilitate new packages safely and effectively. Records showed that there was partnership working with professionals in the Speech and Language Therapy team, hospices, physiotherapists, and GPs for example. One professional said, “I have had good past engagement with the Manager who was keen to receive support information such as respect trainer details to support Advanced care planning.”

Identifying and implementing ways to improve was inconsistent.

As discussed within this report, the home was undertaking changes in leadership structure, new delegated roles for senior staff, improving quality assurance processes and facilitating system changes. The leadership had an understanding of how to make improvements happen although feedback we received indicated that these changes and improvements had not always been implemented in a structured, consistent and workable way.

For example, the identification of the need for increased dementia and awareness training for staff to safely and effectively support new admissions was being considered and actioned even though admissions of people living with dementia had occurred. This meant that staff were not prioritised to improve learning in this area in a timely and structured manner. The need for decision specific Mental Capacity assessments, to be completed by the provider and staff at the home, had been identified but remained an area that had not been actioned. Feedback received that there was a considerable number of governance areas to address and that these would take time to complete.

People we spoke to were happy with the care they received and with staff’s approach to support. One staff member told us that they felt they were now moving towards a firmer, fairer, and more supportive culture under the new management, while maintaining a strong commitment to excellent care.

The registered manager and deputy manager had learnt from issues that had developed under the previous structure and were positive and driven to maintaining an effective staffing team that maintained good quality care. The registered manager said, “We are already improving the management style. I have now empowered all line managers. First, things are relayed to the line manager, they are the decision manager, and that person will inform me, and I will approve anything. That person manages everything within their department. Some of them I've got excellent feedback.”