Harwood 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 good. 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 the oversight and governance at the service.

This service scored 62 (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 had a shared vision, strategy and culture based on equality, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. There was a 'whole team approach' and culture in the service. The managers and staff worked together to ensure it continued to develop and grow and supported provision of good services to the people. The manager said, “For me, it is shared vision and we have business development plan and projecting where we are and what we want to achieve. That’s why I put core values on supervision, and I want to involve staff to understand why we are doing what we are doing…We want staff understand the rationale and I always try to explain why we need to do something or why the decision. We are a team and we work together; by leading by example.” The manager worked with staff to support them and also to ensure equality and diversity were actively promoted, and the causes of any workforce inequality were identified and actioned. Staff were very positive of the changes being made since the new manager joined the service which supported their learning and development. The staff team used shift handovers, meetings and daily communication to share and discuss any tasks to complete or what was going on in the service. The manager worked alongside the staff in the service and guided them to provide the care people needed. This way they were able to monitor practice regularly during the day and ensure appropriate action was taken to address any issues. The manager praised their staff team for positive engagement and added, “[Staff] are a really good team; yes they look after people, and they are good people... We all work really well together. Even form the director level, [the director] comes in every month, and touches base with us.” The manager and staff worked positively with people and the relatives to lead their life as they wished that had a positive impact on people’s life.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The manager understood the requirements of how to deliver care, treatment and support and embody the culture and values of their workforce and organisation. The manager also kept up with updates in the sector to support their own professional development to ensure they had the skills, knowledge, experience and credibility to lead effectively. The manager encouraged integrity, openness and honesty in the service to ensure any issues or concerns were addressed quickly. Staff said, “I think it is very well managed for the residents – the way we have the home, we all have an idea of a care home but they keep it really really homely and that is a really nice thing to do, it is very homely” and “It is a good atmosphere which is why no one leaves – they are well looked after and happy.” Staff felt listened to, supported and the manager was approachable. Staff all worked together well and were positive about the leadership in the service that contributed to better outcomes for people, their relatives and staff team. Staff told us they enjoyed working in the service. The manager and other senior staff were visible to the staff team, people and relatives, and professionals. The manager was knowledgeable about the issues and priorities for the quality of services and told us the changes they have been making since the start of their role. The manager added she felt supported by the provider and senior management to make changes to ensure people continued receiving care and support they needed.

The provider and the manager fostered a positive culture where people, their relatives and staff felt that they can speak up and that their voice would be heard. Staff’s feedback was taken into account to support any improvements. The management team encouraged staff to raise any concerns and promoted the value of doing so. Staff were confident that their voices would be heard, and they were happy to approach the manager or senior staff for support. There was a culture of speaking up where staff could raise concerns and would be supported, without fear of detriment. When concerns were raised, the manager and provider have investigated those. The management team was open and transparent with people and relatives if something went wrong. Staff said, “I am not one to be quiet and I feel supported enough to raise something – I would have the support of the management team” and “I support people to raise issues as well as raising my own. I very much feel able to raise things for the [people] in the home.” The manager and staff worked together to promote people's wellbeing, safety, and security and we observed a supportive staff culture. It was clear people who use the service were important to the whole staff team. People and the staff team had good relationships with each other. We also observed staff and the managers were respectful and kind towards people and each other. The manager promoted a positive, caring, transparent and inclusive culture within the service. The staff team were motivated to provide care and support to people as their needs and health were changing.

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 provider valued and respected diversity in the workforce. They took action to improve if there were any disparities in the experience of staff with protected equality characteristics. The manager communicated with staff and they shared any ideas or suggestion to ensure staff were included and were able to contribute to the service.Staff felt positive about the changes in the service. They were confident their concerns and ideas would result in positive change to shape services and create a more equitable and inclusive organisation. They felt supported, treated fairly and looked after by the managers.They worked towards an inclusive and fair culture by improving equality and equity for staff who worked at the service. The manager worked alongside staff delivering care so they could understand any issues staff encountered. This approach also encouraged an inclusive and equal workforce and mutual respect amongst staff. The manager used effective and proactive ways to engage with and involve staff, with a focus on hearing the voices of staff. The working environment was inclusive, and staff’s wellbeing was considered. This ensured the service had a positive culture which supported better outcomes for people.

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. Services registered with the Care Quality Commission (CQC) are required to notify us of significant events and other incidents that happen in the service, without delay. This is important as it means we can check that appropriate action had been taken to ensure people are safe. During this assessment, we found the registered person did not notify CQC of reportable events including allegations of abuse, police incident, serious injury and event that stopped the service. The oversight of recruitment process and selection had to be improved. We found missing recruitment information for staff suitability and policy did not reflect the requirements of the regulation. The provider was working to improve management of medicine. However, we still found issues with medicine management, and this was not always identified during quality assurance checks. The provider identified gaps in training and put a plan in place to address this. However, oversight of the training needed improving to ensure consistencies in staff’s learning, compliance, and skill development. This meant systems and processes required embedding into practice more effectively to ensure issues with training were proactively identified in the future. This was to ensure people remained safe and ensured compliance with fundamental standards. We found there were improvements needed to ensure issues were identified and mitigated using provider's quality assurance system. The areas included risk monitoring records for people, aspects of environment safety and suitability. The provider had to ensure the service was consistently well-managed and improvements were sustained and embedded. For other areas of the service, the manager and the provider had an oversight of the service provided and ensured people received the care and support they needed. They used tools such as audits, observations and feedback from people, relatives and staff to monitor, assess and improve the quality of the service. There was an improved emphasis on continuously improving the service and meaningful learning was applied across the whole staff team.

The provider and the manager 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. Where necessary, external health and social care professionals had been consulted or kept up to date with developments. The manager told us how they worked with people, their families, professionals to ensure people received the care and treatment they needed. Professionals were positive about the service, the manager’s and the whole staff team’s work to ensure people continued receiving the care and support they needed. One professional said, “I was invited to the home by the new manager to make connections and plan ongoing support. I felt [the manager] demonstrated a clear understanding of the service’s regulatory responsibilities and has proactively identified a number of areas for improvement, including the review and strengthening of staff training records to ensure accuracy, completeness, and ongoing compliance.” Staff and the manager were open and transparent, and they collaborated with all relevant external stakeholders and agencies to ensure they achieved positive outcomes for people. Provider encouraged partnership working with key organisations to support care provision, service development and joined-up care, as well as, keeping up with any updates in the health and care sector.

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. The provider and the manager worked together to establish clearer responsibilities and roles for the staff team that supported positive changes and improvements in the service. They also had been working on reviewing the service and changes needed to support care and treatment to people. The manager communicated with staff to share information and act on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. The manager told us how they oversaw and managed behaviours and performance of staff as and when needed. They also engaged with the whole staff team to ensure they understood the meaning and importance of ethos, values and effective quality assurance and monitoring. This meant the staff team were involved in not only people’s care but also the service welfare and management. Staff told us they did not have monthly staff meetings, however, they regularly communicated with each other regarding different topics such as people’s care, their daily life, activities, meals, health and well-being as well as, any other business. The collaborative work demonstrated staff provided support to people maximising the best outcomes for them. Where we identified shortfalls during this assessment, the provider was responsive to our findings and started working on areas of improvement.