Job's Close Residential Home for the Elderly Limited

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• 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 as 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 provider was in breach of legal regulation in relation to good governance.

This service scored 43 (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, culture and engagement. They did not always understand the challenges and the needs of people and their communities. Staff were unable to tell us the provider’s shared vision for the service.

Reviews of people’s care plans had not always ensured a fully inclusive and collaborative process of care plan development. Risk assessment and care planning processes had not always resulted in care plans which reflected and acknowledged people’s known health needs.

The provider’s staff training provision required improvement to better reflect people’s individual learning needs. Staff told us they would prefer face to face training onsite. The registered manager told us that she had taken this feedback on board and was going to arrange more face-to-face training to meet the preferred training style of some staff members. People and relatives told us staff were kind and compassionate.

Staff feedback showed that the provider didn’t always promote an open culture. Some staff didn’t feel confident reporting poor practices and worried their concerns wouldn’t be taken seriously by management. However, other staff felt comfortable raising concerns and suggested that having a direct process to report issues to the trustees would be helpful, especially if management didn’t address them. This feedback was shared with the provider, and they planned to put these changes in place. Despite these issues, people and their families described the staff as kind and compassionate.

Some leaders did not always understand the context in which the provider delivered care, treatment and support. They did not consistently reflect the culture and values of the workforce and organisation and at times, their skills knowledge and experience were not always sufficient for effective leadership.

The registered manager had not received any supervisions or appraisals since 2020. This ensures they have the skills and knowledge to be an effective leader and to identify extra support or development they might need. Without them, there was a missed opportunity to review the registered manager’s work and identify areas for improvement within the service.

People and relatives knew who the management team were and said they were visible and approachable. One relative told us “The deputy manager is a class act knows [my loved one) really well, was promoted 18 months ago you can see why she was promoted; she’s brilliant.” However, two relatives said they didn’t know who the registered manager was, but they knew how to get in touch if needed.

The manager completed safety checks however, we found areas of concern were not identified by these checks including fire drills not being completed routinely and PEEPs not being in place.

The registered manager did not have an awareness of the missed safety checks and audits were not robust in identifying this.

People did not always feel they could speak up and that their voice would be heard.

The registered manager told us they had an open-door policy to allow people, relatives, staff, and professionals to raise feedback and were working on a new website. However, the service did not always foster a positive culture where staff felt they could speak up and their voices would be heard. The service was not able to evidence regular feedback had been collected from staff and other professionals. Some staff members felt the provider did not always listen to concerns and act. However, some staff felt they could raise concerns, and action would be taken. There were missed opportunities to use feedback to help drive improvements within the service. Following our assessment the registered manager told us they had arranged feedback questionnaires for staff to complete.

The provider had a whistleblowing policy and complaints management system and staff were informed of this as part of their induction. However, one staff member told us “[Name] would not use the company’s whistleblowing process as she did not feel it would be confidential.”

Surveys and questionnaires were distributed to people living at the home, their families and friends, to invite their feedback on the service. However, the response rate was low. Some relatives were unaware of the questionnaire, as no information about it had been shared with them. One relative told us they could raise concerns if they arose. Another relative told us “I don’t recall any questionnaires they’re more likely to talk to us when we visit.”.

One person said “We do fill in a questionnaire and so does [my loved one]. It’s multi choice questions with the opportunity to make suggestions. I don’t think filling in the questionnaire makes much difference; they probably don’t improve.”

Some relatives preferred speaking to staff directly when they visited. Others felt comfortable raising concerns with the registered manager and told us “I’ve met the deputy manager they are really accommodating. If we have questions, they’ve gone out of their way to answer them for us.”

The provider valued diversity in their workforce and worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The provider recruited from diverse backgrounds which was reflective of the broader community.

The deputy manager shared an example of actions taken in response to a discrimination allegation involving staff. A risk assessment was carried out, which included a policy of staff working in pairs to help address the issue.

Staff meetings were held, but not everyone could attend. Some staff also told us that meeting minutes were not always shared consistently. This made it difficult for them to stay informed about discussions and decisions made.

The provider did not always have clear responsibilities, roles, systems of accountability and 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 provider failed to operate robust quality assurance systems and processes. Audits were completed by the management team but many of these failed to identify the shortfalls at the service.

Systems to assess the effectiveness of staff training were not robust to ensure they were competent to carry out their roles. This lack of oversight meant the provider could not assure themselves their staff were skilled and had the necessary knowledge and skills to undertake their job roles. Processes to ensure statutory and regulatory notifications were made to the local authority and CQC were not always effective.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider and registered manager had not engaged in local or national forums or development groups. This meant there had been missed opportunities for learning to improve people’s experience of care. The Local Authority provided funding for a new IT system to help record and analyse care more effectively and improve risk assessments and care plans. However, there were long delays implementing this system, meaning a chance to improve record-keeping was delayed resulting in the shortfalls we identified.

Where external health professionals visited, such as district nurses and GPs, their advice or actions were recorded in the communication book. However, this information was not always included in people’s care records.

The local authority gave feedback that the provider was not fully engaged with them. It was unclear how the provider worked with local commissioners to keep up to date about best practice, training, and how to improve the safety and quality of care provided., make safeguarding referral as required. Staff said they could refer people to health and social care professionals through the management team. Relatives and the provider confirmed that professionals were involved in people’s care. District nurses who were at the service gave positive feedback. They said they had a good working relationship with the provider and that health concerns and equipment issues were reported quickly.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

There were systems and processes for assessing and monitoring the safety and quality of people’s care. However, these were inadequate at identifying and driving improvements. The provider had failed to follow their own policies and procedures. This meant guidance was not always followed or implemented.

The registered manager carried out audits of the service. However, these audits failed to identify the concerns we identified during our assessment to ensure the safety of people and staff. The provider lacked effective systems to monitor and mitigate risks and to learn lessons to prevent incidents from happening again. The provider did not conduct any analysis of accidents and incidents to allow lessons to be learnt to help keep people safe from further injuries.