Loyd 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 Requires Improvement. At this assessment the rating has remained Requires Improvement.

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 reg 17 good governance.

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.

Improvements were required in governance of the service to ensure it was robust and effective in day-to-day quality assurance. Audit processes needed strengthening to help the management team identify required problems and the actions required. We looked at a range of audits, and these did not identify our findings during this assessment. An example of this was the medicines audits. They had not identified people’s creams did not have an opening date, or that risk assessments were not in place for flammable creams. The service would benefit from regular staff meetings and encourage staff to raise any concerns.

Staff had completed some training: however further work was needed to ensure all staff were up to date and trained for the tasks they supported.

Improvements were required in relation to the culture of the workforce, and communication with staff required improvement. Staff described how staffing levels and communication from the management team impacted on their ability to do their job.

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.

Prior to the inspection visit CQC received concerns about the leadership and poor culture that could affect the quality of people’s care and impact on staff. These concerns were shared with the provider. At the time of this assessment, there was no registered manager in post. Whilst recruitment was underway, interim support was being provided by a registered manager from a local sister service alongside the deputy manager

We received mixed feedback from staff; some told us they felt supported and valued whilst others did not.

Mechanisms for gathering feedback were in place, including resident and relative meetings, and surveys. However, not all residents or relatives felt their views led to meaningful change. For example, requests for more activities had not been actioned. This indicates that work is needed to ensure feedback leads to lasting improvements.

We reviewed a sample of audits. While some of our findings had been identified through their health and safety audit, others had not. For example, medication audits had not captured our concerns found during this assessment. This was discussed with the management team who told us they are committed to strengthening audits and introducing spot checks.

There was an action plan in place, but this did not cover all our findings, requiring improvements to ensure comprehensive oversight.

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

Staff told us they were confident to raise concerns and provided examples of doing so previously. However, not all staff were confident they would receive feedback or that issues would be addressed appropriately. Team meetings were held but would benefit from becoming more frequent and encouraging wider participation and open discussion. Staff had individual supervisions, though some required these to be more regular.

The service had policies in place such as freedom to speak up/ whistleblowing and a speak up champion had been appointed. However not all staff knew who the champion was, indicating a need for better communication and awareness.

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.

Some staff reported feeling undervalued and raised concerns about the high use of agency staff, which they felt affected consistency and quality of care. One staff member told us, "Agency workers are not doing their jobs properly. There are a lot of agency workers. Why are we having lots of bank/agency instead of employing more permanent staff? If we had more permanent staff, then things would be going better.”

The provider promoted diversity and inclusion through policies, procedures and relevant training. Relevant legislation and best practice guidance was implemented to ensure staff were treated in a fair and equitable manner. Recruitment processes supported fair employment opportunities.

Staff surveys had been conducted.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider had systems and processes to monitor the quality and safety of the service. Some audits were carried out but no observational checks. We reviewed a sample of completed audits and found whilst some of our findings had been identified not all had been. For example, audits had not identified gaps in care plans, recording of carer notes or the concerns with medicine management we found.

The findings raised concerns about the oversight, adherence to evidence-based practice, and endurance of safe care delivery. Governance mechanisms failed to identify several concerns found during this assessment, including incomplete risk assessment, recruitment gaps, and lack of monitoring of call bell response times, and mattress settings. People were not being weighed monthly as per their care plans, and suitable scales for some people were not available during this visit. They were then ordered and the management team assured us people would be weighed accordingly going forward.

Although some actions were taken following feedback, such as purchasing appropriate scales and starting a full care plan audit, further work is required to embed improvements and ensure sustained oversight. The provider's action plan did not include our findings, and audits were not sufficiently robust to highlight shortfalls, such as medicines management and care record accuracy. A business continuity plan was in place but required adaptation for the service. The provider acknowledged these issues and plans to work closely with a newly appointed manager, once they have been recruited, to improve governance.

There was poor oversight and governance of the service which placed people at increased risk of harm.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

People's feedback was obtained through surveys and was generally positive. As part of our assessment, we requested feedback from external partners: however, no responses were received. We saw evidence of partnership working with GP'S, social services and nurse practitioners. The service also collaborated with specialist consultants, including Parkinson's and Huntington's, to support people's care needs.

People were supported to attend day centres and voluntary work.

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

Most staff told us they were not actively involved in discussions about improvements and were unsure if feedback was acted upon, which was reflected in meeting minutes. The service did not have effective systems and processes to access the quality of care and drive improvements. Action plans were in place; however, these did not contain our findings and were not consistently followed. We were not assured the provider had learned from previous inspections, as some concerns such as bowel monitoring and opening dates on creams- were repeated. Audits and oversight were insufficient, and performance monitoring was poor, placing people at risk of harm.