The Chiswick Nursing Centre

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 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 his 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 17 in relation to systems or processes operated to effectively ensure compliance and good governance at the service.

This service scored 57 (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. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.The provider mission statement and philosophy of care stated the objective was to provide safe, consistent, effective, reliable, good value services that are person centered and of an excellent quality through the empowerment of people. They also recognised people’s rights to dignity and privacy. However they were not consistently achieved. One person was lying naked on their bed with their bedroom door open. One of the inspectors checked the person’s care plan and risk assessment. Both addressed walking about the corridors naked and offered actions relating to this. Neither identified being naked in the bedroom with the door open as a concern. Two of the nurses on duty did not appear to have recognised this practice as a concern or inappropriate. This was discussed with the registered manager during the end of day feedback and appropriately addressed the following day.

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. Staff and relatives said some of the management team at the home and within the organisation were not very accessible or responsive and some people were unaware of who the registered manager was. A person said, “I’ve never met them.” A relative commented, “There is a lack of communication, and they need to up their game.” Some staff said they didn’t feel listened to when they told the management they were short staffed and struggled to provide the care as nothing changed.

People did not always feel they could speak up and that their voice would be heard. A relative said, “If you raise a concern they will acknowledge it. But that is as far as it goes.” Staff did not feel they were given the opportunity to drive improvement, encouraged to raise concerns and the value of doing so was not promoted and recognised. One staff member told us, “The management don’t listen to us.” The complaints logged were handwritten and very difficult to read. They were also not recorded contemporaneously. A number of complaints logged on the CQC safeguarding system were not recorded in the provider’s complaints records. They included, “How many times do I need to complain before something is done.” “I have raised issues with the new director, but he has done very little to address them. I have so many concerns I need to speak to someone about this.”

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. Staff did not raise concerns regarding equality, diversity, and inclusion. There were provider policies and procedures in place.

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. We identified areas requiring improvement in relation to audits and good governance at senior organisational and care home level. This was due to inconsistency in operating monitoring systems and processes. It included completion of all audits on time as per the audits matrix, ensuring they were robust in content such as care plan audits and contained specific measurable achievable relevant time-bound (SMART) actions that are followed-up and signed off as being completed. Maintaining a legible contemporaneous complaints and concerns log, demonstrating complaints and concerns were fully investigated in a timely manner, medicines audits were carried out within the stipulated monthly cycle, sharing mental capacity and Deprivation of Liberty Safeguards (DoLS) referrals and information consistently with staff so they are kept up to date.

• The provider did not always 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. From the monthly summary information the provider submitted it was unclear if all the accidents and incidents had been recorded and not all had outcomes submitted. Also fall report forms across all units were not standardized to ensure consistency. The staff meeting minutes forwarded did not record specific actions and no high level analysis of people’s feedback or ‘You said we did’ was provided. The provider told us “A centralised Service Development Action Plan is currently being developed to consolidate all actions arising from audits and service improvement initiatives across the group.”

The provider did not always 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. From the monthly summary information the provider submitted it was unclear if all the accidents and incidents had been recorded and not all had outcomes submitted. Also fall report forms across all units were not standardized to ensure consistency. The staff meeting minutes forwarded did not record specific actions and no high level analysis of people’s feedback or ‘You said we did’ was provided. The provider told us “A centralised Service Development Action Plan is currently being developed to consolidate all actions arising from audits and service improvement initiatives across the group.”