Alicia 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 requires improvement. At this assessment the rating has changed to inadequate: This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service continued to be in breach of legal regulations in relation to governance at the service.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a risk of closed cultures developing within the service. Some staff told us they did not always experience a positive and supportive culture. Staff told us they sometimes felt they were treated differently by their colleagues based on their cultural backgrounds, leading to the formation of groups among staff. Additionally, staff told us they had to skip breaks due to staffing shortages and heavy workloads, and they often did not feel listened to when speaking up about these issues. Despite this feedback, staff were generally positive about the senior leaders and were complimentary and positive about the recent introduction of speaking-up guardians and were positive this would help address these issues over time.

During this assessment, we identified 2 continued breaches legal regulations and 3 new breaches of legal regulations. This meant leaders had not always identified and taken action to ensure people received care that was in line with legal requirements. We could not be assured leaders learned from previous findings or took appropriate action to address shortfalls in the service. However, people were complimentary about the leadership team and said they were approachable and accessible. A relative said, “The manager is approachable, I have utter faith in them.” Another relative said, “[Registered manager’s] communication is good, [Registered manager] is a good person, [Registered manager] and the deputy will always sort things out.”

Due to our findings around safeguarding concerns not always being identified by the provider, we could not be assured people, and their relatives would be informed of these promptly and would be given an apology where required. However, people and relatives did not raise any concerns to indicate they could not speak up or their voices would not be heard.

We received mixed feedback from staff around freedom to speak up. Some staff told us they didn’t feel their views or concerns were listened to. However, other staff told us they were able to speak with the management team about any issues, concerns or ideas and would be supported.

A recent ‘speak up guardians’ initiative had recently been introduced, which encouraged freedom to speak up. This initiative was in its early stages and needed time to be embedded in the service. The nominated individual and registered manager were aware of some of the themes in relation to these concerns and told us they were in the process of investigating concerns raised by staff.

The provider did not always ensure they worked towards an inclusive and fair culture. Staff reported a culture within the service, where team inclusion was influenced more by personal relationships among staff members. However, staff we spoke with said they were treated fairly regarding diversity by the leadership team overall. The provider was aware of these concerns and was in the process of investigating concerns raised by staff. Staff said they had been supported to develop their skills. One staff member said, “[Registered manager] supported me to get my nurses PIN, they have helped me to progress.”

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.

We identified continued and new breaches of legal regulations during this assessment. Whilst the provider had a range of systems in place to monitor quality in the service, they failed to identify the concerns found during this assessment. However, the provider was responsive to our findings, took immediate action to address some of the shortfalls identified and developed an action plan for longer term improvements. We will check for sustained improvements at our next assessment.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They had not always identified issues found during this assessment and therefore did not always share information and learning with partners or collaborate for improvement. For example, we identified a number of incidents that had not been identified by the provider and subsequently shared with the local authority safeguarding team and CQC.

The service did not demonstrate they had learnt and improved from the outcomes of our previous inspection. We identified similar shortfalls during this assessment. This meant we could not be assured leaders had a good understanding of how to make and sustain improvements at this service. This placed people at continued risk of not receiving care that met their needs and preferences.