Cockington 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.

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 good governance at the service. 

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.

Staff voiced concerns regarding the culture and leadership at the service. They did not feel the registered manager listened to them or acted on concerns particularly about people’s quality of life. Other concerns included issues around people’s access to finances, medicines errors not being openly reported and addressed, staff members relatives working together in the home and that the culture was not one that fostered inclusion, equity and transparency.

The concerns raised indicated a closed culture. Any service that delivers care can have a closed culture. We define this as ‘a poor culture that can lead to harm, including human rights breaches such as abuse’. In these services, people are more likely to be at risk of deliberate or unintentional harm.

We advised partner agencies of the concerns identified at assessment. We also discussed these concerns with the provider and regional manager who provided assurances that work would be done to support the registered manager to make improvements at the home.

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.

The registered manager had a clear job description outlining their role but our review of documentation, observation, and feedback during the assessment indicated that this had not been consistently met including ensuring the “delivery of person-centred care/support services that promote independence, choice and dignity to empower people to live as independently as possible.”

We spoke with staff who had disclosed personal health issues to the registered manager, but this had not been assessed, or the staff been supported appropriately, in line with their duty under the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations 1999.

Staff spoken with after the on-site assessment confirmed there had been an improvement in person-centred activities since our visit. One staff member told us, “It’s changed very quickly since you guys have come, you guys coming is literally just what we needed. Before it wasn’t the best, it really wasn’t the best, but now I do feel like [registered manager] is trying, you can definitely tell they are trying to make it a better place not only for us staff but residents as well.”

The provider committed to ensuring the regional manager would provide additional support at the home to address any concerns and support the registered manager in their development. This approach would benefit people living at the home and the staff team.

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

People living at the home and their relatives felt able to speak with staff and the registered manager about concerns, but staff did not feel they were able to speak up and that communication between staff and the registered manager was poor.

Staff consistently told us they felt communication between the registered manager and the staff team was poor and if they raised matters or suggestions for improvement they were not listened to. One staff member said, “Communication’s not good at all. I feel like since you (CQC) did come down I feel it has been better, but before that it was horrible. It is hit and miss but it’s more times [name] doesn’t really listen to us.” Another staff member told us, “What can I do? We don’t want the trouble. We like our job, but we’ve got to say something.”

It is essential that people feel able to speak up about concerns to ensure issues are addressed promptly and people experience good quality care and support from a team who are empowered to raise concerns and make suggestions for improvements at the service.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they did not always feel they were treated equally and fairly. Some staff raised concerns regarding their wellbeing and the number of hours they worked but felt they were not able to speak up about this and stated they would work additional hours to ensure people supported received the care they needed. Some staff raised concerns about relationship dynamics within the team which meant some staff felt they were treated less favourably than others.

The provider had an appropriate policy regarding equality, diversity and inclusion and staff completed diversity questionnaires as part of the onboarding process when they were recruited.

The provider did not have consistently good governance processes in place. They did not always act on the best information about risk, performance and outcomes.

The provider had a designated job description for all staff which outlined their specific role and responsibilities. However, people were not consistently taking accountability for their specific responsibilities meaning tasks were being missed or not carried out effectively.

Some of the providers governance systems and ways of working were not effective. For example, risk assessment documentation was found to be unclear and scoring for risk was not explained or understood by the registered manger or staff. Another example was auditing processes carried out on care plans and medicines records which had not identified errors.

The poor governance processes in place and management of these processes meant issues were missed by the registered manager regarding the quality of the environment, issues identified with care plans and risk assessment, and medicines records. This increased the risk of harm to people. The regional manager advised the inspection team of improvements that were being implemented and updated documentation to better support the governance and oversight at the home, for example, new risk assessment templates with clearer scoring to rate the level of risk to people and support with identifying measures to reduce risk.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information with partners and collaborated for improvement.

We found evidence of partnership working with other agencies including people’s GP, social work teams and psychiatrist.

People’s relatives felt the registered manager and staff team worked collaboratively with them and communicated effectively with them regarding their loved one. One relative told us, “[Name] is really being looked after well. I’m sure they [staff team] would let me know if any problems.” Another relative said, “I think if we needed to know [about something] I’ve got full confidence they [staff team] would let us know.” This relative also gave examples of how the regional manager had engaged with multi-disciplinary meetings with family and the day services provider for their loved one prior to them moving into Cockington House.

This collaborative approach meant people received care and support that met their holistic needs, wishes and preferences.

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.

The registered manager had failed to learn from and implement robust ways of working based on the findings from the last CQC assessment to make improvements at the home. This resulted in similar issues being identified at this assessment.

The provider had other services in the area however good practice at these homes had not been consistently shared to support improvement across the network. The regional manager had started the process of working with the registered manager to adopt new ways of working to improve management oversight, documentation and ways of working at Cockington House.

Improving governance systems, documentation and practice at the home will influence positive changes in people’s experience of living at the home.