Archived: Lower Bowshaw View 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 provider was previously in breach of legal regulation in relation to governance at the service. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

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.

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. There had been many changes in the staff team and management, and there had been a lack of consistent approach and improvement. We observed a more positive culture lead by the new management team, people were positive about the care staff and the support they received; however, the provider had failed to sustain and embed good practice. For example, the service has been inspected on five occasions since January 2020, and breached regulation 17 four times and regulation 12 three times. This shows a failure tomaximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care needs

The provider did not always understand the context in which care, treatment and support was delivered. 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. However, a new management team was in place, and there had been recent significant changes in the team. The clinical lead had stepped down and the previous deputy had left. The service was relying on agency senior care staff and nurses. This was impacting on the governance of the service.

We received positive feedback regarding the new management team from the staff. However, they were struggling to implement all new systems in a timely way to ensure improvements.

People did not always feel they could speak up and that their voice would be heard. There was not always a positive culture where staff felt comfortable to raise concerns.. Staff felt supported by the manager and new deputy. However, there was no regular formal supervision to enable staff to raise any issues or request support. There had also been many changes in management and a lack of governance and oversight by the provider. Which meant there was lack of a consistent approach for staff to speak up. We also observed a lack of leadership and effective deployment of staff on some shifts; this was predominantly due to use of bank and agency staff.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. Processes were in place which helped to protect the rights of staff under the Equality Act. This helped to create a more equitable and inclusive organisation. However, lack of oversight by the provider meant staff were not always supported. Staff were not regularly supervised and training was not up to date.

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.

There has been a long history of non-compliance with regulations and breaches of regulation, warning notices and poor ratings. In the last eight inspections, 1 was inadequate and 6 were requires improvement. This shows a lack of commitment to improving the service by the provider.

At this inspection although we saw new audits and quality assurance systems, these had not been embedded into practice and with the past compliance history, did not give satisfactory reassurance that these would be sustained.

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

Professionals raised serious concerns with us regarding peoples safety. Professionals are visiting the service regularly to review their action plan and ensure people are safe. Professionals have continued to identify serious issues that are not resolved effectively. For example, two recent concerns were regarding poor catheter care and incorrect wound dressings applied, these could both have a detrimental effect on the person. The provider did not maximise the effectiveness of people’s care and treatment as care plans were not up to date so they were not assessing and reviewing people's health, care, wellbeing and communication needs with them.

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, positive outcomes and quality of life for people. They did not actively contribute to safe, effective practice and research.

The manager understood their responsibilities under duty of candour, to be open and honest when things went wrong. They told us they were committed to working with health care professionals to try to improve the service. However, this was not always the feedback we received from professionals, who have said they are continually identifying more concerns which are on a similar theme and are not being listened to. The provider did not learn lessons or maintain improvements to ensure the service improved to good. For example, the continued non-compliance and repeated breached of regulations.