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 inadequate. At this 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 service continued to be in breach of legal regulation in relation to 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 management team were supporting staff to have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Communication between some staff teams required further development. For example, the communication between senior care staff and nurses could be improved to ensure better outcomes for people. The management team had implemented systems to support better communication, however these needed embedding in to practice. One professional said, "Staff culture was an issue for some months, recent visits I have seen very good care, good team working on tasks, which include observing a moving and handling task by 2 members of staff with a resident."

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 management team consisted of a manager, senior care workers and nurses, with a consultancy company working with the home to implement and oversee changes. People, relatives and visiting professionals had confidence in the manager and consultant, however teamwork between the senior care workers and nurses needed to improve to ensure changes were implemented effectively and embedded in to practice.

Staff and leaders fostered a positive culture where people felt they could speak up and their voice would be heard. Staff had access to speaking up and whistle blowing policy, to ensure all staff understood the importance of raising concerns and knew what process to follow. Staff told us the management team were approachable, and they felt at ease to raise concerns and felt they would be addressed appropriately. One staff member said, "[Manager's name] is amazing they are always on the go and if we go to [manager] or [consultant] with a problem, they sort it out straight away." Another staff member said, “I can make suggestions or raise issues, and I feel listened to. Sometimes I share my suggestions in staff meeting or with our management team. They [management team] are very friendly and supportive and sometimes I get feedback about what has been done.”Another staff member said, “I can make suggestions or raise issues, and I feel listened to. I usually share them in meetings or directly with the manager. They are supportive and act on concerns, and sometimes I get feedback about what has been done. It would be helpful to have a little more regular feedback, but overall, I feel my voice is heard.”

The management team valued diversity in the workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Whilst there had been some improvements to the frequency of supervision sessions, systems required embedding into practice to ensure all staff received the appropriate level of supervision and training. The current manager had a schedule in place to address this. Staff found the management team approachable and said they were committed to improving the service. One staff member said, “Personally, my experience with management has been positive. For the times I had concerns, they were responsive, sometimes not as fast as I would want but they eventually responded and provided solutions. The manager is approachable, warm, friendly, and understanding. I do not hesitate to contact [manager] whether via text message, email and phone call when I have the need.”

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. At our last assessment the management team were in the process of implementing a governance framework to assist in identifying issues and producing action plans to address concerns. This had now been implemented and was supported by a live governance tracker which was reviewed weekly during management and clinical governance meetings. These processes required embedding in to practice to ensure concerns were consistently identified and actioned. Whilst we acknowledged the management team had taken action to improve governance, the provider had not implemented systems sufficient to ensure adequate provider oversight. During this assessment we found some issues still required attention. The management team were aware of these and had plans in place to address them but had to prioritise actions. One visiting professional said, "They have implemented new governance systems to follow up on concerns and issues identified by other professionals, implementing a system for professionals to share written feedback regarding residents, implementing shadowing to ensure firsthand changes to resident care is received in a timely manner."

The management team understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. One visiting professional said, "I have found both the manager and [consultant] to be approachable, they work well together, engaged on every visit, give information, share concerns and always listen and discuss improvements suggested.It is always evident through discussion how knowledgeable they both are of the residents and their needs. The home are attempting to link in with the local school and shops in the area for resident activities." Another visiting professional said, “There has been a clear improvement in communication from the management team at Lower Bowshaw View. When I have discussed required changes to documentation, management have been receptive and responsive, with amendments carried out in a timely way. Management have also demonstrated greater openness about the challenges they are facing. They have proactively shared difficulties experienced with external services, including paramedics and the GP practice, not to escalate concerns but to strengthen working relationships and find collaborative solutions. This willingness to engage transparently with partner agencies, identify challenges, and improve communication reflects a positive shift towards collaborative, integrated working in line with CQC expectations.”

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research. However, the management team encouraged creative ways of delivering equality of experience, outcome and quality of life for people. A range of new governance, audit, and reporting tools had been introduced by the management team, which were proving effective but still required time and consistency to become fully embedded across all levels of staff. While the management team demonstrated clear understanding and commitment, some staff continue to adjust to new expectations, documentation standards, and accountability processes.