Lotus 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 good. 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.
 

This service scored 61 (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.
We identified some practice that led to concerns regarding the provider’s culture. For example, relating to the undignified way staff sometimes spoke to people and the lack of evidence of actions taken to support people who were distressed. These concerns had not been identified by staff or management.
However, staff praised the supportive culture amongst staff and senior leaders. One staff member told us “Oh yes, I feel supported, area manager comes weekly, to check if things are ok, head office calls to check on us and service users, I feel we have support. We have supervisions and team meetings monthly, but if you have things to discuss we don't wait for meetings. Any concern, I tell [manager].”
 

Leaders had not identified the shortfalls that we found during the inspection. For example, in relation to unclear, inaccurate and misleading daily records.
Leaders had not identified their own learning and development needs and were not alert to the examples of poor culture we identified. However, following our feedback they made plans to address these areas and implemented changes to recording systems, spoke with staff and updated their service improvement plan.
Leaders were visible and available and staff told us they felt supported. One staff member told us, “I feel supported, when I have something, I tell my manager, here we support each other, work well as a team.”
Another staff member told us, “If we need something we can request it, ask anytime and they [managers] come and help us, even out of hours, and there is someone on call from head office.”
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.
Staff meeting minutes and supervision records evidenced effective collaboration between staff and managers where staff could speak openly about issues they wished to discuss.
People were happy to share their honest opinions with staff. One person’s representative told us, “Overall, I find it very welcoming when I go. I find it all very open, not a closed culture.”

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.
The service had a diverse workforce, and the registered manager had developed an inclusive working environment.
Staff told us they really appreciated the flexibility of the management in understanding their home circumstances and responsibilities. The provider supported staff who were undertaking higher education qualifications, recognising the value their knowledge brought to the service.
The registered manager told us that the service was very caring, and it was important to them that they lead it properly and maintained the staff team. They also said, “Of course if we can do something better and there are areas where we can improve…new ideas, I am open to work with that”.
One relative told us “[Person] doesn’t talk, but does a bit of Makaton, but they all communicate okay. Yes, I would say it is a nice culture.”
 

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. The areas the provider had advised they were working on were not included on the service action plan for example, decoration of the home, developing service user surveys and improving daily records.
Some documents were repetitive and inaccurate for example, the wrong gender used, repeated statements, unclear dates and unclear stock levels on medication documents.
Audits were regularly completed however, some of the areas that we identified that required improvement had not been identified by the home, for example, the lack of information about de-escalation techniques used by staff and infantilising language. However, the service was very responsive to making changes.
 

The provider 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.
The provider had a positive relationship with other services, and the local authority told us they had no quality concerns.
The management and staff shared the same goal to provide positive outcomes for people.
 

Robust quality assurance systems were not in place and did not evidence continuous improvement. Staff spot checks and audits had not identified staff learning needs in relation to the disrespectful language used. There was a lack of evidence that leaders and staff strived for improvement and innovation. For example, the service improvement plan actions were not specific, with no set timescales except for those related to maintenance and the care planning system. Leaders told us that the technology introduced to record daily notes was not supportive of person-centred care and record keeping was too clinical. The service had not participated in research projects, accreditation schemes, or learning from external reviews.
Leaders demonstrated some awareness of the need for continued improvement and described how they kept themselves and staff up-to date with guidance and legislation. The provider shared information with staff on changes to policies and procedures and shared new training opportunities, although not all staff had embedded guidance in practice.
Staff were encouraged and supported to develop their knowledge by attending training and completing qualifications.
The provider quality and compliance manager regularly visited the service and provided support to the registered manager. However, we found further improvements were necessary to governance systems and processes to ensure people received good quality and consistent care.