Nether Place 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. That was because we found breaches of regulation for good governance. At this assessment we found new breaches of regulations in good governance and the rating has remained the same. 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 57 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Some improvements in the service were seen since the last inspection. Leadership culture was seen to be positive and proactive in wanting to improve the quality of service and in recognising where improvements were needed. The registered manager/director of care was transparent in recognising the areas of improvement still needed and in sharing the direction in which the service needed to move.

The provider did not have consistent leaders who understood the context in which care, treatment and support was delivered or had the skills, knowledge, experience and credibility to lead effectively.

The lack of consistency in management over recent times demonstrated during this assessment some areas for improvement. There was a registered manager for the service however, they did not support the home daily in that role. The provider level of management support visited the home regularly. However, areas of concern found during the assessment had not always been identified through the oversight systems and processes used. For example, the quality and accuracy of care records.

One relative told us, “I don’t think there is a manager. There is someone looking after the home as I have seen them.” Another relative said, “The manager has changed recently and I don’t know who is in charge now.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. However, the formal system for providing opportunities for staff to speak up and discuss their development on a one to one were not consistently followed.

Regular team meetings between the management team and staff took place. Staff were given opportunities to discuss performance via a supervision and appraisal process. However, the frequency of staff supervisions had not always been completed in line with the providers policies. A plan was in place for these to be brought in line with the policy by the acting manager. Staff told us they could speak up about anything and were listened to and things would be acted on.

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.

A proportion of the staff team were from overseas and the provider operated a sponsorship scheme. The staff we spoke with spoke very positively about their experiences of being recruited and working at the home. The diversity of the staff team was clearly supported by the provider and management.

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.

The management team were seen to be present frequently in the home and there was a temporary arrangement of delegation and responsibilities in place for the day to day running and oversight of the service.

There were a range of quality monitoring and auditing systems and processes in place. However, improvements were still needed as systems and processes were not always effective in identifying the concerns we found during this assessment. Records used were not always accurate or current about people’s needs. The management and oversight of accidents and incidents was not always recorded effectively. Some notifications required by us legally had not always been submitted.

Some staff recruitment files had not been consistently completed, and no audits checks on the files had been completed. The recording of best interest decisions and consent were not always completed in line with the MCA. The service did not always make sure that medicines record keeping supported medicines administration to safely meet people’s individual needs, increasing the risk and potential for mistakes. The acting manager had identified the need for improvement in this area but this was not reflected in the home’s recent medicines audits.

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.

Staff and management were working in close collaboration with the local authority quality team to improve the safety and quality of the service. Other partnership working including relationships with the local GP and practice staff had improved and were now seen to be working well together.

The home had developed very good relationships in the local community with social groups and advocacy services who visited the home regularly and this had improved outcomes for people.

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 and research.

In the management team there was a strive for improvement and development evident. However, there were aspects of this assessment that found areas for improvement. The eLearning training matrix showed some delays in staff completing their refresher training, meaning continuous learning was not always supported. Opportunities for where lessons needed to be learned were being missed because the oversight and management of information from accidents and incidents was not always being used.However, where learning had been recognised this information was shared with the staff team.

The acting manager demonstrated their drive for continual improvement and development to ensure the home could provide the best care possible.