Silver Howe

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 safe, high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

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 management team did not have a clear shared vision, strategy and culture which was based on transparency and engagement.

There was a lack of clear vision and direction within the leadership structure about how the service was being delivered and overseen. The registered manager and staff team demonstrated a positive and compassionate culture promoting trust with people in the service.

Not all leaders had the skills, knowledge, experience and credibility to lead effectively.

The provider level of management support visited the home regularly. However, areas of concern found during the assessment had not always been identified by them or through the oversight systems and processes used. There was a lack of consistency in the management approach of oversight in the home. There was a lack of support for the registered manager in the day to day running of the home which had also resulted in some of the concerns found during the inspection.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Regular meetings between the registered manager and staff took place. Staff were given opportunities to discuss performance via a supervision and appraisal process. Staff told us they could speak up about anything and were listened to and things acted on by the registered manager where they could be.

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. Staff spoke positively about their experiences of being recruited and working at the home. Staff also told us they felt very supported by the registered manager.

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 was a lack of arrangements for delegation of responsibilities in place to support the registered manager in the home. There were a range of quality monitoring and auditing processes in place. However, improvements were still needed as these were not always effective in identifying concerns such as what we found. Records were not always accurate or current about people’s needs. The management and oversight of accidents and incidents was not recorded effectively.

The recording of people’s capacity, best interest decisions and consents were not always completed and recorded in line with the MCA. The service did not always make sure that medicines were managed safely. Actions required to manage medicines safely that were identified on medication audits were not completed in a timely manner. Changes that had been made to recording formats and systems had resulted in some records not being effective, current or accurate.

Some statutory notifications required to be sent to us had not always been made, for example, where referrals were made to the local authority safeguarding team or for some serious injuries that had occurred. We discussed with the registered manager and provider’s compliance manager and identified gaps in their knowledge and understanding of our requirements to notify.

Partnerships and communities

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 registered manager was working in collaboration with the local authority quality team to improve the safety and quality of the service. Relationships with the local GP practice were seen to be effective.

The provider’s systems and processes 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.

There was a strive for improvement and development evident during the inspection by the registered manager to ensure their regulatory responsibilities were fulfilled. The eLearning training matrix showed some staff had not completed all of the training modules identified. Opportunities for where lessons needed to be learned were being missed because the oversight and management of information from accidents and incidents was not being used.