Prideaux 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.

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

This service scored 50 (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. The registered manager acknowledged there were issues with paperwork with most care plans and risk assessments needing reviews. They also acknowledged staff morale was currently low and there had been a high turnover of staff in recent months. They were unable however to identify the reasons leading to these issues. They told us that some staff, no longer working at the service, had neglected many processes and system checks. However, there was no oversight from the registered manager of these issues until recently. The registered manager’s vision moving forward was to stabilise the workforce and to try and get systems for review and learning in place. Although attempts had been made to bring the staffing team together both at work through meetings and outside of work with social events. There remained divisions within the workforce with not everyone willing to join in and contribute.

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. Staff comments about the registered manager varied significantly. Some staff described them as being supportive and approachable and always available to answer questions. However, other staff members told us the registered manager was not approachable and did not listen or respond to requests they made. There was a clear division among the staff regarding their views of the registered manager. More than one member of staff told us the registered manager was dismissive. They had been approached to request annual leave, to request topping up of essential supplies around the service or simply for advice relating to people’s support and had been either ignored or turned away without issues being resolved. Staff told us that the registered manager did not take responsibility for many of the tasks around the service which they felt they should be responsible for. A staff member said, “The seniors are quite new but they are given a lot to do for example, completing safeguarding reports and DoLS applications. I think these should be done by the (registered) manager but they don’t do it.” Staff did tell us that the registered manager was a visible presence at the service.

People did not always feel they could speak up and that their voice would be heard. Until recently, team meetings had been inconsistent and had not been a forum in which staff felt confident to speak up. Although some staff told us there were opportunities to speak up, this was not evidenced or apparent from meeting minutes. Following a safeguarding incident the operations manager had chaired several team meetings to provide reassurance for staff and had provided opportunities for staff to speak up and had re-enforced the need to report issues and incidents. However, there was still a reluctance within the staff team to come forward. Supervision meetings were scheduled to take place every 6 months but again these were inconsistent with some staff having not had a 1 to 1 meeting with the registered manager for nearly 12 months. Feedback from staff was similarly inconsistent with some telling us they were confident to approach the registered manager and that they would listen and act upon any issues raised but others said they would not approach them as they did not listen to them or act on concerns.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. The registered manager had made some adjustments to meet staff needs however some staff had left the service because their needs relating to work life balance were not met by the service. Within the staff team equality, diversity and acknowledgment of peoples protected characteristics were mostly respected.

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. Auditing processes were in place but were poorly managed and recorded. Auditing was carried out by senior staff or specialist staff for example the maintenance lead. Most auditing processes involved a tick box or a code to indicate if there were any changes. However, there was no commentary alongside these audit records, nothing to indicate exactly what had been looked at and what, if any, action was then needed. We did not find any evidence of follow up actions from auditing processes. The registered manager had minimal oversight of these processes. A front cover to the auditing folder had a check list of the different audits which had simply been initialled by the registered manager each month, with nothing to indicate they had been read. Consequently, things were missed. For example, care plans and risk assessments not reviewed and updated. Accidents, incidents, safeguarding issues and complaints had all been missed and not recorded. A staff member said, “I do some auditing. I think (registered manager) looks through them but I don’t know when.” Medicine audits had been completed but were not thorough. First aid boxes had items that were out of date and again, there was no apparent oversight form the registered manager and so this had gone unchecked. Concerns relating to the first aid equipment was brought to the attention of the registered manager and steps taken to address the issue. The area manager had identified all of these shortcomings and had produced an action plan to address the issues.

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 had developed a working relationship with other professionals who then attended the service to make sure people received the support they needed. Relatives told us that their loved ones needs were met and that district nurses and GPs regularly attended the service. If there were concerns in-between scheduled visits relatives said the staff would call out specialists if needed. A professional said, “Our visits are supported with accurate information before we arrive, and during the visit we always have a person-centred conversation around needs and holistically what is necessary and practical.”

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. The lack of managerial oversight of systems and processes had resulted in no organisational improvements at the service with no trends, themes, good or poor practice being identified. This had resulted in the service not moving forward and improving over time. As these issues had not been identified there was very little to share with staff to guide and support them to improving their general practice when providing care and support for people. Many of these issues had however, now been identified by the operations manager and processes had begun to address some of the issues. For example, the registered manager had begun a complete update and review of care plans and risk assessments. However, this process would take time to complete and for there to be an effective and embedded process in place for the future.