The Mead

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.

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

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's culture had not been consistently embedded into the home. The home was without a registered manager for a period of time which contributed to a lack of consistent leadership and oversight. A new manager was now in post and had begun to implement changes to the day to day running of the home, although this work is still at an early stage.

The new manager had worked for the provider for many years, and it was evident they embodied the culture and values of the workforce. They had recently started working at The Mead. The management team had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness, and honesty. Staff described the new manager as approachable and friendly, and reported feeling able to raise concerns or seek advice when required.

People, their relatives, and professionals spoke positively of the leadership of the service and confirmed they were always visible and approachable. One professional told us, “I have found the team to be consistently professional.”

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

People and their relatives, as well as external professionals felt able to raise anything with the management team, they told us they would be listened to, and actions would be taken when required.

There were policies and procedures to support workforce equality, diversity and inclusion. Staff told us their individual needs and diversity were respected. The management team supported staff with flexible working arrangements. Managers cared about the wellbeing of staff and staff felt supported. Staff received equality and diversity training, and the provider had policies in place relating to equality and diversity.

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 provider was carrying out regular audits of the service, but they had not always identified the concerns we found during the site visit.

There was no assurance that accidents were recorded correctly. The provider's audits did not always detect errors in staff records. Documentation of incidents, such as falls, was inconsistent. Although managers conducted monthly audits to track falls, this process failed to reveal inaccuracies in some fall-related records. People’s care plans had not always been updated with new strategies to prevent further incidents.

People’s care plans were at times inaccurate, which meant staff did not have the most accurate information to care for people.

Medicines were not always administered safely. We identified concerns with how PRN medication was administered and recorded. Not all staff had completed mandatory medicines training.

We were not assured there were enough staff to care for people safely. Whilst a dependency assessment was being completed, information about people’s care needs was inaccurate, which meant the tool did not always have the correct information to determine staffing levels.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

Feedback from external professionals was positive about how the service worked collaboratively with them, one professional said, “staff demonstrate a clear understanding of people’s needs, have effective communication and offer a person-centred approach to care”.

The provider had systems in place to focus on continuous learning, innovation, and improvement for the organisation and local system. However, this was not always effective.

The provider had audits in place, and they were regularly conducted; however, these processes did not identify the same issues that were uncovered during the inspection. This highlights a gap in the effectiveness of current auditing systems in recognising and addressing all areas of concern.

In response to the concerns raised during the site visit and subsequent feedback, the management team took steps to address the issues. This demonstrates a willingness to act upon findings and make improvements where necessary.