Oakwood Acquired Brain Injury Rehabilitation Service

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 a legal regulation in relation to governance at the service.

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 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.

There had been several changes in arrangements for the management of the service which had impacted upon the running and culture of the service. One relative commented, “What happened was there were a lot of work-place politics going on, and a lot of staff left, there was a lot of unrest.” Some improvements were noted with some recent team leaders appointed being well organised. A new service manager was in the process of being recruited, and a deputy manager had recently commenced in post. The provider had plans to address many of the areas of shortfall we noted, but at the time of our visit there was limited evidence of processes becoming embedded.

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.

At the time of our inspection there had not been a manager registered with CQC for some time. An interim manager was in post and taking steps to address of shortfalls, including some of the areas we noted. One person commented, “There has been a lot of turnover at staff management level. This has had a real impact.”

Feedback from people and staff was that the interim manager and new deputy were bringing about some stability with one staff member commenting, “Things are a bit more stable. We have an interim manager and a deputy, and there are new team leaders in post. As a team we have gone through a lot of changes.”

Further work was needed to ensure processes were implemented effectively to drive the change needed.

People did not always feel they could speak up and that their voice would be heard.

Whilst the provider had suitable policies in place it was not clear that staff felt able to raise concerns. There had not been consistency at management level to ensure staff were supported in this area, until the interim manager had recently begun to support the service. Training in relation to whistleblowing was available but not all staff working at the service had completed this training.

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. Staff generally spoke positively about the support and training provided. Staff spoke positively about working at the service.

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 had completed some recent checks of the service. However, it was not evident that these were being followed up effectively in the absence of a registered manager. A quality assurance action plan was in place but many of the issues identified in this had had not yet been embedded. This included person centred reviews and record keeping in the kitchen. We found some areas which had been assessed as being resolved, continued to have issues, for example in relation to the management of the emergency bag where we found accurate evacuation plans for people were not being maintained. Further work was needed to ensure systems of oversight were effective and addressed areas of shortfalls the provider found during their own process of checks and those which were found during our site visit. The provider had already begun to take these steps.

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. Feedback from other professionals was generally positive. One visiting professional commented, “They are responsive, approachable and easily contactable if ever needed.” Another professional told us, “They have always been available to share relevant information and support with the assessment process.” At the time of our visit there was limited evidence of how people were supported to access the community, but the interim manager was taking steps to support people to access leisure pursuits.

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 systems in place to ensure lessons were learnt did not reflect some of the concerns people and their families raised around the management of laundry and promoting healthy diets and independence. One relative told us, “I was contacted by an ‘improvement manager’ who asked if we wanted to meet them, in the email it said there would be an opportunity to talk. This was a couple months ago. At the same time a senior manager told us they would be coming on a certain date, but I turned up, and there was no evidence that they were even there.” Another relative commented, “There are questionnaires at reception but they are not visible.”

Complaints were responded to but based on feedback from people, we were not assured that low level concerns were being clearly documented to ensure lessons learnt.

The provider had a variety of plans for action to address issues and work in these areas was ongoing.