King Street - Care Home Physical Disabilities

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• 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

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 rated inspection, we rated this key question Inadequate. At this inspection 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.

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. They did not always understand the challenges and the needs of people and their communities.

While there had been noticeable improvements in the shared direction and overall culture of the service since the last inspection, this area still requires further development. Stronger and more consistent leadership had begun to establish clearer expectations and had contributed to building trust within the staff team. Staff spoke positively about these changes and reported that the service had improved, with a more open and supportive culture developing.

However, the service had experienced a number of structural and leadership changes, and staff told us they were still in the process of adapting to revised expectations, new ways of working, and developing systems and processes. This meant the shared vision and values were not yet fully embedded or consistently understood across the team. As a result, practice was not always aligned, and the culture, although improving, remained in transition.

Leaders demonstrated a growing understanding of the context in which care, treatment and support were delivered, although this was not yet consistent across the service. There was evidence that some leaders were increasingly reflecting the culture and values of the organisation, with improvements noted in openness and engagement with staff.

While there had been positive developments since the last inspection, with leaders becoming more visible and approachable, this was not yet fully embedded across the service. The management team were new to their roles and were still developing systems and effective oversight processes. At the time of the inspection, they were continuing to adapt and settle into their positions.

While many staff felt increasingly supported and listened to, some did not always experience the same level of inclusion. There were instances where opportunities to fully embed an inclusive culture, where all voices were consistently sought, valued and acted upon, were still developing. Variability in leadership capability also meant that communication and decision-making were not always as clear or consistent as they could be. Despite this, there were clear signs of progress, with improving staff confidence and a developing culture that was becoming more compassionate and inclusive over time.

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

Systems and policies were in place to support freedom to speak up, and staff were aware of how to raise concerns, including through formal channels. Many staff told us they felt increasingly confident in approaching the management team and that there had been positive improvements in openness and responsiveness. Records showed that concerns raised were acknowledged and, in some cases, led to appropriate action being taken.

However, this was not always consistent, and some staff were less assured that their concerns would be followed through or that feedback on outcomes would be routinely shared. The provider recognised the importance of strengthening this area and needed to continue developing their systems and oversight to ensure all staff felt fully supported to raise concerns, that these are managed transparently and promptly, and that learning is consistently shared to support ongoing improvement.

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.

The provider promoted equality and diversity within the workforce and ensured staff were treated fairly and with respect. Staff told us they felt included and valued regardless of their background, and there was a culture of mutual respect across the team. Policies and practices reflected a commitment to equality, diversity and inclusion, and staff had access to relevant training to support their understanding.

The provider fostered an open environment where differences were recognised and respected, and staff felt able to raise concerns without fear of discrimination. This inclusive approach supported positive working relationships and contributed to the delivery of person-centred care.

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.

Governance, management and sustainability arrangements required further improvement to ensure they were fully effective and consistently embedded. Since the last inspection, the interim manager had implemented a range of governance systems and processes, supported by increased oversight from the wider management team, which had begun to strengthen monitoring and accountability. There was a clearer focus on delivering safe care and capturing learning, and some improvements were evident in how risks were identified and managed.

The interim manager ensured oversight of risk was strengthened, with information shared promptly and appropriately with leaders and partner organisations to support a coordinated and timely response. This improved visibility and responsiveness to risk across the service. However, despite these developments, systems and processes were still maturing and not yet consistently embedded, which meant the full impact of these improvements was not always realised in practice.

The wider leadership team continued to support and monitor the provider’s improvement action plan, providing challenge and direction to drive progress over time. However, these governance arrangements were still in development and not yet fully embedded into everyday practice. As a result, oversight was not always sufficiently robust to ensure all areas of concern were consistently identified, monitored and addressed promptly.

While there was a clear intent to drive service development and improvement, this had not yet consistently resulted in sustained, measurable improvements for people. Overall, systems were strengthening, but further time was needed to ensure they were fully effective in supporting meaningful and lasting improvements in safety, quality and people’s outcomes.

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 provider worked effectively in partnership with other agencies to support people’s health and wellbeing and promote positive outcomes. Health professionals who regularly visited the home told us there had been a noticeable improvement in their working relationships with the service. They described the interim manager as approachable, responsive and proactive in communication.

There was clear evidence that changes in people’s health were recognised promptly, with timely referrals and interventions made to community teams such as GPs, district nurses and specialist services. Staff followed professional guidance and contributed to a coordinated approach to care. This collaborative way of working supported continuity, improved outcomes for people and demonstrated a strengthened commitment to partnership working within the wider community.

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 provider did not consistently demonstrate a strong focus on continuous learning, innovation and improvement, and this area requires strengthening. Since the last inspection, the interim manager and new deputy manager had worked hard to develop systems and processes aimed at improving the care and support provided to people, and there was some evidence of positive changes. However, these improvements were not yet fully embedded or consistently applied across the service.

Creative approaches to delivering equality of experience were not always evident, and this limited the extent to which people consistently achieved positive, person-centred outcomes or experienced meaningful improvements in their quality of life. In particular, there were missed opportunities to tailor care in more innovative ways that reflected people’s individual preferences, aspirations, and evolving needs. In addition, the provider did not consistently demonstrate active engagement with wider learning, research, or initiatives to promote safe and effective practice. Overall, this meant people could not always be assured that the service was evolving in a way that consistently enhanced outcomes and experiences.