Fryers House - Care Home with Nursing Physical Disabilities

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

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 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. Systems and processes had not ensured that all staff worked consistently across the service. Feedback from people and relatives relating to the experience of care was mixed, with some people reporting their experience was dependent on the staff memberproviding the support.

Leadership instability had impacted the service, resulting in inconsistent oversight and weakened risk management. Without stable leadership there is an increased risk of delays in identifying and addressing concerns, unclear accountability and missed opportunities to improve care quality.

Some staff expressed uncertainty about the support available from senior leaders and described a sense of disconnection from the wider leadership structure. One staff member told us, “At the moment quite scared and worried.” This increased the risk of low staff morale, reduced engagement, higher turnover of staff and a lack of shared vision. Despite these challenges, feedback about the manager was positive. Staff described them as approachable and visible.

Although the provider had systems in place to support leadership and governance, these were not always effective in identifying and managing risks. Staff were not always aware of how senior leaders were supporting the service, which contributed to gaps in communication and oversight. The provider demonstrated a commitment to develop and support staff, improve consistency and foster a person-centred, values-driven culture.

The service had systems and processes in place to enable people and staff to speak up. A whistleblowing policy was in place and we saw information signposting staff where to go for support and the processes to follow. The manager told us they operated an open-door policy and encouraged people, relatives and staff to speak up freely.

Leaders demonstrated an understanding of their responsibilities under the duty of candour. The duty of candour is a legal responsibility for health and social care providers to be open, honest and transparent when something goes wrong with a person’s care or treatment. Although we saw examples of the provider having identified actions to prevent recurrence, feedback from relatives and concerns identified during our assessment indicated that these actions had not always been effectively embedded or sustained within the service. We have reported on this in more detail elsewhere in the report.

Throughout the assessment, we found staff, leaders, and senior leaders to be open, honest, and transparent in their engagement with us. They responded to our enquiries with candour and demonstrated a willingness to reflect on feedback and acknowledge areas for improvement. This approach contributed to a culture where speaking up was encouraged and where concerns were increasingly seen as opportunities for learning and development.

The service demonstrated a commitment to valuing diversity within its workforce and worked towards fostering an inclusive and fair culture. A diverse staff group was employed, representing a wide range of backgrounds and experiences.

Staff were provided with information about independent services they could contact confidentially for support with their health and wellbeing. In addition, the provider had mechanisms for peer support across the service, including forums, working groups, and networks open to staff at all levels. These groups focused on themes relevant to staff experience, such as the women’s network, and helped create safe spaces for discussion, shared learning, and mutual support.

However, feedback from some staff indicated that they did not always feel listened to or involved in shaping decisions that affected their working experience. This suggests that, while inclusive structures were in place, they could be strengthened further ensure that all voices, particularly those from marginalised or underrepresented groups, were actively heard and meaningfully included. We have reported on this in more detail elsewhere in the report.

Governance arrangements were in place, but they were not always operated effectively. The provider did not always act on the best information about risk, performance and outcomes.

The provider’s systems of accountability and governance had not always been followed and had failed to ensure people received safe care. Risk management processes had not consistently ensured that all relevant information about risk management was documented or that all necessary actions were taken to mitigate risks. Further detail on these concerns is provided in the Safe section of this report.

Audits were completed but did not fully identify all the concerns, or the extent of the concerns, found during our assessment. For example, where sufficient risk assessments were not in place to mitigate risks to people, where care plans lacked sufficient information to guide staff, incomplete staff recruitment records, and gaps in documentation. This meant the provider could not be assured that all areas of service delivery were being adequately and effectively monitored.

The service expressed a commitment to quality improvement. Leaders acknowledged that improvements were still underway and demonstrated a willingness to drive change. While they were aware of some of the concerns identified during the assessment, they had not recognised all of them, particularly in relation to restrictive practices and legal processes. However, leaders were responsive to feedback and began taking action to address concerns during the assessment.

The provider understood their duty to collaborate and work in partnership. They shared information with partners, although one told us that while the service did work collaboratively at times, communication could be timelier and more robust. Records were available to be shared with health and social care professionals as required. Where people required support from outside services, for example for appointments, the service ensured these were arranged. Both leaders and staff shared examples which illustrated partnership working with other external agencies and professionals.

Leaders spoke passionately about the need for continuous learning to drive improvements for the service. They described a strong ethos for continuous learning and improvement and shared their plans to drive improvements. Prior to the assessment the provider had developed a detailed and comprehensive service improvement plan, which demonstrated a significant level of analysis and targeted several key areas of concern. Whilst we did identify shortfalls during this assessment, we found the provider was responsive and was taking action to make improvements. Time was needed for these changes to be fully implemented and embedded into practice.

There were systems and processes to promote learning across the organisation. For example, regular operational updates were shared across the organisation which provided a centralised source for clinical alerts, key actions, policy changes, and reminders, which staff could access.

However, feedback from people, their relatives, and staff indicated that they had not consistently felt involved in shaping or evaluating improvement initiatives. The changes in management the service had experienced had disrupted continuity and impacted confidence in leadership. This meant whilst the provider had developed improvement strategies and promoted organisational learning, their systems and processes could be strengthened to ensure people, relatives and staff were actively involved. The provider demonstrated a commitment to strengthening engagement and rebuilding trust to foster a culture of inclusive and sustainable improvement.