Gloucestershire 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 – 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 outstanding. 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 always 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 provider did not always take timely action in response to risks and concerns or prioritise safe good quality care. We did not identify a consistent culture of learning and improvement. Actions identified from the audits which were carried out were not always completed without delay.

Staff knew and understood the service's values and described the importance of having a positive approach, showing dedication, and supporting people in line with these values.

Guidance outlining expected behaviours, responsibilities and ways of working had been developed and shared with staff, supporting a consistent culture and shared understanding of expectations within the service.

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.

Further information is detailed under the previous quality statement of this report where we identified areas for improvement in respect of the provider’s shared direction and culture.

At the time of the assessment the service had a registered manager in place. As part of the management structure, they would have been supported by a deputy manager, however this post was vacant.

The provider shared with us their plans in relation to an interim management team in the service as well as the timeframe for its implementation. Leaders were open about issues identified within the service and they were responsive to feedback received during our assessment.

Staff were complimentary about the registered manager. One staff member described them as good, kind and very hard working.

People were complementary of the registered manager and the way the service was managed. One person told us; “The manager is very good. She makes time for you to chat to her. Excellently managed I would say.”

Some relatives commented on management changes and the absence of a deputy manager to support the registered manager. Some felt this had affected communication and completion of tasks.

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

The provider had policies and process in place to support staff in raising concerns, including whistleblowing procedures.

Staff felt able to raise concerns and knew how to report these and who to escalate to if necessary. One staff member told us, “When I raise issues, they have been dealt with. I have raised safeguarding concerns before, and they were dealt with. We have the flash meetings which helps staff to raise things as easily as possible.”

We were given examples of how the provider dealt with concerns.

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 told us they felt listened to and could voice their opinions at any time. The service employed a culturally diverse staffing team, and a world map was displayed, allowing staff and people to identify their countries of origin.The service had Culture Days, where everyone explored, celebrated, and learned about different cultural traditions. For example, they held an event called “Taste of the world” took place where staff and people shared foods they enjoyed and reflected their cultural heritage.

The theme of a recent staff meeting was “A respectful workplace that values different culture, backgrounds and perspectives” where various topics such as cultural habits, behaviours from other countries and British culture were discussed.

The provider had a Disability Equality Network staff were invited to join.

We were provided with an example of staff support through which the service demonstrated a commitment to equality, diversity, and inclusion by providing workplace adjustments, flexibility and support in relation to protected characteristics so a staff member could carry out their role.

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.

Leaders did not operate effective governance systems to assess, monitor and improve the quality and safety of the service. Quality assurance processes were not robust enough to identify and address risks in a timely way, and the provider could not demonstrate effective oversight of key areas of the service.

For example, care record audits failed to identify shortcomings in care planning, risk assessments and documentation, and infection prevention and control monitoring was incomplete and not effectively overseen. Other areas included medicines, staffing and safety of the premises.

Although the provider had policies, audits and monitoring systems in place, records did not demonstrate these were operated effectively. There was limited evidence of trend analysis, action tracking or assurance that identified risks were being addressed. Oversight of safeguarding, staff supervision, recruitment records, mental capacity and service improvement actions was not sufficiently robust. Actions identified through audits, risk assessments and quality reviews were not always completed, monitored or escalated appropriately.

The provider also failed to demonstrate effective systems for monitoring service performance and driving continuous improvement. As a result, people were placed at risk of receiving unsafe or unsuitable care and support.

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 service worked with the local schools and nurseries, giving people living at the service meaningful opportunities to educate children of different ages about disability and inclusion.One person told us; “I have spoken to children in a workshop that I have helped to design to tell them what being disabled is like. When I first came here, I helped with new staff interviews. I was their “guinea pig” doing things like pretending to be scared or angry because they didn’t listen.”

The service had links with the local community, for example a partnership with a Cheltenham based project offering work opportunities, social events, and networking for people with disabilities. People living at the service attended weekly, and many built longstanding, meaningful relationships through the project.

The service started to build links with the County Council to develop a training programme for social work students as part of their professional development.

The registered manager in partnership with people was actively seeking and applying for funding opportunities to re-open and sustain the hydrotherapy pool in the service which was greatly missed by everyone. The physiotherapist at the service told us about the positive working relationship they developed with the local wheelchair service which visited the home on a regular basis.

People were supported to be involved in various campaigns such as reforming social care, changes to visas and accessing nature in the local area.

People and staff were involved in initiatives to support environmental sustainability; such as introducing more vegetarian options on the menu and inviting the local school to make posters and be involved in gardening.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system.

The provider had failed to meet their legal requirements and demonstrate a commitment to drive the improvements in people’s care through their governance and quality assurance systems.

While some systems were in place to support improvements in the quality and safety of care, there was little strategic approach to addressing identified shortfalls. Furthermore, there was little evidence at service level to demonstrate the effective implementation of these systems or their impact on driving improvement.

Records indicated some learning was being applied, such as improvements to recording related to situations when people experienced any skin integrity concerns. The provider engaged with external reviews to continue their learning around people’s safety when things went wrong. The provider and management team were receptive to our feedback, which they used to start making some improvements and considering further actions.