Hill 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 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 good governance.

This service scored 54 (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.

The provider had not always focused on learning and continuous improvement; however, progress had been made in this area. During our assessment, the management team operated a transparent culture around the shortfalls in the service and acknowledged improvements needed to be made. They were committed to acting on their service improvement plan and were working in conjunction with the local authority. Some staff reported some individuals worked on their own list of jobs and did not help other colleagues, however, the majority of the team worked collectively to achieve common goals. The manager told us, "I want to build confidence, admit our mistakes and work as a team to move forward."
 

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders received regular supervision and support and promoted a similar approach across the staff team. Some staff told us previous management changes had resulted in some issues not being addressed promptly. However, they said the current manager was working to make necessary improvements. Staff spoke positively about the manager and commented, "The place feels more inclusive, (Name of manager) is very calm and we feel calm - it's nice to know they are around" and "I feel like I have approached the manager with questions and they have been very supportive and comforting, I don't feel judged and recently I feel more comfortable."

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

Complaint and safeguarding trackers had recently been introduced to support the monitoring of feedback and identify emerging trends and themes. As these systems were newly implemented, they had not yet captured all feedback and required further time to become fully effective. Some relatives told us they had needed to raise concerns on more than one occasion before they observed positive action being taken.

The provider had taken steps to encourage feedback from people and others involved in their care. Posters were displayed throughout the service to enable people to provide feedback anonymously. Staff attended regular meetings and told us they were encouraged to speak up and share concerns. The manager described how they were working to develop an open and transparent culture where people felt able to raise issues and were assured they would be supported and protected when doing so.

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 had completed equality, diversity and inclusion training and received regular supervision to support them in their roles. Flexible working arrangements were also available for staff where required, helping to promote wellbeing and support individual circumstances. Most staff told us they had not experienced discrimination within the service.

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.

There had been a breakdown in governance arrangements, which had resulted in incidents not always being reported, shortfalls in IPC practices, unsafe medicines practices, poor staff recruitment records and a lack of effective oversight. We also identified there had been inconsistent application of the duty of candour and limited accountability. The new management team had recognised these concerns and was working to re-establish governance systems to ensure staff followed appropriate policies and procedures.

Some monitoring processes had only recently been introduced. For example, checks of vital equipment had commenced; however, guidance for staff on escalating and reporting faults remained unclear.

The provider had begun holding regular service improvement meetings to monitor progress against improvement plans and help ensure actions remained on track. The management team continued to review and refine newly implemented systems; however, as these were still being embedded, further time was required to demonstrate sustained improvements and ensure effective practices became fully established across the service.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

We received mixed feedback from healthcare professionals. They told us prescribed medicines had not always been administered as intended and raised concerns that some staff did not always demonstrate a good understanding of people's individual needs, particularly during emergency situations. However, they stated referrals were made appropriately and staff generally followed the advice and instructions provided.

There was evidence of positive partnership working with external professionals. Staff worked alongside other services such as district nurses to support people with complex healthcare needs. The manager had also taken steps to develop and strengthen relationships with partner agencies to promote collaborative working and help ensure people's needs were consistently met. The manager had oversight of referrals, and any guidance and outcomes were now shared with the wider staff team through daily meetings to ensure continuity of care.

The provider did not always focus on continuous learning and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research.

Learning from previous concerns and incidents had not yet been fully embedded, and quality assurance systems required further time to demonstrate their effectiveness in measuring and sustaining improvements.

The manager was receptive to feedback and had already started making improvements prior to the inspection. Managers demonstrated a positive and open approach to learning, and staff told us they felt listened to when raising concerns or sharing ideas. Systems to recognise and reward staff contributions were in place, and there was growing evidence that lessons learned were being shared more widely across the service to support continuous improvement.