Bells Piece - Care Home Learning 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 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 had a shared vision, strategy and culture. However, due to the concerns with the leadership of the service, some staff and relatives we spoke to following our visits felt the culture could be more transparent and supportive.

Whilst most relatives told us they felt staff were caring and wanted the best for people, some staff and relatives also expressed concerns that a lack of management oversight did not always support these aims. One relative told us, “The staff need more support and direction. Things are being missed due to management failures.” A staff member told us, “Staff just want to do a good job but there are so many changes all the time and not all staff work the same way. It could be better for the staff and residents, be more supportive.”

During our visits to Bells Piece, we found there was a positive and welcoming atmosphere where people were supported to take part in a variety of interests and develop friendships. However, systems and processes to holistically monitor the quality of people’s lives were not fully embedded into practice. This meant people’s goals, aspirations and the support needed to achieve them were not always understood by staff. The management team told us they felt they had made good progress in making improvements to the support people and staff received, including how people could be more involved in the running of their home. They told us they were working to embed these systems into practice and ensure there was a shared vision and purpose. To this end, we found staff and the management team were consistent in what they wanted to support people to achieve. One staff member told us, “We want residents to have the same rights as anyone else and have a happy life doing what they want.” The manager told us, “We want to get people as involved in the local community as we can and for them to be leading the life they choose. We want residents being at the centre of everything.” We observed staff had a positive and caring approach when supporting people, offering choices and discussing different options.

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. The service had not had a registered manager in post for over 18 months. A number of managers and interim managers had been in post during this time. Although the provider had taken steps to recruit to the post, they had not ensured the consistency of support and oversight of the service.

Throughout our assessment, we received feedback from relatives and staff in relation to the impact of a high turnover of managers and the lack of support and consistency because of this. One relative told us, “When there were a [stable] manager and deputy there, things were much better.” Another relative commented, “The instability of the management has had a big impact on the performance of Bells Piece.” Staff members told us they have struggled to find consistency due to the high number of different managers. One staff member told us, “They all come in and want things to be done differently, and we must try and comply with different priorities. It can be really confusing to know how they want things done.” Another staff member told us, “The staff have been running things here because of all the management changes. It’s not acknowledged though.”

The provider told us they had been continually trying to recruit to the manager’s post. Whilst they had had some success, those recruited had not stayed, mainly due to personal reasons. At the time of our assessment, the service was being supported by an interim manager whose contract was due to end shortly following our visit. The provider had made the decision that the regional quality assurance manager would be based at the service until a new manager was recruited and inducted. Staff told us they felt this would be positive for the service and for the staff team as the quality assurance manager had existing knowledge and relationships at the service.

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

Staff told us they felt if they had any concerns or made any suggestions, they would be listened to. One person told us they were confident that staff would help them resolve a problem and felt they were approachable.

Staff told us they had several ways to voice their opinions, and whilst they were concerned about the management structure, they felt they would be listened to. One staff member told us, “When I’m comfortable with [a manager] I have no problem speaking up and generally feel they listen.” Regular staff meetings were held to share information and enable staff to have an input into the running of the service. The number of meetings had increased, and minutes showed these were well attended. Where staff had raised issues or suggestions, we saw that these were acted upon. Examples included staff commenting that, due to rota changes, mornings at the service were too busy. The manager had responded and scheduled an additional staff member on duty. Staff had also suggested having a specific day each month to review each person’s care and support needs. Staff were starting to trial the effectiveness of this.

The manager told us they felt staff were confident in bringing any issues to their attention. They told us, “I think they are quite a proactive group. We are working on staff bringing things to us as they have worked without a manager for so long. We want to make sure things are done more systematically.”

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 worked with staff to ensure there was a fair and inclusive culture. The manager told us that where possible, they would look to adjust people’s hours and working patterns to meet their specific needs. They told us that by following this process, they had reduced staff sickness levels and made staff feel more valued.

Staff told us they felt they were all treated equally and their needs were respected. One staff member told us, “I don’t think there’s any discrimination here. We might not fully agree with some of the changes but we are always consulted and given the chance to give our point of view.”

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.

Quality assurance systems in place did not always ensure effective management oversight. Audits completed had not highlighted concerns identified during our assessment. For example, infection control audits and building walk arounds had not identified the issues found relating to the cleanliness of the building and medicines audits had not recognised concerns relating to the storage of medicines.

In other areas, we found systems recently implemented were working well such as systems to review accidents and incidents, the reporting of safeguarding and the monitoring of people’s health. The quality assurance manager taking oversight of the service assured us that when a registered manager came into post, they would receive a detailed handover and induction to ensure these systems were sustained and built upon.

The provider did not always work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners.

We received mixed responses from relatives regarding how the service worked in partnership with them. One relative told us they wanted to work with the service and their family member’s keyworker to achieve the best outcomes but found this difficult as emails and contacts made went unanswered. A second relative told us, “I am always invited when reviews take place. I’m kept informed.” The manager told us they were trying to rebuild trust and partnership working with families. We saw they were reviewing communication systems and holding regular meetings for families to share general developments at the service.

Professionals supporting the service also told us that at times, communication could be difficult and that issues had not always been openly shared. Whilst they felt these processes had improved, they expressed concern that these improvements would not be sustained following any future changes in the leadership of the service. The management team told us they recognised there had been previous difficulties, but were confident that due to the new systems in place, these would be sustained going forward.

People had been supported to build meaningful links with different organisations in the local area. These included the local church, friendship and activity groups and local amenities. In addition, the service organised regular fetes in the grounds of the service. People told us they enjoyed these events and were involved in making decisions regarding the different stalls and who would be invited to take part.

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

The provider had implemented a service improvement plan to address shortfalls which had been identified. However, due to the changes in the management of the service actions were not always met in a timely manner. The manager informed us several systems had been reviewed and actioned, such as people’s monthly meetings with keyworkers and reviews of capacity assessments and best interests’ meetings. However, we found that continued improvements and consistency were required in these areas.

The provider and management team had been working closely with the local authority to ensure that shortfalls identified were addressed and sustainable management oversight systems were implemented. The management team told us they were fully committed to this process and valued the support provided by the local authority team. This work was on-going at the time of our assessment.

The provider and manager were receptive to the feedback we gave following the assessment. The manager took action to address some areas immediately when they were brought to their attention.