Moorhouse Care Home

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 requires improvement. At this assessment the rating has remained 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 46 (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.

Leaders had not always ensured that meaningful, person-centred engagement was embedded into the home's vision, governance, and daily strategy. During the morning there was no activity taking place and most people were just sat in the lounge with the television on. Comments from people about whether there were enough activities for them to do included, “I would like to be taken out more I sometimes get bored”, “I get fed up. There is nothing to do. We never used to just sit here” and “There is not enough to do, I get bored. They don’t go outside. I miss getting out.” When we observed an activity taking place in the afternoon, this was a very infantile activity that most people were not engaged with.

There was a mixed response from people and staff about the culture within the home. One person told us they did not feel acknowledged by leaders. Other comments included, “I see the manager occasionally”, “Management don’t come to help on the floor”, “There has been a lot of support. I feel there isn’t an all-round spirit with the staff team. Certain groups support each other” and “It’s like family more here. Much better than in a big home. It comes from above and [leaders] show that.”

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.

The management of the service did not always lead by example; the registered manager did not ensure incidents were recorded in accordance with the providers policy, including those they were directly involved in. . There were staff that raised concerns about the behaviour of particular leaders including how they made reference to people in an undignified way. Comments from staff about this included, “We, many times, have asked [name] to stop but she doesn’t and says she can do whatever she wants” and “As a management team they need to set an example. If they don’t treat residents properly it makes things too difficult for staff.”

However, other staff felt the management team were supportive. Comments included, “[Leaders] are really good. They always have time for you, and they have such good knowledge. The company encourages that through the awards they give for positive, compassionate roles”, “I would definitely speak to [registered manager] if I had any concerns and she would listen”. “I can’t say anything bad about [registered manager. She is lovely, really kind and very supportive” and “The way [registered manager] has turned things around is amazing.”

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

Responses were divided regarding the openness of the workplace culture and whether they felt comfortable to speak up. There was also mixed feedback on whether they always felt heard or supported by the leadership team. Some staff reported feeling that their concerns were dismissed. Comments from people included, “I was worried if I say anything I would be out on my ear” and “My only grumble is that we are ‘expected’ to go into the dining room. You feel pressured to go downstairs…. I’d just like to make my own decisions.”

Comments from staff included, “If we raise concerns [management] picks on us. We are scared to raise concerns. If we raise them how is it going to affect us in the future”, “[Leaders’] door is always open. One of the owners came yesterday, they come fairly often. I haven’t needed to speak to them, but I know I could. The ops director holds a surgery for staff every few months where staff can go and speak with them” and “There have been little issues, but all have been dealt with and there has been a really good response. [Registered manager] has an ability to make people heard – it’s quite a skill.”

The registered manager told us, “People are encouraged all the time if they have a concern to make sure that they voice it.” They told us that provider’s representatives would attend the home and speak to staff about any concerns they may have.

The provider confirmed that staff have multiple accessible opportunities to make their views known and to raise concerns safely and confidently.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff feedback on equality and diversity was varied; while some staff reported feeling supported and that their diverse backgrounds were valued, others noted inconsistencies in how policies were applied across the home. Comments included, “There is discrimination between staff” and“There may be some divisions but that’s natural. It doesn’t cause any issues within the team, and they seem to try and bring everyone together. It’s a close, family type atmosphere. We all know each other a lot better.”

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.

The provider’s governance systems were not operating effectively and had not always identified some significant shortfalls in the management of the service and people’s care and safety. This had placed them at risk of avoidable harm and in places, undignified treatment. This included the lack of monitoring of people experiencing emotional distress and their health conditions. Where audits had been completed, they did not always identify the concerns we found. Oversight within the service and at provider level was not robust enough to identify elements of poor culture and disrespectful conduct of some staff. In addition, leaders did not always adhere to their legal responsibility to ensure CQC was notified of significant events at the service including incidents of safeguarding. These were submitted retrospectively.

After the assessment, the nominated individual told us they were commissioning an external consultant to work with leaders and staff at the service to support with improvements. The nominated individual is the person responsible for the service on behalf of the provider.

We did see other audits that were effective in driving improvements including around the maintenance of the environment and the mealtime experience for people. The registered manager told us, “We complete the audit and then any areas of non-compliance that identifies that have to then be put in an action plan that comes up and then our regional director then has to authorise it.”

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.

Leaders did not always share information and learning with partners or collaborate for improvement including around safeguarding incidents and people who experienced distress. Where referrals were being made to external professionals including the dietician, information was not always accurate or being shared with them on people’s progress. This was because staff had not always followed the correct guidance that had been provided.

However, links with the local community were well developed. Community partners supported activities within the home, including activities and wellbeing opportunities, which people were observed to enjoy. The registered manager told us, “We have a great relationship with our local Scouts and Brownies. They're our charity for this year. So any monies that are made, half will go to them, and half will stay here for the residents.”

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

Leaders did not always have oversight of how care was delivered. This meant opportunities to analyse and review accidents and incidents for themes and trends did not occur. Effective learning was therefore not always identified or shared with staff. This meant improvements to the service and the care people received were not always considered or implemented.

However, leaders were responsive to our concerns throughout the assessment and told us they were committed to ensuring improvements were made and sustained to enable high quality standards of care.During and after the assessment, the providers representatives assured us that they were eager to make the necessary improvements and had already taken steps to do this.