Albany House - Tisbury

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• 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 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 provider was previously in breach of the legal regulation in relation to governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

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. They did not always understand the challenges and the needs of people and their communities.

We observed some practices, which did not always reflect the values of the registered manager and the culture they were promoting. For example, one staff member talked about a person in front of them and another used task related terminology. This included, “Will you toilet [Name of person] before you come down?” This did not promote dignity or recognition of the person.

Some practices encouraged routine-based care and did not put people at the forefront of the service. For example, 1 staff member told us night staff helped some people to have wash before the day staff came on duty, and vice versa. This did not demonstrate people’s choices were promoted but gave priority to a routine. Another staff member said they had a spare few minutes so was told to check the laundry. They were not directed to spend time chatting with people, offering drinks or checking individual wellbeing.

The registered manager was disappointed with the interactions we observed. They said they always promoted the philosophy of the service being the person’s home. This meant their rights were paramount and always had to be promoted. They said they had worked to eradicate institutional practices some staff had gained from previous roles but confirmed more work would be done. Other interactions were more positive. This included a staff member talking to a person about their meal and giving further choices to improve dietary intake. Another staff member had a friendly manner whilst supporting a person with their mobility.

Staff told us they enjoyed working at the service and had built good relationships with people and their relatives.

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.

Formal systems to support staff had been developed and were being embedded. For example, there was a schedule of one-to-one meetings with the registered manager on the notice board in the office. This demonstrated initial meetings had been undertaken. Records were maintained of each session and placed in the staff member’s personnel file. There were handover meetings to share information, and the registered manager spoke to staff regularly throughout the day.

Staff told us the registered manager had discussed the findings of the last inspection with them. They said there were regular staff meetings although could not remember when the last meeting had taken place. Staff continued to be positive about the registered manager. Feedback included, “They are really supportive” and “They’ll help if we need anything, they’re really good and know the residents well”.

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

The registered manager continued to encourage staff to raise any concerns they had. This was generally informally or through systems such as formal supervision. The registered manager told us they aimed to be easily accessible and spent most of their time around the home, rather than in the office. This enabled timely discussions, and resolutions to be reached.

Staff told us the registered manager encouraged them to make suggestions as well as concerns. They said they felt listened to and were confident anything they raised would be addressed.

There was a whistleblowing policy available for staff reference as needed.

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.

There continued to be a supportive culture, and the individuality of people and staff was encouraged. The registered manager told us diversity was considered and discussed within the initial assessment process. They said research into community engagement was undertaken to provide additional support if needed.

There was a supportive staff team and diversity was promoted. The registered manager told us additional support was available as required to ensure all staff reached their full potential. However, this was at times restricted due to staff shortages.

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 was a lack of provider oversight. For example, whilst some improvements had been made, the provider had not ensured the service was safe. This was because they had not identified, assessed or mitigated the risks to people’s safety regarding hot surfaces or hot water. This was identified at the last inspection, but remained outstanding, which placed people at risk of harm. The provider had not identified other risks people faced, were inadequately assessed or mitigated, or that care plans were not updated following an incident. They had not identified information about falls people sustained had not been analysed. This had not enabled potential causes, patterns or trends to be identified to minimise a reoccurrence.

The provider regularly visited the service but did not maintain a record or undertake formal audits. This did not demonstrate clear management oversight. For example, the impact of staffing numbers and availability had not been identified. This included staff covering other roles such as catering and some institutionalised practice. The registered manager told us they were recruiting additional staff, but the location of the service had not made it easy. Strategies to promote the service and make it more appealing to candidates had not been considered. The provider did not have a dependency tool to assess the number of staff required to support people safely. This did not ensure current staffing levels were adequate or conducive to people’s individual needs.

The registered manager had introduced a new quality assurance system. However, the checks such as a daily walkaround and ‘Resident of the Day’ were not completed when the registered manager was not on duty. Senior staff had not been given additional support to fulfil their management responsibilities or deputise effectively in the absence of the registered manager.

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 in partnership with a range of healthcare professionals to ensure people’s needs were met. All professionals including GPs and community nurses knew the service well, which provided consistency. Care records demonstrated consultations undertaken including reviews of people’s medicines. The registered manager and staff confirmed positive relationships had been established with all health professionals. They said people always received prompt medical attention when needed.

Partners were positive about the service and had no concerns.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

The provider had a poor history of compliance and had not achieved a good rating for the last 5 consecutive inspections. This showed shortfalls were not being identified or addressed, or that a learning culture was adopted.

Key systems such as staff shortages impacted on the quality of care delivered and not all staff had the required support to reach their potential. These factors had not been considered to enhance improvement. Auditing systems were not fully effective, and lessons were not always learnt following incidents and accidents.

However, some improvements to the service had been made following the last inspection. This included fire safety work, improved heating systems, redecoration and the replacement of some flooring.