Homelands Nursing 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 inadequate. 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 continued breach of legal regulation in relation to processes of governance.

This service scored 62 (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 was in the process of sharing their vision, strategy and culture. This was to be based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. Managers had provided staff with more training to increase their knowledge on how to support people living with dementia. Professional advice was now sought promptly and their details were now accessible for staff to make timely contact. Monthly meetings for people and their relatives were now held in the Coach House and Manor House. Where relatives were unable to attend, a staff member contacted them for feedback and minutes of the meetings were circulated. Some relatives told us they were unable to attend the meetings due to the timings; we fed this back to the provider who said they would review this. Some relatives told us about the meetings and said, “Meetings happen while I’m at work. Notes of the meetings are left in the residents room and I see them. At the Spring party the [nominated individual] introduced themself. They said their audits and records needed improvements. Now everything is noted.” Results of surveys were analysed; suggestions and comments were added to an action plan for staff and managers to address. We saw the majority of survey responses were positive.

The provider had inclusive leaders at all levels who mostly 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. There was a very new management team in the service who were supported by a consultancy agency. The management team consisted of a new nominated individual, interim manager, general manager and unit manager, some of these managers had been in post for less than a month. There had been rapid changes which meant some staff were not fully aware of who their line managers were. The interim manager was highly regarded by people, relatives, staff and professionals. Towards the end of our inspection, staff were informed of the management structure and their lines of responsibilities. The provider kept staff up to date with interim changes through meetings, handovers and emails. A member of the management team told us about changes and said, “It's for the best, the owners have been really helpful.” Managers were more visible in the service. A staff member said, “[Nominated individual] attended the spring party. I found they are really taking responsibility and giving reassurance to residents and their families. [Nominated individual] said what went wrong, what happened and this is what we are doing about it.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff told us they felt able to speak up when needed and were able to do so confidentially or during staff meetings. A staff member said, “After the inspection we had a lot of meetings and they (management) were open for us to give suggestions and staff were encouraged to say what needed to be done for improvement.” Staff had access to a whistle-blowing policy should they need this, freedom to speak up posters were displayed in staff areas.

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. Improvements had been made to create an inclusive culture for staff. Staff gave examples of how their shift patterns had been organised to accommodate their home lives and cultural needs. An international day had been planned to celebrate the different cultures of people and staff. A staff member told us, “I do feel valued, there is a reason why I have been here so long. I feel like they are my family, it is the way we treat each other, we are always there for each other and I feel valued. We are given autonomy to make decisions, if we have done something wrong no pin pointing and we are given more support and supervision. I have never felt uncomfortable.”

The provider had not yet embedded processes to promote clear responsibilities, roles, systems of accountability or good governance. Due to the new management structure, governance systems, processes and responsibilities had been planned but not yet undertaken. Managers were in the process of understanding people, staff and the service as a whole and had clear direction of their priorities. The service had been supported by outside agencies, for example, the local authority and pharmacy who produced reports on their conclusions. The provider included their feedback on the service development plan along with findings from our last inspection. Findings had been prioritised and considerable works had been undertaken to address concerns identified by all parties. However, in this time the provider had not conducted internal audits to ensure new systems were effective. We identified further improvements were required to ensure people’s care records were accurate and provided staff with clear guidance, additional works were required to ensure care staff documented care delivery in line with people’s care plans. Some environmental risks had not been formally identified or assessed, indicating a lack of oversight in governance and safety monitoring processes. Medicines were not being internally audited which did not allow the provider to proactively capture any errors or identify where additional training was needed. The provider had a new auditing toolkit which managers were due to commence using on the day of our visit, managers of the Coach House, Manor House and the general manager had planned to audit each other’s building to ensure a continuity of standards.

The provider mostly 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. Partners in care were kept up to date with changes in people’s needs and when planned support was not providing the desired outcome. We received mixed feedback from professionals in respect of how staff worked with them. Comments included, “There have been times I have visited and the instructions I had given had not been followed and it took a number of weeks to make sure all staff were using (equipment as required). Ample information was sent with instructions in pictures and writing. The family have expressed the same concerns but we all stress that this is variable, dependent on which member of staff is present.” And, “There have been no concerns regarding observed interaction between staff and residents, and in general feel confident that staff follow any guidance or advice we give.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. The provider placed a high emphasis in responding to our previous concerns. Managers were transparent and shared our findings with staff, professionals, people and relatives to create a joint vision of continual improvements. A staff member told us, “After the inspection we had a lot of meetings and they were open for us to give suggestions. Staff were encouraged to say what needed to be done for improvement. Especially with giving medications and supervision of the care workers.” A person said, “I see changes and I am happy.” And a relative commented, “I met the new manager a couple of weeks ago. They introduced themselves and met [person]. They’re very pleasant, nice and proactive in tightening things up and making changes. They are building the name of Homelands with the community.” A professional added, “We appreciate there has been a period of change in the last few months regarding the management structure at Homelands,but have found the interim management to be approachable, proactive and supportive.” Managers undertook daily walk rounds of the service to observe staff practices and identify where additional equipment may be required. A manager told us, “[Nominated individual] told me to get a shopping list together. They want my suggestions. They want a fresh pair of eyes.” The service had demonstrated learning and improvement; however, they needed time to embed new systems and processes to evidence ongoing and sustainable improvements.