Higher Bank

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 inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to good governance and oversight of the service.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

It was difficult to determine the providers vision, strategy and culture. This did not always appear to be 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 and the necessity to refer to and involve professionals in some decision making.

Some professionals did raise some concerns in relation the culture at the service. One professional said, “Staff know individual’s care needs and this information is available when requested. However, the home has a closed culture with professionals attempting to access the home.” It was difficult at times to determine the culture within the home due to the limited amount of external input, feedback from some professionals and the fact multiple documents were not always readily available for us to review, and some documents were not always appropriately completed.

A registered manger spoke about an open culture and said, “I am always here and I have an open-door policy always for everyone." Various policies were in place to support an open culture. Staff spoke about the visions and values of the service. One staff member said they thought the service aimed to provide "Good care."

The provider did not have inclusive leaders/staff at all levels who always understood the context in which they delivered care, treatment and support. Leaders did not always show the skills, knowledge, experience and credibility to lead effectively.

The registered managers did not display the necessary skills and knowledge to maintain good oversight. We found at times accessing documentation was difficult and there were no clear archives of old records (some of which were 20 years old) which were mixed in with new records. Many records we reviewed were not robust or did not show how the management had appropriate oversight of these and many documents were not fully completed.

The registered managers did not always model open and cooperative relationships with external professionals and risks were not always professionally managed. A professional said, “While the staff clearly care deeply for the residents and deliver care with positive intentions, they struggle to receive constructive feedback. Any critical feedback tends to be taken personally rather than objectively, leading to defensive reactions and a tendency to catastrophise concerns. This makes collaborative working and raising service issues difficult at times, as feedback is frequently misinterpreted as a challenge to their personal integrity and dedication rather than an opportunity for service improvement.”

The registered manager we worked with was very involved in the service and explained that it was not a job but a vocation for her, but they were not always knowledgeable about issues at the service.

Staff spoke positively about the management of the home. One staff member said, “I love the registered managers, they live in on the 3rd floor. If you need anything you go and get them.”

Although staff felt they could speak up, we found that records around this were not kept under review and staff had not always seen/had access to necessary policies to support this.

The provider had a whistleblowing policy available to staff though this had not been personalised, signed, dated or reviewed. Staff knew how to whistleblow and they felt confident to speak up should they need to, though not all staff said they had seen the whistleblowing policy, one staff member said, "I haven't seen the policy in this job. I know what it is, I could report problems to CQC or social services."

Staff were able to raise any concerns in team meetings or directly with the management.

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 told us they felt they were treated equally and that the manager was approachable and fair to all staff. An equality and diversity policy was in place which set out how they supported equality and diversity, though the policy had not been reviewed annually as set out and the last review date was 09/09/2023.

The service employed a diverse range of staff who confirmed they felt well treated by their colleagues and managers.

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.

Multiple audits and oversight tools were in place, though these were not robust at identifying issues, having failed to identify some of the concerns we found, as detailed in this report. Whilst we did receive assurances in some areas, this was not consistent for all concerns, and we were not fully assured how the provider would drive the necessary improvements.

Arrangements for the availability and integrity of data were not robust, as mentioned earlier in this report, there were some gaps to care plans and records, and information required was not always available.

The home supported a number of people with dementia, but was not registered to support people with a primary care need of dementia.

We could not be assured staff had a clear understanding of their roles and responsibilities, or they fully understood any legal requirements. Multiple policies did not detail the necessary information, had not been signed, dated or reviewed, were not personalised and were not consistently being followed.

During our inspection we found that a number of the issues identified were not acted upon immediately. The home had two registered managers and one of the registered managers explained that the other registered manager was on annual leave, and this is why some things could not be accessed or acted on. However, the expectation is that both registered managers would be able to safely run the service and have full oversight. This offered limited assurances that safe, good quality care could consistently be provided to people.

Staff told us they felt the service was well managed.

The provider did not fully understand their duty to collaborate and work in partnership with all external professionals based on feedback, to allow services work seamlessly for people. They did not consistently share information and learning with partners or collaborate for improvement.

It was not always clear how people and their loved ones accessed the community. Staff spoke about a van that helped people access the community, but it was not clear how often this was used. One person said, "No (I don’t go out), not really, sometimes I would like to go out but I don’t."

We saw limited examples of the service working with external organisations. We received mixed feedback from professionals regarding the home working in a collaborate and joined-up way with their organisation. One professional said, “The service works well with healthcare.I have not had direct experience of the service actively engaging in forums/events or schemes designed to share learning,” whilst another said, “The home are on the distribution list for a monthly bulletin that is emailed to all providers to support shared learning and events that providers would find useful to support service improvements/development. Whilst they will also receive the minutes from the quarterly forums that are in place, our records show they have only attended once in the last 3 years.”

A registered manager told us how they worked in partnership with/and involve external professionals, they told us "We have had people coming in to sing to them [people] and we have occupational therapists involved, we have physios involved."

The provider did not consistently 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 in line with guidance. They did not actively contribute to safe, effective practice and research and any examples given of this type of work was historic and not consistent.

Based on our findings at this assessment it was not always clear how the provider or registered managers ensured that the service actively contributed to safe, effective practice as detailed throughout this report. We saw limited evidence of the registered managers working with other services to try and drive improvement. The service needed to improve some of their external relationships, this was what came through from organisations we spoke with who were involved helping drive improvements, growth and learning.

One of the registered managers told us how they plan to improve going forward and spoke about becoming more, “Tech Savvy” and they spoke about their plans to go onto electronic care planning in 2027.