St Oswalds

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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 leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for St Oswalds Care Home. This key question has been rated 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.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. People and relatives described a care environment which was caring, responsive to their needs and provided individual care and clinical interventions which were based on their specific circumstances. A relative told us, “It is the kindness and commitment the staff have. [Name] is safe, warm and in a caring environment, it is like a big family. They [staff] are very inclusive and lovely to us as well.”

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, or they did not always do so with integrity, openness and honesty. We reviewed some documents and found some incidents required notifying to CQC and or the local authority were not done, when we spoke with the manager, we were not assured the manger understood their role in reporting concerns to CQC or the local authority.

We have since been updated and these concerns have been addressed. Staff were positive about the management team. A staff member told us, ‘I am happy working here, this is the best place I’ve worked in. Managers are approachable and they listen to our concerns.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff told us they were confident to speak up and gave examples where they had done so in the past. They told us they were listened to and suggestions were taken into consideration. The provider had policies in place such as the whistleblowing policy to support staff to speak up.

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 were able to request reasonable adjustments to their working patterns to meet specific needs, for example, to accommodate family commitments.

The provider did not 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. Governance arrangements required strengthening to ensure they were effective, robust, and provided appropriate oversight of service quality. Issues identified during this assessment had not consistently been detected through the provider’s internal governance systems.

While the registered manager and senior staff were able to clearly describe the governance framework and their respective responsibilities, improvements were needed in several areas, including the care environment, infection prevention and control, staff training and the reporting and oversight of accidents and incidents.

We raised this with the management team and evidence of up to date training was sent before the end of our assessment process.

Although staff understood their responsibility to collaborate and work in partnership to ensure seamless services for people, information and learning were not consistently shared with partners. As a result, opportunities for joint improvement and fully integrated service delivery were not always realised. For example, some incidents had not been reported to the relevant organisations such as the local authority or CQC. However, a range of care professionals described the positive and responsive working relationships the provider had. The management team were positive about their links with local partners and health and social care teams.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local systems. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. We spoke with an individual who expressed frustration regarding the support provided to manage their diabetes. The person told us management was aware of their concerns; however, no alternative or improved approaches had been implemented to better meet their health needs. Discussions with the management team did not provide assurance they fully recognised the importance of exploring and implementing more effective strategies to support the person’s ongoing healthcare requirements.