Manor Care Home - Middlewich

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 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 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 good 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 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.

The provider’s philosophy of care focused on creating and providing a secure, relaxed and homely environment. This was evident during our assessment, staff interactions promoted warmth, humour and inclusivity. One relative told us. “The staff here always make us feel very welcome, and all the team are approachable."

The registered manager fostered a positive culture by sharing compliments and feedback from people and their relatives directly with the care team.

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. Whilst leaders had the skills, knowledge and experience to lead with integrity, openness and honesty, governance processes were not always effective. This impacted the provider’s ability to consistently identify and respond to quality and safety issues in a timely manner.

Staff felt supported by the managers. One staff member said, “I can approach them all [managers], they’re very friendly and we can go to them with personal problems or problems within the home.” People told us they would feel comfortable speaking to the managers and one relative said, “The manager is always helpful.”

The provider fostered a positive open culture where people felt they could speak up and their voice would be heard. The provider had a clear whistleblowing policy in place which was visibly displayed in the staff room to ensure all staff were aware of the process. Staff consistently told us they were encouraged to share their views openly. They reported their feedback was valued, listened to, and acted upon by the registered manager. One staff member told us, “The management currently is brilliant, and I feel valued as staff, I feel safe and supported at work. I feel as though I am free 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.

The registered manager provided several examples of how staff had been supported and their individual circumstances accommodated. The provider had comprehensive equality, diversity and embracing culture policy in place, and staff had received relevant training. Staff reported feeling confident that equality and diversity were respected, with one staff member stating, “Everyone treats everyone the same.”

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.

A lack of oversight meant that some areas of concern identified during our assessment were not detected or addressed promptly. Some audits, such as those for medicine stock counts and temperature checks, were not fully effective in identifying concerns or lacked actions to remedy concerns found resulting in unresolved issues. Additionally, there were no auditing processes in place to monitor call bell responses, the safety of mobility equipment or identify environmental hazards. Care plan audits were absent, which contributed to care plans sometimes being inaccurate or out of date.

However, the registered manager had previously introduced, developed and implemented some quality assurance schedules. Following our site visit, immediate action was taken to address our concerns raised and additional systems and processes were introduced to strengthen monitoring, oversight and overall governance.

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.

People’s care records did not consistently demonstrate effective partnership working with external agencies, particularly in areas such as mobility management, nutritional support and skin integrity.

However, the provider actively collaborated with partner organisations to reduce unnecessary hospital admissions. This collaboration included providing staff with additional training and implementing assessment tools to help recognise early signs of deterioration, enabling a more proactive response to people’s changing needs.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcomes and quality of life for people. They actively contributed to safe, effective practice and research.

The provider actively sought support from external professionals to implement positive changes in care delivery and prevent falls. Monthly training sessions focused on various factors contributing to falls, such as, hydration and nutrition, ensuring ongoing and embedded learning for staff. One professional stated, “Other professionals have commented [to me] on how much of an improvement the training had made to staff which had a direct positive impact on the care given to people. The registered manager's continued dedication to staff development and improving people's care is commendable.”

Staff reported having regular meetings, with one staff member saying, “I would feel comfortable speaking to managers and suggesting ideas.”

Whilst lessons were learned following concerns, the provider did not always update the relevant documents promptly to reflect these improvements.