Albert House

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 remained. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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.

Staff demonstrated a shared commitment to providing kind and respectful care. They knew people well and understood their individual needs, preferences, relationships and communication styles. People's dignity, rights and preferences were respected in practice and equality, inclusion and human rights were reflected within support planning and day-to-day care.

Observations demonstrated a calm, respectful and responsive culture. Staff understood people's non-verbal communication and adapted their support to meet individual needs. The provider's stated values around dignity, respect and person-centred support were reflected in many day-to-day interactions.

Records provided stronger evidence that people were cared for kindly and safely than how aspirations, independence and meaningful outcomes were progressed and evaluated over time. This was reflected across several areas of the assessment, including care planning, goal setting and review.

However, staff consistently demonstrated a caring and respectful culture and there was evidence leaders were committed to improving the service and responding to feedback. The provider recognised a number of these issues and began implementing improvements during the assessment process.

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.

Leaders were visible, approachable and knowledgeable about the service and the people living there. Staff described feeling supported, listened to and able to raise concerns.

Leaders demonstrated a compassionate approach to supporting staff and promoting development. Succession planning was being encouraged through leadership development opportunities and there was evidence that leaders understood the importance of responding to concerns and supporting improvement within the service.

During the assessment process, the provider relied on support from senior leaders outside the service to progress information requests and provide additional oversight. Leaders recognised this need and responded by introducing additional management support and oversight arrangements.

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

Information about how to raise concerns, safeguarding issues and whistle-blowing was available and accessible within the service. Staff described feeling able to speak up, raise concerns and seek support from managers when needed.

Staff told us they felt listened to by leaders and were confident concerns would be acted upon. They spoke positively about the support they received from managers and described an open culture where concerns could be discussed.

Observations demonstrated staff were comfortable sharing ideas, seeking advice and challenging practice where appropriate. Staff spoke positively about leaders and described a supportive culture where concerns were taken seriously and acted upon.

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.

Leaders described a multicultural workforce which was valued and respected. Staff had equal access to information through a range of communication methods, including staff meetings, noticeboards, communication books and rotas.

Staff had access to supervision, training and development opportunities. They also had access to confidential well-being and support services through the provider.

Staff described feeling supported, listened to and able to contribute ideas and suggestions. Observations demonstrated positive working relationships between staff and leaders and a culture where staff were encouraged to contribute to the development of the service.

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.

Governance systems were in place to monitor safety, quality, staffing, training, incidents, medicines, care planning and the environment. Managers and senior leaders demonstrated awareness of areas requiring improvement and had introduced action plans to support service development. There was evidence of support and oversight from locality and quality improvement teams and systems were in place to review incidents, audits, accidents and environmental risks.

However, governance information was not always translated into clear actions, accountability and measurable improvement. Governance records identified concerns regarding supervision, training, care planning, activities and quality assurance, but several of these issues remained evident during the assessment period. This indicated that improvements were not always embedded or sustained in practice.

Our findings also identified examples where care planning arrangements had not kept pace with people's changing needs and service developments. Information relating to one person's needs was held across multiple records and sources and had not yet been fully consolidated into integrated support planning at the time of our visits. Governance records also provided limited evidence of how feedback from people with complex communication needs was gathered, analysed and used to inform service improvement.

The provider responded positively to feedback and demonstrated a willingness to make changes. Several improvements relating to care planning, activities, independence and quality assurance were introduced or significantly progressed during the assessment process. Leaders recognised areas requiring improvement and were taking action to address them. However, at the time of the assessment, some of these improvements were still being embedded and their effectiveness had not yet been fully demonstrated.

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.

Staff worked effectively with a range of health and social care professionals to support people's needs. Positive relationships were evident with specialist services, including Speech and Language Therapy (SALT), dietitians, physiotherapists, occupational therapists and specialist nursing teams.

The service worked collaboratively with families, commissioners and healthcare professionals when planning and reviewing people's care and support. People were supported to access opportunities within their local community, including day services and other community activities.

The provider also made use of wider organisational resources, including specialist activity and therapy teams, to support people living at the service. External quality assurance processes demonstrated partnership working with commissioners and responsiveness to improvement actions.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. 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.

The provider demonstrated a willingness to learn and improve following incidents, audits, inspections and external feedback. Lessons learned were communicated to staff through meetings, supervision, policies and internal communication systems. Leaders also sought specialist input and wider organisational support to strengthen practice and improve outcomes for people.

However, learning identified through governance processes was not always embedded and sustained in practice. Several issues discussed through governance meetings, staff meetings and quality assurance processes remained evident during the assessment period, including themes relating to activities, care planning, independence and quality assurance. This indicated that learning and improvement activity did not always result in timely or sustained changes.

Improvement activity was evident during the assessment period, including developments to activity planning, support planning, environmental improvements and staff development initiatives. However, a number of these initiatives were either under development or significantly progressed following feedback received during the assessment process. As a result, evidence relating to their impact, effectiveness and long-term sustainability was still emerging at the time of the assessment.

The provider demonstrated openness to learning and a commitment to improvement. However, systems did not always demonstrate that learning was consistently translated into measurable improvements in people's experiences, outcomes and quality of life.