Welcome House - The Chestnuts

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 breach of legal regulation in relation to good governance.

This service scored 46 (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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

There was no clear vision both for the service as a whole, and for what individual people wanted to achieve from living at the service. Although staff and leaders were kind, they had no holistic plan for each person around aspirations or goals and how they could be achieved. People generally participated in activities together and there was a lack of exploration of individual cultures, wishes and preferences. Tasks were generally done on behalf of people with limited evidence of independence and choice being encouraged, or of a clear focus on enabling people to have the best possible quality of life.

Leaders did not understand context in which the provider delivered care, treatment and support. They did not embody the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively.

Although people and partners we spoke to had noted some improvements had been made by the manager, they did not have a clear vision for the service or knowledge of the people being supported. They had a limited understanding and focus on how people’s mental welfare could be promoted holistically through choice, independence and meaningful activity. We identified that a number of areas continued to fall below the standards expected or reflect best practice care for individuals living with a mental health diagnosis. The manager was not knowledgeable about the people being supported, and when asked to tell us about people stated they had only been at the service for 6 months so did not know people well. Some elements of care such as around activities, food and daily living tasks remained institutionalised and did not consider how people could be challenged to take positive risks.

The provider developed a culture where people could speak up and their voice would be heard. However, we could not always see this had happened in practice.

Staff felt comfortable about being able to raise concerns openly, and these would be listened to and acted upon. One staff member told us “I can definitely can speak to my manager or senior carer. They are very open”. Another staff member echoed this and told us “I like the manager. She is very approachable”. Despite this, we identified that people continued to live lives that did not reflect their diverse needs, interests or aspirations. They were not consistently treated with dignity or supported to gain in independence, grow and develop in skills and wellbeing. There was no evidence that this had been identified, and there remained a culture that did not focus on the people in their care.

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 provider and leaders ensured that staff were treated equally at the work place, and considered how barriers faced by the diverse workforce could be overcome to improve their experience at work. Where people needed to work flexibly around personal commitments such as children, family or any health needs this was supported. One staff member had recently been unwell for a period of time, and spoke highly of the support and care they received from their manager and colleagues. They stated “I got great support from my colleagues and manager. They all rallied round me, and even arranged a video call with the people who I care for which was a nice touched as they were worried having not seen me. It’s a lovely place to work”.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a regular schedule of audits and checks to ensure the ongoing quality of care, however these were not as effective as they needed to be. They did not consistently ensure the safety of the building, level of cleanliness, accuracy of care documentation or that a clear plan was in place for how people could be supported to achieve their goals and aspirations. Spot checks by provider representatives were undertaken in addition to those completed by the manager, and although they were identifying areas for improvement these had not all been realised at the inspection. For individuals with a learning disability and autistic people, the provider had not fully considered the principles of RSRCRC to ensure they receive care that was person-centred and promoted independence.

There was a business continuity policy to cover any emergencies such as the loss of an important utility or extreme weather event to ensure people would have continuity of care. There was also an on-call system where there was always a management representative available to respond in urgent situations.

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.

The service worked closely with partners in their local community to support the needs of people, which included supporting regular appointments with health services for routine checkup’s and if staff were concerned about people’s welfare. Health and care professionals who shared feedback with us spoke of positive relationships with the home. One stakeholder told us “I have a good relationship with the staff and management. They always make me feel welcome”. The provider also worked to form relationships with wider community groups, including mental health support groups which were attended by people regularly, as well as local places of worship.

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.

Although areas of care delivery had improved since the inspection, it had not yet reached the standard that we would expect. There had been additional training for staff around mental health and a consultant had worked with the service to review care planning documents, but the care being delivered still did not reflect a holistic model that considered all factors that could promote people’s emotional wellbeing.

There were very few incidents recorded at the service, however that that we saw were investigated well and appropriate action taken. This learning was shared within staff meetings, handovers and individual supervisions.