Chater Lodge

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 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 key question the rating has remained good. 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 feedback about the culture and shared direction of the service was positive. Staff felt involved and engaged in the day to day running of the service. A staff member told us, “The culture has improved now; particularly with new staff starting. We have been through a difficult time, but things are much better and more positive now.” A second staff member told us, “The best thing about coming to work is the people and the staff; we are like a family and we can speak freely.” Staff told us they embedded the values of the home through discussions, including daily team meeting where heads of department met and shared key information and through team meetings. The registered manager also said there had been improvements in the culture of the home.

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. Staff spoke positively about the registered manager, who they described as supportive and approachable. A staff member described how managers and staff had supported them when they started which, they said, was helpful as English was not their first language. The registered manager and provider representative were receptive to our feedback throughout the assessment process and acted where we highlighted shortfalls. For example, where there were shortfalls in care records, they updated them promptly and provided evidence to the assessment team. There were processes in place for the registered manager to communicate with people, relatives and staff. The registered manager demonstrated they were open and compassionate throughout the assessment process, and this was corroborated by staff and stakeholders.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. Staff were aware of the processes to raise concerns and felt empowered to speak openly. They told us they were confident to escalate concerns if they needed to. Staff comments included, “I can speak freely and know I will be put on the right track if I need to know something” and “If I had a concern I’d speak up. You can always speak to [registered manager], but I could also go to one of the other managers, within the whistleblowing line or even CQC. [Registered manager] always takes feedback well about things at Chater.” Regular staff meetings took place, including daily handovers and information sharing meetings, and there was evidence of good attendance and staff involvement.

he service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. All staff and managers spoken to identified with a shared commitment to good practice and an open approach to problems and issues. Staff felt well-supported in doing their jobs and spoke positively about teamwork, shared values and care for people. Staff described management support for them to achieve a good work-life balance, and provided flexibility when health or family circumstances required it. Newer staff described a welcoming, supportive and inclusive culture which enabled them to feel comfortable and confident in their roles.

The provider had clear responsibilities, roles, systems of accountability to support governance but these required further development to ensure they were always effective in having full oversight of the care provided. Audits to monitor the quality of the service were regularly completed and action plans created and reviewed. However, they had not identified shortfalls we identified around medicines and care planning as part of the assessment. Following our inspection, the provider and registered manager implemented more robust processes to improve oversight and identify any shortfalls at an early stage. Although these were not embedded in practices, this provided assurance the provider was committed to making sustainable improvements. People were positive about the leadership of the service. Comments included, “I do see [registered manager] about and I know I can speak to them any time” and “The [registered] manager is very friendly and helpful.”

The provider understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement. Staff followed clear systems and processes which demonstrated a commitment to achieve effective partnership working within the providers' staff team, as well as with external professionals and partners. There was good evidence that staff worked as part of the community in the links they had forged with local community groups, including places of worship and cultural groups.

Whilst the provider was focussed on continuous learning, innovation and improvement across the organisation and local system, the changes they had made required further embedding to ensure improvements were sustained. There had been improvements to auditing processes, but further improvements were required to ensure these were embedded and areas where we found shortfalls were developed fully. The registered manager attended regular meetings with management teams from the provider’s other services and was supported by the providers’ representatives, which enabled them to keep up to date with key changes and share best practice. They provided examples where they had identified short falls and acted to address this and ensure lessons learnt was shared with staff. For example, they shared learning with staff following a person leaving the premises without support and worked with staff teams to implement new processes to mitigate future risks.