Tandridge Heights

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 Requires Improvement. At this assessment the rating has remained 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 governance at the service.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although management had a shared vision, strategy and understood the challenges and the needs of people and their communities we received mixed feedback from relatives and staff around the current culture within the service.

Relatives told us, “It used to be an amazing family atmosphere, but now it has become unpleasant with changes in staff. Continuity is important for my dad and some staff cannot give the commitment that my dad and others require”, “I think there is a deputy manager, but I do not know if we have a manager. There has been no communication regarding management. The negative changes that I have noticed has been since (registered manager) left.” and “I have no idea when a new manager will be appointed. There’s lack of communication.”

Staff told us that following the recent safeguarding concerns, staff morale had been affected. Although senior management had held events to keep morale up staff said they felt anxious about all of the recent changes with 1 staff member saying, “It’s affecting staff too much. It feels like everything has changed here and we are working in a constant state of stress.” Other staff said that although they understood why the provider could not divulge any confidential information but the recent situation was unsettling for staff and having an effect on morale.

Staff also told us the use of some temporary staff was affecting the care being provided. One staff member told us, “I think we need to continue to do our best. Sometimes not having our own staff does not give that kind of quality of care. We need to have permanent staff who know the residents and for a relationship.”

We did read however the result of the recent ‘Tell Barchester’ resident, family and friends survey had resulted in positive responses in relation to the food, care being provided, staffing, activities and the care facilities. In addition, compliments received by the service included, ‘I am grateful for the wonderful care here’, ‘the standard of care and support is very good and my husband is very settled’ and ‘keep up the good work!’. We were also told by 1 relative, “I think it’s a good home. The care is good there are plenty of activities. She is well looked after.”

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. 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.

Upon arrival at the inspection, management experienced difficulty providing information about people using the service. A significant proportion of the management team were new to their roles, which limited their ability to respond to the requests we had for information. Additionally, senior management asked a nurse to assist us while they were in the middle of a medicines round. This interruption increased the risk of a medicines error.

Although the interim manager had been in post for nearly one month, they were unable to provide information about people living at the service and were unclear where this information was held within the provider’s internal systems. The regional manager also experienced difficulty accessing the requested information, resulting in a prolonged delay. Consequently, we proceeded with the inspection without the level of detail normally required to support the visit. This did not provide assurance of effective management oversight at the service and we fed back our concerns to senior management at the time.

However, following our inspection, senior management supported us fully in our requests to provide additional documentation and information.

Relatives and staff gave mixed feedback on the management structure within the service. One relative said, “The management are largely good. I have been given the details of the interim manager and I’ve probably met her in passing, but I haven’t had a need to talk to her yet. I feel I could contact them with issues though.” Staff told us, “The first time (I worked here) they did not give me an induction, the second time they did. It wasn’t structured properly. It was a bit hit and miss. It’s not the staff because they’re willing to do the job, but the place is not structured. It’s affected staff”, “The nurses are good and the interim manager is supportive”, “Management, team and colleagues are really nice” and “I did feel supported by (registered manager) but she left 2-3 weeks ago.”

We found notifications were not always being submitted to CQC as required by law. A notification is the action that a provider is legally bound to take to tell us about changes to their regulated services or notifiable incidents that have taken place in them. Two incidents of ‘alleged abuse’ occurring at the service had not been notified to us. This included where an altercation had occurred between 2 people living at the service. In addition, services are required to notify CQC of serious injuries and this includes when people’s skin is damaged. Records showed 1 person had been diagnosed with an ‘unstageable pressure ulcer’ on their heel, but this had not been notified to us.

Management fostered a positive culture where people felt they could speak up.

Staff did not always feel comfortable to speak up. Our inspection was prompted by serious safeguarding concerns which had not been reported to the management of the service. Some staff did not communicate their concerns in accordance with the providers policy and safeguarding practices. This meant people were at an increased risk of harm and abuse.

We received feedback from some staff who told us they felt happy to speak up if there were concerns, however this had not always happened in practice.

In response to the concerns, management discussed carrying out refresher training on the internal safeguarding policy with staff. They had also reminded staff on how to whistleblow and that there were ‘Speak Up’ Champions on site. These staff were the spokespeople for the home and staff could go to them if they had any concerns, feedback or ideas. Champions met with management weekly to relay any messages and in turn senior management held monthly meetings with the provider’s human resources team to discuss any feedback received.

The provider ran a ‘Your Voice’ survey for staff to enable them to give their views and feedback on working at the service and working for the provider.

Management 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 had learning and development training for new staff requiring additional support and in addition, there was no discrimination when recruiting new staff. The provider had a sponsorship licence which meant many of the staff on duty each day were from overseas. This promoted diversity and a rich culture within the team.

Staff’s individual culture’s was recognised by recognising days relevant to them. For example, Diwali or Christmas.

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

Governance systems in the service were not operating effectively. The service was not safely monitored which has resulted in 2 breaches of regulation. Governance systems included a large suite of weekly, monthly and quarterly audits which were double-checked by senior management. Despite this, the found shortfalls at the service had not been identified through these processes.

Quality assurance arrangements were not applied consistently and were ineffective. For example, oversight of risk assessments, care planning, medicines, IPC, staff deployment and the environment meant people were exposed to avoidable harm. Processes were not in place to ensure sustainable and dedicated management of the service. Systems to ensure oversight of the service at provider level were not always established or effective.

Following our feedback to management we were aware that some people’s care plans were reviewed, a medicines audit was completed and a deep clean of the service was planned.

Staff understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

There was reliable partnership working between the service, health care professional services and the local community. This included working closely with the local authority, social workers, the local pharmacy and hospital discharge teams.

The nearby church held services each week at Tandridge Heights and external entertainers provided activities to people. The service mini-bus enabled people to go out into the community and spend their time in the area participating in outings.

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

We received a large amount of feedback to indicate improvements were needed in the service in relation to staffing levels to ensure people were receiving safe, effective and timely care. We were told there were not enough care, laundry, housekeeping or activities staff. We were told by 1 staff member, “I was told the hours are not there for activities. We have created a tick list and we may not have seen someone in their room for 3 days. There are also not enough housekeeping staff. Some days there are just 2. Baths and showers could be increased.” Other staff said, “Sometimes there are not enough care staff. People are not being cared for properly. Staff don’t get a chance to see people in their rooms” and “We are always short of staff. Checking on the welfare of people is missed out, repositioning is impacted. On a Sunday there are no activity staff. (Care) staff would love to get more involved, but we are too busy.” Our observations during our inspection supported these views.

Management told us they were looking at ways to improve the service as they recognised there were some areas needing to be actioned. Following our initial feedback to the service we were told improvements would be made the cleanliness of the service as well as the medicine practices. We were also told housekeeping task allocation would be reviewed.

The service held a ‘perpetual central improvement plan’ which was monitored by senior management. Actions and timescales were included and these were signed off once completed and following the recent safeguarding concerns daily observational checks were introduced by senior management. These included managers checking allocations properly, knocking on people’s doors more regularly and checking people’s wellbeing. Regional teams of staff had been involved with training and compliance running refresher training programmes with staff, such as moving and handling to help reduce the number of minor injuries within the service.

The provider had also recently introduced a new clinical development nurse role to the management team who supported clinical staff and sat in on clinical meetings