Buckler's Lodge Care Home

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 the same. 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 regulations in relation to oversight and management of the service and governance.

This service scored 50 (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 always ensure the service had a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people, staff and their communities.Staff told us they have not had regular meetings to review the service and discuss different topics. The registered manager did not always maintain regular communication with the whole team to ensure they were able to share and discuss any matters or what was going on in the service. Some staff noted there has not been any formal supervisions for them to review their performances. Staff said, “Staff need to get a sense of worth. No team building held. Staff are supporting each other as much as we can” and “Communication is lacking. I only get told about the previous shift. This does not help me when I may have been off for more than a few days”.This did not evidence the registered manager and provider engaged effectively with staff to ensure the service was working strategically and in line with a shared vision. The staff felt the registered manager did not always work with the staff team so they could demonstrate a shared responsibility for promoting people's wellbeing, safety, and security. This did not always ensure there would be a positive and compassionate culture that supported people, their relatives and staff. This was also confirmed with our observations that we shared with the registered manager.

The provider did not always understand the context and oversight of delivered care, treatment and support. The provider did not always demonstrate they had the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. Although the staff team were motivated to provide care and support to people as their needs and health were changing. However, there was a lack of consistent oversight and support from the registered manager and provider to ensure they promoted a positive, caring, transparent and inclusive culture within the service. The registered manager told us they communicated with staff regularly and also provided specific time to raise any concerns or private matters. However, staff told us this was not always the case, and some have only seen the registered manager only a few times.

Staff told us about how they supported people and were positive about being able to approach their senior staff with their queries. However, staff also told us they did not have much communication with the registered manager. Staff described how they always ensured people were safe, looked after and respected. They showed enthusiasm in supporting each other. But it was their own initiative to do that rather than management team making sure they worked together and brought that culture of togetherness and collaboration at the front that would ensure consistent and positive outcomes for people and the staff.

The provider and the registered manager did not always ensure the staff team were also equipped with required skills to care for people according to their needs and wishes. For example, we observed and overheard some staff not speaking properly and displayed dissatisfaction of being there during lunch time. Some people told us or made it verbally clear on a few occasions they were bored without much stimulation or things to do.

The registered manager and provider did not always foster a positive culture where people, their relatives and staff felt they can speak up and that their voice will be heard. We asked about freedom to speak up and the registered manager told us how they supported staff to share any issues or concerns. However, from evidence and feedback collected, the leaders did not always act with openness, honesty and transparency. Some staff told us they would like to be listened to more, and they did not think the registered manager promoted empowerment. People and relatives were not always informed about staff changes such as when staff left the service.Some staff also told us about the positive relationship they had with their colleagues. But some were uncertain about raising concerns with the managers as they may not be listened to.The communication between different staff or teams could be also improved and better organised. This would ensure when concerns were raised, the leaders investigated them properly and lessons were shared and acted on positively.

Staff felt the management team was not very visible to the staff team and the people so they rarely saw them around. This was missed opportunity to support staff by modelling inclusive behaviours. The provider did not always embody the culture and values of their workforce and organisation to ensure people did not experience poor care and have detrimental impact on staff.

People and relatives felt they could share their experiences and that this feedback would be heard. Some people added they would receive an apology and information on actions being taken when something went wrong.People and relatives felt staff were mostly happy and positive working at the service and worked well with people using the service. They said, “All the residents seem happy as do the staff. They’re always very chatty, polite and smiley, I’ve never seen anyone unhappy”, “I think they feel stressed, I feel for them because they do their very best. Some staff work conscientiously whilst others hide behind corners and hope someone else gets called” and “[Staff] often say they are understaffed which makes me sad that they are over worked. There’s a good atmosphere. There are people that choose to stay in their rooms so we can all choose”.

The registered manager and provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.The registered manager did not always review their policies and procedures to ensure these supported and reflected staff needs and their responsibilities. Staff were not always able to share ideas or able to contribute to the service and its development and improvements.

Most staff supported each other however some of them also felt support and engagement from the registered manager could be improved. The registered manager did not always work alongside staff delivering care or support to help them to better understand any issues or disparities staff encountered. We were not assured the working environment was always inclusive, staff’s roles clearly established, and that staff’s wellbeing was considered consistently.Staff told us, “Staff appear fed up and deflated. There is no enthusiasm anymore”, “No, I do not think staff are happy. Morale is so low. We must do everything, however, do not get the support to address” and “Staff morale is rock bottom now. We got an email last week saying we are not allowed [provisions] as this will be classed as theft. We all feel undervalued.”This did not always ensure the registered manager and provider monitored the service had a positive culture which did not always support better outcomes for people. It did not demonstrate how they took action to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion.

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.Provider’s quality assurance systems did not identify concerns we found during this assessment which are described throughout this report.The provider did not always maintain an effective oversight of the quality of care being provided, risk management and mitigation, staff practices, knowledge and competency to support people.The provider did not always monitor recruitment checks were appropriately carried out to ensure all required information was gathered to ensure there were suitable staff to work with people.The people were not consistently safeguarded from the risk of harm. Staff were not always adequately trained and competent prior to providing care and treatment.When incidents, accidents and complaints occurred, the registered manager could not always demonstrate how they proactively looked at trends and themes. This would help them identify areas of concern, different strategies for support and take action to prevent reoccurrence and safeguard people.

The registered manager and provider did not always ensure management of medicine and records was safe and proper. The provider gathered some feedback from people and relatives about their experiences in the service. However, it was not clear what actions were taken afterwards to ensure the process of gathering feedback was meaningful and useful to the service development. It was not clear how feedback from staff and professionals was gathered and used to monitor, develop and improve the quality of the service.

The registered manager completed some audits, night checks and service walkaround checks. But we identified the registered manager did not always ensure reportable events were notified to CQC. The registered manager provided audits completed for call bells usage. It noted an increase to 59 calls being over 8 minutes but it was not clear how this information was used to review effectiveness of responses. This meant information relating to staff response time was not fully analysed and actions were not taken to improve the response.

The registered manager did not always ensure accurate, complete and legible records were maintained or updated when necessary to support effective management of people’s care and treatment, staffing and the service. For example, there was one person who communicated using gestures, but not all information was part of the care plan to ensure staff knew how to respond to the person well. We observed this person was indicating they needed staff’s attention, but the staff did not respond to the person. For another person, their diet was recorded to be provided at specific level to support safe swallowing. There was a note “diet as per SALT (speech and language therapist) guidelines”, however, the care plan lacked specific instructions drawn from the SALT assessment. This limited staff guidance around person’s nutritional needs.One person was supported with end of life care, and family told us they were happy with the support so far. However, we noted to the registered manager the records could be better to ensure it was clear the support was provided in a timely manner for this person. This demonstrate the provider and the registered manager were not always aware of people’s individual needs and records so they could ensure safety from the risk of harm or improper treatment. The provider did not always ensure there was effective oversight to identify if risk assessments and care plans in place were followed and reflected in people’s daily notes.

The registered manager understood their duty to collaborate and work in partnership with different stakeholders, so the service worked seamlessly for people. They shared information with partners and collaborated for improvement. The registered manager told us how they worked with people, their families, professionals to ensure people received the care and treatment they needed.People benefited from the service that worked in partnership with different professionals to ensure people were looked after well. Where necessary, external health and social care professionals had been consulted or kept up to date with developments. Staff used different systems to report, record and refer people for further clinical support.

A few people and relatives noted relations and contact with some professionals such as a doctor and community nurses could be better at times, especially if they wanted to discuss their health more often. But others agreed the staff and leaders worked well with relevant outside agencies and professionals, to get the care they need. Staff and the registered manager maintained partnership working with key organisations to support care provision, service development and joined-up care, as well as, keeping up with any updates in the health and care sector.One professional was positive about their experience working with the service. They said, “I know sometimes [the visit] can feel a bit disorganised…[the service] is a very large home and I think things are slowly getting better - for instance they now get a list in advance…which is helpful. They have also signed up for the remote monitoring system which they didn't used to do…[The registered manager] is working hard as a manager and things seem to be improving. The care that is given seems to be good and residents generally seem happy and respected and well looked after in my opinion.”Another professional added, “We have been working with [the registered manager] for past few years. [The registered manager] is really proactive and request for appropriate support from [our] team to manage risks as part of risk management.”

The provider and the registered manager did not always focus on continuous learning, innovation and improvement across the organisation and local system. The registered manager did not always use their policies to focus on continuous learning and improvement from incidents, reportable events, audits and information gathered at the service.Staff confirmed they did not have regular staff team meetings to discuss items, issues or feedback arising from running of the service. Staff felt this was missing in the service as this would give them the opportunity to discuss important aspects of the service and identify areas needing attention. Staff said they did not really discuss events or lessons learned from those events that could also encourage reflection and collective problem-solving. This did not demonstrate the registered manager consistently involved the staff team to use their policies and procedures for effective and meaningful learning, measuring outcomes and impact or the services provided.

The staff team were motivated to provide care and support to people as their needs and health were changing. However, we received a mixture of feedback from staff. Some staff felt supported by the manager and senior staff. However, others noted not all staff had a voice or opportunity to share their ideas. Some staff felt the management needed improvements regarding their insight and awareness of what was going on in the service and the quality of it. They said, “I have raised things with the manager and nothing changes. The manager is very quick to tell staff off but not quick to listen to us” and “On more than one occasion I have wanted to suggest ideas that I have in [the meetings]. However, the agenda is pre-planned and we never have time to raise anything else.”From staff’s feedback and our findings of issues, the provider and the registered manager did not always encourage staff to speak up with ideas for improvement and innovation and actively listened and engaged with them. Where we identified shortfalls during this assessment, the registered manager was responsive to our findings and started working on areas of improvement.