Chilton Meadows 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 inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement.The provider was previously in breach of the legal regulation in relation to governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 43 (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 clear vision and strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. However, this was not consistently implemented in order to understand the challenges and the needs of people and their communities. A relative said, “They are not very good at communication, I have to ask but I do get answers.”

Systems to monitor the safety and quality of people’s care were not used effectively across all units. We found a variance and inequality in people’s experiences and the level of care they received. There was mixed feedback from people, relatives and staff about the management and being listened to. Staff described how staffing levels, communication and lack of management support impacted on their ability to do the job well. For example, a member of staff told us, “We have had 3 unit managers on Beech since I have been here, and the current one started 2 months ago but has not been around for a while. The impact is we don’t have unit meetings and communication is lacking. Carers are supposed to have handovers from the nurse who get a handover from the night nurse. However, the nurses don’t always give us a handover. We have agency nurse today. If agency nurse is on, they don’t always know the home and people so well.”

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. There was a manager on each unit and overall, a clinical deputy, a deputy manager and a registered manager. Across the units’ managers were responsible for the day-to-day oversight varied in the length of time they had been employed and their management experience. There was also a variance in the number of, and the frequency of management changes on one unit. We received mixed feedback from staff across the units but found where there had been frequent management changes, staff felt the most unsettled and not as supported.

We also received some feedback about differing management styles of the unit managers and the registered manager. One staff member said, “The [unit] manager values all their staff and treats us as an individual and as a team, but the home manager has different rules.” Another staff member commented, “[Unit manager] is always hands on. [Unit manager] is the best, however, communication from the main office is lacking, they need to encourage two-way communication not one way.” Another member of staff told us, “Senior staff are not visible, there is no communication between manager and staff. You very rarely see the manager on the units.” Another staff member commented, “I work in [unit name] and the unit manager is the best. [Unit manager] values us and believes in us, [unit manager] knows what we are capable of and tells us when we are lacking behind in delivering absolute care. ”

The provider promoted a positive culture, however, not all staff felt they could speak up to the management team and that their voice would be heard. There were systems in place to ensure staff were supported, which included staff supervisions, internal mechanisms to give feedback and the whistleblowing procedures. However, staff spoke of different experiences of these processes and how effectively they were implemented.

The provider believed they looked after their workforce well and promoted their well-being. There was a whistleblowing policy in place. We saw information signposting staff where to go for support and the processes to follow.

The 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 service had a diverse workforce in place; however, staff did not always feel they were treated fairly when they raised concerns. A member of staff said “I feel valued by colleagues but not at all by management. The manager is a distant figure who we rarely see or come across and [manager] is feared especially by staff on [overseas] sponsorship.Our rotas get changed around frequently at the last minute causing huge stress for staff who have responsibilities. There is much I could say but I have spoken up many times before and I’m not aware of any changes as a result.”

Systems in place for accountability and good governance, were not always effective. The provider had failed to implement a consistent, consolidated system of oversight. In the past 10 years, since 2015, they had only achieved a rating of good once at Chilton Meadows, this was in 2019. The other ratings have been requires improvement 3 times and inadequate twice. In this time there have also been multiple repeated breaches of the regulations relating to the safe management of medicines, staffing and good governance. CQC have also taken enforcement action to encourage sustainable improvements. Despite successive inspections, enforcement action and action plans, the service has never sustained a rating of good.

At this inspection, we found risks identified within the environment had not been prioritised. In addition, risks relating to the management of people’s medicines, identified in previous inspections had not been fully addressed.

We saw areas of improvement were needed in care records. This had been identified by the registered manager who was addressing the short falls, but this had not yet been fully implemented.

Systems to ensure safe practice were not effective. For example, the provider had not ensured sufficient oversight of staffing numbers despite concerns being raised by staff, people, relatives and external agencies.

There were shortfalls in providing care in a personalised way to meet people’s individual needs. This had not been identified and addressed through the management and quality assurance systems.

The registered manager accepted improvements were needed and has taken some action to ensure people’s safety such as purchasing new garden furniture for all units and work to make the pathways safe.However, the governance systems in place should support the provider and management team to independently identify shortfalls and address them, rather than them being pointed out by external professionals.

The provider did not always understand their duty to collaborate and work in partnership, to ensure services worked seamlessly for people.Feedback we received from system partners raised concerns about professionalism and a lack of appropriate referrals to external health and social care professionals where this was required for people.

The provider had good links with local community groups. A member of staff told us, “One thing that stands out about Chilton Meadows is commitment to community engagement. They regularly organise events that bring residents together and foster a sense of belonging.

There was a lack of focus on continuous learning, innovation and improvement across the organisation and local systems. Management audits had not identified the shortfalls we found at this assessment. Overall, the quality of the service provided had not improved since our last inspection and we identified repeat breaches of the regulations. There was no effective system in place to drive improvement and the quality assurance process in place was ineffective as it had failed to identify and address the shortfalls we identified in staffing levels, cleanliness and peoples experience in a timely manner.