St Mark's Care Home Also known as St Mark's

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 outstanding. At this assessment, the rating has changed to requires improvement. This meant the management and leadership were 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 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 share a clear vision, strategy and culture with staff.
Relatives told us they did not always feel that the provider worked together with staff to ensure a shared culture within the service. One relative told us, “I'm unsure how they work together with their staff. I get a feeling there is a little bit of 'them and us' mentality from the management and sometimes I can see some unhappy staff putting on a brave face.”
The registered manager told us how they worked with staff for a shared strategy and engagement. They said, “[Staff] give us more feedback of what they want to see in the home, and we action it. We also ask this at every staff meeting, what can we do to be more inclusive and support each other.”
However, we also received mixed feedback from staff. One staff member said, “We work according to the values the provider sets out.” Another staff member told us, “Some staff are quick and efficient, and others do not seem to work in this way, which can lead to some stress. We need to coordinate and communicate well so that [people] get a good service.”
We reviewed staff meeting minutes and noted there were discussions around training, wellbeing and lessons learned. However, it was unclear how lessons learned were consistently shared with the wider team, as staff unable to attend these meetings were often left out.
 

Leaders did not always lead effectively. Not all leaders embodied the culture and values of their workforce and organisation.
One relative told us, “I get a feeling there has been some unrest amongst the staff.” Another relative told us, “I do worry that if [staff] are not treated with the respect that they deserve, they will leave.”
Staff told us they did not always feel the leadership was compassionate. One staff said, “I feel that the manager is quite rude to the staff, if they want things done, [they] need it done now.” Another staff member told us they did not always feel supported by the registered manager to take their breaks due to the heavy workload of tasks to do, yet other staff were able to take their breaks. Some staff told us they lacked clinical supervision due to the clinical lead leaving the service. However, the provider told us all clinical staff received supervision with the supporting clinical lead and shared supporting evidence of this.
The provider told us how the manager completes ‘Your time’ meetings with staff to share any concerns and identify needs. The provider also said they have several staff who have been promoted including 7 carers who have been promoted to senior carers, and 2 senior carers have been shortlisted for the Trainee Nurse Associate programme.
 

People did not always feel they could speak up and that their voice would be heard. We received mixed feedback from staff regarding how supported and encouraged they felt to speak up. Staff told us they were aware of the whistleblowing policy and posters provided in the home. However, one staff member told us, “The staff are frightened to talk.” Another staff member told us, “I don’t feel I want to speak out anymore as I feel like nothing will change and whatever I say will act against me.” This meant staff did not always feel empowered to drive improvement by speaking up. This also demonstrated leaders had failed to establish and maintain a culture of speaking up where staff actively raised concerns, and were supported, without fear of detriment. The provider told us they have an anonymous and confidential speak up service, available in 75 languages and open to everyone. The provider also said they offer regular HR drop-in sessions where staff have been able to speak in confidence and voice any concerns.

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. One staff said, “I feel that everyone from different cultures and religion has this respect – there is no compromise with this.” Staff also told us how they were supported by the provider to develop their skills and qualifications. The registered manager told us how they were focused on continuing to improve diversity and inclusion within the service. They said, “We are really diverse but need to work on being more inclusive, how do we embrace our cultures more. Everyone is so unique.”

The provider lacked clear responsibilities, roles, systems of accountability, and good governance. They did not act on the best available information about risk, performance, and outcomes, or share this information securely with others when appropriate.
The provider failed to maintain effective oversight of people’s care planning and risk assessments to ensure people did not experience risk of avoidable harm. Governance systems were not always effective in identifying risks and ensuring actions were taken. The systems and processes used for medicines management had not identified concerns related to the covert administration of medicines. Audit systems were not effective in identifying the concerns we found during our assessment, particularly in relation to safe care, records, medicines, environmental risks, and recruitment. Evidence gathered during the assessment revealed that the systems and processes used did not always support staff in providing appropriate care for individuals. People’s care records did not always include significant information, such as the support they needed for specific high-risk conditions. We found gaps in information in staff files reviewed as part of recruitment. There was no effective system in place to audit staff employment records to ensure they contained all the required information before working with vulnerable individuals. The lack of oversight by the registered manager meant that governance of the service needed improvement. The service was in breach of legal regulation in relation to good governance.
 

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people.
The registered manager told us how they worked in collaboration with other homes to share information and learning for improvement. The registered manager told us, “I do look at other homes and see what they do well, I look at their reports. Learning from what has and hasn’t gone right…I share a lot of information. I keep communicating as well; up and across the business.”
Some people told us they did not receive support from external agencies when required. For example, one person said, “When I first came I was told I was going to have physio because of my chest, I have COPD, but I haven’t had it.”
 

The provider did not consistently promote continuous learning, innovation, or improvement across the organisation and local system.
The provider used quality assurance systems as a tool to continuously improve the service. However, these quality assurance systems did not always identify the issues we found during our visit, for example, with recruitment, equipment requiring calibration and care records.
The registered manager told us, “We have a quality improvement plan on our system” and “Individual actions go to the units.” We also noted the provider completed regular audits on people’s care records, infection prevention and control, and medicines. One staff told us, “We get a lot of training and regular refreshers which gives me confidence to approach [people] according to their needs.”
We received mixed feedback from staff regarding the promotion of learning and improvement. For example, one staff told us, “We discuss the incident and review what could be done differently or what safety measures to put in place.” However, another staff told us they also raised concerns regarding one person’s needs and felt they required additional support during mealtimes. The staff told us they were told, “[They have] days like this.” The staff told us they escalated their concerns, however, “The unit manager spoke with me later and thought I had gone behind [their] back.” This did not demonstrate the environment was always conducive to continuous improvement across the organisation.