Highgate 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 good. 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 governance.

This service scored 61 (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. The home had a clear vision which was outlined in the statement of purpose. On the day of the inspection, we observed the culture at the home was ‘people first’ and person centred care was delivered. Staff were passionate about the people they cared for. Staff we spoke with told us they felt supported by the management team. Regular supervisions, training, reflective practice and an effective induction helped to ensure staff felt supported and equipped to carry out their care roles. Staff also told us they felt they worked well as a team.

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 ensure people had their rights protected and did not always seek consent where it was required. For example, although some mental capacity assessments were carried out for specific decisions, assessments for the use of CCTV cameras were not completed. However, the management team were open, honest and responsive to our findings throughout our assessment and were aware of the improvements needed to systems and processes to improve the quality of the service.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. One person told us, “I do know who the manager is and is approachable and the staff.” Staff told us they knew how to raise concerns and felt they would be listened to. The registered manager understood the duty of candour and their responsibilities. The provider had a policy in place to support staff in raising concerns, allowing them the freedom to speak up and whistle-blow. The policy gave guidance to staff on how to raise concerns and assurances that concerns would be taken seriously and investigated appropriately.

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. The provider had a policy in place to support equality and diversity. The policy set out to ensure all staff worked in an environment which was free from harassment and discrimination. The policy set out how staff would receive equal treatment regardless of their protected characteristics in all aspects of their employment.

The provider did not have effective oversight systems in place to provide good governance and did not always have clear responsibilities, roles and systems of accountability. Although systems were in place to assess and monitor the quality and safety of the service, further improvement was required to ensure compliance with regulations. There were some audit systems in place to check on the quality of the service, however these were not always effective in identifying areas for improvement and driving change. For example, medicines audits failed to identify the absence of 'as required' protocols, and no action was taken to address inaccuracies in stock records. As a result, the auditing process did not ensure that people consistently received their medicines as prescribed. The environmental safety audits had not identified that window restrictors were not always in place or that an exposed pipe was present in a communal area. However, other audits in place were effective in identifying and addressing safety and quality concerns. This included audits of; infection control, the dining experience and pressure care. With support from the local authority, the registered manager was working on making improvements to care plans and governance systems. We will check on their progress with this at our next assessment.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The manager told us they worked in partnership with people, relatives and other professionals. For example, the manager told us they had been working in partnership with the local authority to develop care plans. Partners we spoke with confirmed the manager positively engaged with them. Referrals to health and social care professionals were made when required and the provider worked collaboratively with professionals when people’s needs changed. This helped to promote positive outcomes for people using the service. A relative told us “Staff are excellent at working with other agencies and have sorted [Person’s name] appointments and patient transfers”.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. The quality assurance processes in place were not fully robust and had not consistently identified areas of risk. They had not always identified those aspects of the service which required improvement, as evidenced by the issues we identified at this inspection. There were missed opportunities to learn and make improvement to the overall quality and safety of the service. However, both the registered manager and the provider have taken positive action in response to our feedback from the site visits, as detailed within the report.