Muscliff Nursing 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 outstanding. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to good governance. Systems were either not in place or not operating effectively as they had not identified the shortfalls found at this inspection.
 

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.
The culture of the service did not support staff and management to recognise shortfalls in the service relating to safeguarding adults and restrictive practice.

Comments from staff included, “Staff morale is very low, and many feel unable to speak openly for fear of being targeted or ignored”, “The current environment does not feel supportive or safe for staff or residents, and it’s difficult to take pride in a role where you feel unheard and overstretched”, “The home lacks a culture that values and empowers the residents” and, “When feeding back to the registered manager teamwork needs to improve, the response was we are working as a team.”
 

The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

The provider could not be assured staff, including the registered manger, overseeing the service had the appropriate experience and training to effectively manage the service.

Records demonstrated staff had persistently raised concerns relating to the care of people, insufficient equipment and a lack of teamwork. No actions had been taken by the registered manager or provider to address concerns raised. A staff member described their view of the service’s leadership as, “The registered manager does not live the values of openness or accountability, and this trickles down throughout the team.”
 

Staff did not feel they could speak up and that their voice would be heard.

The culture of the service did not support freedom to speak up. When the provider recognised that some feedback from staff met the threshold of a safeguarding concern, they had then failed to report or action these concerns in accordance with their policy. This posed a risk to people and staff not being heard, concerns not being always appropriately recognised or investigated. This had meant lessons were not learnt and acted on to protect people.

Staff said, “Communication between management and staff is inconsistent, and concerns raised are not always taken seriously” and “There is a culture of discouraging staff from reporting things. There is a fear of backlash from management or other staff members if you speak up.”
 

The service did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff described supervision and appraisals as a “tick-box exercise” and “rushed.” Evidence showed the registered manager and provider had not effectively addressed the divisions in the staff team. Records such as staff meeting minutes demonstrated staff concerns about the lack of teamwork had not been responded to. There was an accusatory tone throughout the records with consequences for lack of compliance clearly stated by the management team. There was minimal praise or invitation for alternative views.

The leadership of the service had a strong focus on image, directing staff with “work together” and ensure a united front for people relatives and professionals but did not guide staff on how to do this or act on staff feedback with suggestions of improvement.

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

The service did not have effective processes to ensure continuous learning and improvement. Therefore, opportunities to improve the service and learn lessons were missed and shortfalls identified during this inspection were not recognised or acted upon by the provider. There was no robust oversight to monitor raising concerns about the culture of the service. For example, when staff raised concerns at team meetings about poor teamwork there was no response from the registered manager about what investigation or action would be taken in response to these concerns.

The service was not effectively led. The registered manager did not ensure the service developed and used an effective governance system and failed to identify shortfalls in the service. For example, in relation to managing safeguarding concerns and reporting events to the local authority or CQC. This meant risks in the service were not understood or managed which led to an increased risk of poor care and avoidable harm to the people receiving care.

During our inspection there was no evidence the provider had oversight of concerns at board level or equivalent. Without a process in place the provider was not able to make improvements to the service in response to the changing needs of people who use the service. This placed people at risk of both abuse and not having care needs identified or met.
 

The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Care plans lacked detail and appropriate referrals to the local authority and CQC not been made which meant information was not always shared and collaboration for improvement was not possible.

However, some health and social care professionals shared positive observations of activities being well attended by people and interactions with staff when visiting the service.
 

The service did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Staff told us the views of people, and their relatives were often ignored. A staff member commented, “An area that could be improved is the communication between staff and residents' families. Sometimes family members do not communicate respectfully with staff which can be upsetting. Improving this communication and mutual respect would benefit both residents and staff.”