Andrew Smith House - Nelson

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 remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (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.

Staff could describe the vision of the service which aligned with the managers. Staff felt the culture was positive, and they were focussed on delivering good quality care to people. Staff said they felt supported by the managers. They were aware of health and safety and equality policies and knew how to access them.

The provider had leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Staff said they enjoyed their jobs and morale was good. Managers led by example and had a good understanding about the challenges staff faced. Managers were encouraged to complete further learning and development to complement their knowledge and skills.

The management structure was stable, and both the registered manager and deputy manager had been in post for some time, providing consistency and continuity to staff and the service.

Processes and policies reflected transparency, equality and meeting people's human rights.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There were appropriate policies to support staff to raise issues; staff said they were confident in raising concerns and felt they would be listened to.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There was a clear and robust governance structure and processes. Managers had a good awareness of risk and analysed the performance of the service, and outcomes for people on a regular basis. The registered manager and deputy manager submitted statutory notifications to relevant bodies which is their legal responsibility to do so.

The managers conducted regular audits of the service, both clinical and environmental, to identify areas for change and improvement.

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 provider established links with companies and businesses, and staff took the time to find out what was available locally for people to access. People commented they felt part of the local community and attended activities on a regular basis.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider was enthusiastic about being involved in local projects and pilots. For example, the home was about to commence participation in the ‘thrive project’, looking at ways to support people to remain healthy in care settings. The managers encouraged staff to become champions for specific issues such as falls or pressure care, to help achieve better or positive outcomes. A recent initiative had resulted in a reduction in falls for someone living at the home.