Tunstall Hall Care Centre

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 requires improvement. At this assessment the rating has remained requires improvement.

This meant the management and leadership was 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 the leadership and governance at the home. We have asked the provider for an action plan in response to the concerns found at this assessment.

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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The culture within the home did not always promote a positive environment for people living with dementia. Systems in place were at times task-centred rather than person-centred which meant people did not always have their needs met in a personalised way at the time they wanted. For example, we observed people only being offered drinks at mealtimes and during the tea trolley run and not at a time that suited them.

There was not always a clear strategy in place to meet people’s dementia needs. The registered manager told us there had been a shift in people’s needs in the home and an increase in the number of people living with dementia. Dementia training was completed during this assessment. The registered manager told us they intended to provide more advanced training with a view to improving the quality of care provided to people living with dementia in the home.

The listening culture in the home was not always positive and did not always promote trust and understanding between management and staff. Staff told us they did not always feel heard, and they did not always think sufficient action was taken to ensure workforce equality.

Staff told us the staff dynamic was not always positive which did not promote a shared direction and culture in the home and did not always ensure optimum care was provided for those who lived there.

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 have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders did not always understand their responsibilities. For example, they did not always submit safeguarding referrals and statutory notifications when required. We raised this with the registered manager who immediately reviewed accidents and incidents and submitted any missed safeguarding referrals and CQC notifications retrospectively.

Leaders did not always disseminate a person-centred culture throughout the home. Some practices encouraged by the leadership team promoted a task-centred approach to providing care. This was addressed by the registered manager during this assessment.

Staff told us a poor culture at the home was having a detrimental impact on some staff. The registered manager acknowledged there were some concerns, but staff did not always feel enough was done to address concerns and improve morale at the home.

Senior leaders visited the home to support the registered manager when needed but staff told us this was not always effective in ensuring changes were made to improve the culture of the home. One staff member told us they had raised concerns and, “It went to the regional manager but nothing happened about it, they just said it wouldn't happen again.”

Despite this, staff told us the registered manager was compassionate and approachable when they needed personal support and was flexible around working arrangements when staff needed it. One staff member told us, “[Registered Manager’s name] is generally a good manager, I could go to them for most things, they are supportive.”

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Staff told us they did not always feel supported to raise concerns as they were not always dealt with robustly if they involved certain staff members. Staff also told us they were reluctant to share concerns in these circumstances as they were worried about potential repercussions to them. Staff told us they felt risks may be overlooked in these specific circumstances which may place people at risk of harm, but they did not think risk was generally overlooked.

Despite staff feedback, systems were in place to learn where things went wrong. For example, when accidents and incidents occurred, the registered manager completed a root cause analysis to determine the cause and whether anything could be changed to reduce the risk of reoccurrence. Any learning was then disseminated to staff.

Where things had gone wrong, the provider had made changes to reduce the risk of reoccurrence. For example, one person had moved rooms with their consent due to altercations with another resident to reduce the risk of further incidents occurring.

The provider was very proactive with implementing learning identified during the assessment.

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.

Staff did not feel they were always treated fairly. Staff told us some colleagues got preferential treatment and multiple staff members told us how they were treated depended on ‘if their face fit’. Action taken to address inequality in the workforce within the home was not always sufficient to empower staff and reduce their anxieties.

Where staff were pregnant, the provider completed risk assessments and made adjustments to their roles to ensure they were supported. The registered manager gave us examples of where reasonable adjustments had been made to support staff with disabilities.

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

The provider did not always comply with their regulatory responsibilities. For example, CQC notifications were not always submitted when required for allegations of abuse. We raised this with the registered manager who reviewed accidents and incidents and retrospectively submitted those that had not been notified to CQC.

Accountability arrangements were not always clear. Staff told us they had raised concerns with the registered manager regarding incidents where staff behaviour had been below what was expected but they did not feel sufficient action had been taken to prevent reoccurrences of the behaviour. We spoke with the registered manager regarding this, and they told us they had informally spoken with the staff concerned to reiterate expected behaviour in the workplace.

Systems and processes weren’t successful in identifying where safeguarding referrals hadn’t been submitted.

Audit trails were not always kept to evidence quality checks undertaken. For example, where daily audits were undertaken of medicine stock levels, the registered manager told us they had disposed of them, so we were unable to check if any errors had been identified.

Systems in place to check quality were not always effective in identifying concerns. For example, care plan audits had not identified where language used in care plans was inappropriate or where risks were not being monitored safely.

Best practice in respect of dementia care was not always followed. The registered manager told us of plans to upskill the work force and develop their understanding of dementia care within he home.

Clear arrangements were in place in respect to staff roles and responsibilities and staff understood this.

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

The provider did not always collaborate effectively with partners by sharing information as required in a timely manner. For example, the provider did not always submit safeguarding referrals and CQC notifications when needed which meant relevant agencies were not always aware of concerns when they should have been.

Professionals told us they had seen improvements regarding how the provider supported people with dementia. One professional told us there had been a marked improvement in when referrals were being submitted and whilst this had not always been appropriate, they were now receiving appropriate referrals in a timely manner.

The provider worked closely with the local community, engaging in events and activities to promote positive relationships.

The provider was proactive in investigating and addressing concerns raised during the assessment process.

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

Staff told us they did not always speak up with ideas for improvement at the home as they were not confident they would be listened to.

Learning was not always undertaken in a timely manner as a priority. For example, dementia training was only completed during this assessment despite concerns having been raised by other professionals and people with dementia needs living at the home for a lengthy period.

Where things went wrong, meetings were held with staff to disseminate learning to try to reduce the risk of reoccurrence and learn from these incidents.

Residents’ meetings and relatives’ meetings were undertaken where residents and relatives had the opportunity to put forward their views on the home and suggest improvements.

Professionals told us there had been some improvement at the home in terms of the skills of staff and the provider’s engagement with them.