Heaton House 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 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 provider was previously in breach of legal regulation in relation to governance and oversight. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

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.

Staff understood their responsibility to provide safe and effective person-centred care to people, in line with the provider’s values for the service; policies and procedures were in place to support this. A staff member told us, “Heaton House is a good place to work; good team, friendly, and we have team trips out.”

Meetings were held with people and staff, which provided an opportunity to be involved in decisions made about the home. Staff had been updated following our last inspection and advice had been provided regarding governance arrangements and the need for more detailed recording in people’s care plans. The home manager told us, “The services’ core values emphasise dignity, respect, safety and continuous improvement, reinforced through regular staff communication and training.”

Staff received supervision and appraisal; supervision forms had space for managers and employees’ comments including what was going well, any areas for development, and overall performance rating.

The provider produced a monthly newsletter, which detailed what had taken place within the home over the previous month. Information was also displayed within the entrance area on a large screen.

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 were not always able to demonstrate a clear understanding of the service's current challenges, the needs of people using the service, and the wider context in which care and support were delivered. Whilst some leaders showed commitment to improving outcomes for people, this understanding was not consistent across the leadership team. As a result, opportunities to identify concerns and respond proactively to areas requiring improvement were sometimes missed.

We found leaders did not always possess the skills, knowledge, and experience necessary to effectively oversee the quality and safety of care. Governance systems had not consistently identified concerns, and where issues had been identified, actions taken were not always timely or sufficiently robust to drive sustained improvement. This indicated leaders did not always have the credibility or capability required to maintain effective oversight of the service.

We observed the home manager sitting with staff and people in the garden area on several occasions during this inspection. A staff member told us, “Leaders do take wellbeing into consideration and will allocate other tasks if you are not happy and they will check on wellbeing.”

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

People told us they felt comfortable speaking openly with staff and leaders about their care and support, however, some people said they did not know the home manager. One person told us, “I don’t know (manager name) well. If something’s not right, I’d ask to speak to (manager name).” A second person said, “I’ve met (manager name). I’d complain to any of the staff and I think they’d listen; they are doing alright and I have no complaints.”

Staff told us they felt able to raise concerns, ask for guidance or share ideas without fear of negative consequences. A staff member told us, “We’ve had (manager name) for the last 2 years and he is doing well; residents get options, it was chaotic before. He has improved a lot; more training for staff and the building has improved. It’s much more positive and he works hard.”

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.

Leaders provided flexible working agreements to staff to account for personal circumstances such as caring responsibilities and health issues and considered putting reasonable adjustments in place for some staff to help them carry out their role.

Leaders engaged with staff via appropriate forums such as individual supervisions, various staff meeting types and staff surveys. Staff were confident they could raise concerns directly with their leaders, and had received training in equality, diversity and human rights. This was also supported by policies and information supporting staff, or people and relatives to raise concerns externally if required.

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.

At our last inspection the providers’ audit and governance processes were not robust and had not been used effectively to identify issues and shortfalls in practice. Following the last inspection, leaders recognised shortcomings in record keeping and told us improvements were being implemented; however, these changes had not yet become fully embedded in practice.

Shortly after our last inspection, staff had been reminded of the importance of completing audits correctly and were told they should record what issue was found, what action was taken and what improvement followed. Despite this reminder, and although positive progress had been made since the last inspection, audits were still not totally effective in identifying problems and resolving them.

Whilst some auditing and oversight processes were established, these had not consistently identified concerns we found during this inspection. Audits were not sufficiently detailed or effectively monitored to ensure improvements were embedded and sustained.

Records were not always complete, accurate or contemporaneous. We found inconsistencies between care records, risk assessments and daily documentation. In some cases, information had not been updated following changes in people's needs, increasing the risk staff may not have access to the most up-to-date guidance to support people safely and effectively.

Audit records provided to us indicated care plans were not all reviewed each month and the average number of care files reviewed was 3; this meant gaps in records we found during this inspection had not been identified in a timely way, and action had not been taken to resolve them. Whilst we determined no-one had been harmed, this placed people at risk, and opportunities to prevent repeat incidents may have been missed.

An audit matrix was in place identifying who was responsible for each audit and when they were due. Most audits were completed by a senior staff member and were usually ‘signed off’ by the business director or the home manager. Shortly after our feedback to the provider, we received some updated care planning information, however, this did not include every person.

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.

Staff maintained some links with the local community, helping people to remain connected and supported. However, opportunities to access the community for recreation were limited. Some people only accessed the community with the help of their relatives.

The provider told us they intended to develop a sensory garden; however, this was the case previously and very little had changed since our last inspection. The local authority who supported the home told us the provider was not making enough progress against their action plan, and in response to issues identified at our previous inspections.

The provider worked with a range of external partners, including GPs, community nursing teams, social workers, and other health and social care professionals.

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.

Systems for monitoring risk were not always effective. Although incidents, accidents and safeguarding concerns were reviewed, the provider was not consistently analysing information and trends in enough detail to identify recurring themes or opportunities to reduce future risk. This meant leaders could not always demonstrate they were acting on the best available information regarding performance, outcomes, and safety.

Whilst there were some opportunities for staff to reflect on practice through meetings, supervision and training, systems to capture learning and drive service-wide improvement were not always effective. The provider could not consistently demonstrate how learning from incidents, complaints, feedback, and quality assurance activities was used to improve outcomes for people.

Roles and responsibilities within the management structure were identified, however, some staff carried out more than 1 role at various times of the day depending on any staffing shortfalls. Staff understood who to report immediate concerns to; however, there was limited oversight regarding who held responsibility for monitoring specific areas of quality assurance and governance, and some issues had remained unresolved for prolonged periods.