Belong Chester

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 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 governance at the service.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider had inclusive 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 did so with integrity, openness and honesty.

During the assessment, the service was undergoing a planned transition in registered manager leadership. An acting manager was already in post, with their CQC registration application submitted, and the previous registered manager remained within the service in a leadership role to support continuity and stability.The provider had brought in additional support to assist staff and implement the required improvements. Most staff spoke positively about the management team. One staff member told us, “Managers are lovely. Some real talent, they are encouraging. I have a good relationship with them.”

However, some staff told us not all managers were visible on the floor, and some household leads required further development to improve the service.

Some staff reported team meetings and supervisions were not always held regularly, which limited opportunities to provide feedback. The manager acknowledged this and assured us team meetings were scheduled to take place on a regular basis going forward, and all required supervision sessions would be completed. However, staff told us they felt managers were approachable and they felt able to raise concerns where necessary.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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 governance systems in place. However, these systems were not fully embedded in the service or operating effectively to ensure consistent, safe care.

There were gaps in staff understanding of their roles and responsibilities across the service. For example, staff were unclear about who was responsible for laundry, who undertook equipment cleaning, and how these tasks were recorded.

Some audits were in place; however, they were not always effective in identifying the concerns we found. For example, internal medication audits did not identify issues relating to time critical medication, ‘when required’ medication protocols, or fridge temperatures exceeding recommended limits.

Some care plans did not contain information that was relevant or up to date. For example, one person’s oral health care plan contained information about their history of falls and communication needs. Care plans required for some people with specific health needs, such as epilepsy of Parkinson’s disease, were either not in place or lacked sufficient detail. As a result, staff did not have the guidance needed to provide appropriate, consistent, and safe care. People's care plans included information about their preferences for personal care; however, these were not always up to date or consistently followed.

A review of safeguarding incidents highlighted poor documentation and gaps in recording safety checks. We identified gaps in recording of personal care and oral care interventions.

Some concerns identified during the previous assessment remained a concern at this assessment. For example, some staff had still not received regular supervision, and topical creams in people’s bedrooms were not always labelled or dated. The provider’s governance systems had not been effective in monitoring and improving these concerns.

However, we were assured by the new manager, who was responsive, and by the improvements already underway to strengthen governance systems. Following the onsite visits, the manager took immediate action to put relevant care plans in place, arrange training and development days, seek external support, and introduce tools to improve governance oversight at the service.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.