Asher House

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.

This is the first assessment for this service. This key question has been rated 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 86 (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 created a highly inclusive and values-driven culture where transparency, equality, diversity, inclusion and human rights were at the heart of everything they did. There was a clear shared vision across the service. The registered manager and staff consistently demonstrated a deep understanding of people's individual needs, lived experiences and the challenges they faced. Staff embodied the organisation's values of kindness, integrity, teamwork and excellence (KITE), ensuring people received compassionate, safe and person-centred care.

There was a strong emphasis on ensuring staff felt valued, respected and able to contribute to the development of the service. The registered manager had created an open and positive culture and staff spoke positively about being listened to. Staff said they felt confident raising concerns, sharing ideas and challenging practice when needed. Staff feedback was actively sought and used to improve people's experiences and drive service development. Staff told us they felt empowered to make a difference and understood how their role contributed to achieving positive outcomes for people. Staff worked collaboratively across all levels, sharing knowledge and supporting each other to ensure people received high-quality, consistent care. One member of staff said, “We all step up and help each other out.” Staff demonstrated pride in their work and spoke about people with genuine warmth, compassion and respect.
 

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. The registered manager provided effective and visible leadership, and demonstrated they had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Their commitment and dedication to achieving the best possible outcomes for people was evident throughout the inspection.The registered manager worked closely with staff to ensure people received safe, person-centred care. Staff consistently described the registered manager as approachable, supportive and willing to listen. One staff member told us, “Any concerns, their door is always open.” Staff told us they felt respected and valued by the organisation and the registered manager. Comments included, “The service takes care of the staff,” and “Warm, really nice place to work, very sympathetic manager, ready to listen.”
 

The provider was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard. Policies and processes for speaking up were not only well understood and accessible but formed part of everyday practice, creating a culture of openness, trust and continuous improvement. Staff described a highly supportive environment where they could raise concerns, share experiences and suggest improvements without fear of negative consequences. One member of staff told us, “I would report any concern to the speak up champion. You can contact them, the nurse in charge or the manager. There is also a confidential phone line. It feels safe to raise issues.” Staff feedback consistently demonstrated a strong sense of belonging and shared responsibility for improving the service.Speaking up was not only supported but encouraged. The service had invested in developing a strong speaking-up culture through the appointment of 2 ‘Speak Up’ champions who worked closely with the provider’s ‘Speak Up’ guardian. Together, they ensured concerns were taken seriously, acted upon and used as opportunities for learning and improvement. Regular supervision, visible leadership and open communication further strengthened staff confidence to speak openly about issues relating to care, equality, identity and workplace culture.
 

The provider demonstrated an exceptional commitment to equality, diversity and inclusion, creating a culture where differences were valued and celebrated. Staff described the organisation as fair, inclusive and supportive, with leaders fostering an environment where people felt respected, empowered and able to thrive. The provider placed significant emphasis on staff wellbeing, recognising the importance of mental health, cultural identity and religious beliefs. This included access to a mental health first aider and flexibility to support prayer, religious observance and personal commitments. As a result, staff felt able to balance their professional and personal responsibilities.

The provider demonstrated a proactive and genuine commitment to understanding and valuing the diverse experiences and perspectives of both people and staff. They actively sought feedback and used it to drive meaningful improvements. For example, following concerns raised by staff about being racially abused by people using the service, the provider had taken action to address this. They had initiated a quality improvement project focused on understanding and addressing racist behaviour. This has included staff training, reflective sessions and the development of clear processes for reporting and managing discriminatory incidents. This work had helped staff feel protected, supported and reassured that their concerns were taken seriously and acted upon. The registered manager told us, “The impact of this work has been significant. Staff reported feeling more included, valued and confident in raising concerns. Team cohesion had strengthened; communication had improved and staff felt empowered to bring their whole selves to work.”
 

The provider had clear leadership arrangements, defined roles and responsibilities, and governance systems to support the safe delivery of care and ensure compliance with regulatory requirements. A range of audits, meetings and review processes were used to monitor quality, performance and safety across the service. These included daily and monthly meetings, regular restrictive practice reviews, and a programme of audits to support continuous oversight and improvement. Health and safety monitoring was supported through monthly and quarterly audits, alongside bi-monthly inspections completed by regional health and safety officers. Findings and actions were shared with the registered manager and discussed through daily meetings and clinical governance processes, with issues escalated to regional leaders where appropriate.However, during the inspection, opportunities were identified to further strengthen oversight of some health and safety processes, including fire safety checks and monitoring actions arising from legionella risk assessments. The registered manager responded positively to this feedback and demonstrated a commitment to continuous improvement. Following the inspection, they worked with the health and safety officer to review existing systems and commenced the transfer of records to a digital platform. They told us this would enhance oversight, strengthen monitoring arrangements and support the timely identification and management of risks, further improving the quality and safety of the service.
 

The provider understood their duty to collaborate and work in partnership, ensuring services worked seamlessly for people. The registered manager and staff worked closely with a range of organisations, including the CQC, local authorities, integrated care boards (ICBs), mental health services and social workers, to support positive outcomes for people.People benefited from joined-up care and continuity of support. Staff shared information appropriately, involved relevant professionals when needed and worked in partnership with others to ensure care reflected people's needs, preferences and changing circumstances. Referrals were made promptly, professional advice was sought when required, and recommendations were followed to help promote people's health, wellbeing and independence. Professionals spoke positively about communication and partnership working. Advocates told us staff worked collaboratively, shared information effectively and were committed to ensuring people received the support they needed. This collaborative approach helped people access services in a timely way and contributed to positive outcomes and experiences.
 

The provider promoted a culture of continuous learning, innovation and improvement, with leaders actively encouraging staff to contribute ideas to enhance people's experiences, outcomes and quality of life. Staff were supported to speak up, share feedback and identify opportunities to improve the service. This helped create an environment where learning and development were valued and where staff felt empowered to influence positive change. For example, the Speak Up champions led an initiative to encourage open communication and ensure staff voices were heard. Following ‘Speak Up Week’, they produced a celebration report highlighting learning, achievements and opportunities for further improvement. The service embraced the theme of ‘A Happy Day’, encouraging staff to wear colourful clothing and promoting the message that staff should “speak up loud like the colours” because “every voice deserves to be seen and heard.” Staff reflected positively on the event, which reinforced the importance of speaking up with confidence and demonstrated the provider's commitment to maintaining a supportive and inclusive culture.

Monthly operational and clinical governance meetings provided a structured approach to oversight, enabling leaders to review audit findings, monitor performance and identify opportunities for improvement. Learning from incidents, complaints, feedback and audits was routinely discussed and used to drive service development. Reflective learning and debrief sessions supported staff to learn from events and share best practice. The registered manager actively sought feedback from people, relatives, staff, professionals and members of the public to understand what was working well and where improvements could be made. Feedback was openly discussed through meetings, supervision and team discussions, encouraging shared problem-solving and collective ownership of service improvement. As a result, there was a clear culture of learning and continuous improvement, with staff working together to enhance the quality of care and outcomes for people.