Tower View Residential 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 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.

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

The provider did not have a clear development plan for the service that was available for inspectors to review at the time of the inspection. Instead, their service plan was linked to the plans for their sister house, Tower House, their sister service. However, the 2 services supported different service user groups and supported people who had different outcomes. The provider explained the main aspiration for Tower View was to be a service to support people who wanted to move away from support in a registered care home, including enabling their independence skills. After the inspection the provider shared both a mission statement and a service plan. However the service plan lacked detail in how they were going to achieve the goals they set and how they were going to assure themselves they were delivering support that was in line with Right Support Right Care Right Culture.

The support provided to people relating to developing independence skills was inconsistent and conflicting. For example, people were independent in their community however they were not independent within their home. The provider failed to develop a culture within the home that encouraged independence and autonomy.

Staff we spoke to could not identify what the direction and culture of the service which meant they could not ensure they were providing support in line with the providers plans.

However staff told us they were supported well by the service manager who they felt was approachable and fair. They felt the service manager had a flexible and cooperative approach to management and they listened to staff.

Leaders did not always have the knowledge, experience and oversight to lead effectively.

People told us the registered manager was seldom present in the service and that it was being managed by the registered manager of their sister house, Tower House. We saw that the registered manager of Tower House managed rotas, completed audits, supervised staff and had oversight of peoples support plans. This meant the registered manager did not have appropriate oversight of the service. After the inspection the registered manager shared some audits records that demonstrated they had reviewed some of the audits completed by the service manager.

The service was being funded to have 24-hour support in place. However, the provider was not delivering this level of support and had reduced staffing levels some years previously. They had not effectively liaised with the local authority to have care and support assessments reviewed and funding adjusted. This meant people were not getting the support they needed to ensure their goals and aspirations were being met. Further the commissioned hours the local authority was paying for were not being delivered.

However, the service manager demonstrated they could manage the service in a way that enabled people to feel safe. For example, they could describe the steps they took when 1 person was experiencing a drop in their mental wellbeing and how they ensured staff adapted the support they delivered to ensure they were still supported safely.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. People felt they would be listened to if they raised a concern. The provider had the appropriate speaking up policy. Staff told us the service manager was approachable and addressed any issues that were raised either through formal supervision or informal meetings when needed. The service manager told us there had been no issued raised with them but that if there were any they would listen to and respond to any concerns in a sensitive manner.

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. There was a diverse work force within the home and staff told us the service manager had a flexible and accommodating approach. For example, when 1 member of staff had needed to have some flexibility relating to their caring responsibilities, they had been able to adjust their work pattern to ensure they could fulfil their caring responsibilities.

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 and outcomes. The registered manager of the service was not present in the service. The registered manager of Tower House had day to day management responsibility for the people and for recruitment and supervision of staff. People told us they only saw the registered manager in the home occasionally.

The provider did not always ensure risks were appropriately managed. They had identified risks to people using the kitchen independently. However, rather than mitigate these risks by ensuring there were staff present at the home they had stopped people cooking. This meant people were being supported in a way which restricted their choices. Since the inspection the provider has demonstrated that 1 person has started to cook some meals with the support of staff.

Mental capacity assessments did not always demonstrate how people’s capacity could fluctuate so this could be identified and appropriately responded to. Reviews of these assessments had failed to identify the shortfalls.

However, the service manager was completing audits including, medicine and environmental audits. Whilst most were effective the environmental audits had failed to identify issues with lighting and heating in the lounge.

The provider understood their duty to collaborate and work in partnership with other services, so services worked well for people. The provider ensured they worked collaboratively with health services. People shared they were happy with the support staff gave them to engage with other services. However, the provider had not always proactively engaged with the local authority about changing support needs of people. We saw staff from another service visiting the home during the inspection. They shared they experience positive and open partnership working with staff at the home.

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.

The provider did not know what best practice looked like in relation to support for people with a learning disability, autistic people and people with mental health conditions. As a result, people were not always supported in line with current best practice.

The provider had been using DVD’s provided by a training company which relied on managers ensuring training was safely delivered and that staff understood the training they had received. They had recently changed their training company and staff were now accessing a mixture of face to face and online training.

There had not been any incidents within the home recently, however the service manager demonstrated they knew the process they would take to record and share any learning point in the event of an incident occurring.

Staff told us they were supported with developing their learning if they wanted to develop their skills.