Wilton 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.

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. 

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst the provider had clear visions and values in place, we could not be assured these were always followed. Lessons learned were not always identified through accident and incident monitoring, meaning lessons learned were not always shared with staff. Staff were provided with opportunities to feedback to senior leaders, and this feedback was used to improve staff’s well-being and performance. Information sheets were used to inform staff of best practice guidance, such as sepsis awareness and risks from emollients. Action plans were also triggered by the provider, following examples of poor practices in other services. However, due to the concerns found during our assessment of the service, these had not been effective. Staff were involved in team meetings and had regular supervisions. Staff told us they felt supported in their roles and worked well together as a team. A staff member said, “It is a fantastic place to work. Manager is fantastic, they are good and friendly and offer you help.”

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. We could not be assured leadership at the service was effective in monitoring the safety and quality of the care people received. Quality audits had been undertaken; however, these were not effective in identifying concerns we found during our assessment. The management team had failed to notify CQC and the local authority about several notifiable incidents. Following our assessment the provider made retrospective reports.

Systems were in place to enable staff to speak up about poor practice, and staff told us they felt able to raise concerns and action would be taken. Freedom to speak up posters and information was available for staff information and guidance. However, due to the lack of reporting of accidents and incidents, we could not be assured the leadership team and staff appropriately recorded and reported incidents. For example, 1 person had disclosed to staff a concern whilst at a day centre, this was not reported to the management team, and the management team failed to identify this due to a lack of monitoring of daily records.

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. Policies and procedures were in place in relation to promoting equality and diversity within the staff team. Staff felt supported in their roles and told us no one had been subject to any discrimination.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Governance systems were in place; however internal and provider level audits had not always identified concerns we found during our assessment. Such as concerns relating to records, IPC, medicines, environmental risks, safeguarding, dignity and respect and managing risks posed to people. Quality matters newsletters were in place which the provider distributed, and included key information about best practice, such as IPC and medicines. However, these were not effective, as we found several compliance concerns. We also had a delay in receiving records during our on site inspection activity.

The provider understand their duty to collaborate and work in partnership, so services worked seamlessly for people. Relatives told us they were kept informed of any changes. We found people had regular access to the community and attended several community activities, such as sports activities, day trips and local discos and day centres.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. The provider had an ongoing action plan; however, this did not include all concerns we had identified during our assessment. For example, there were no considerations in relation to storage of medicines, fixing the drainage issue or taking action to address open areas containing hazardous substances. Concerns were not always recorded, meaning we could not be assured action was taken to address these. Following our assessment, we requested some immediate assurances from the provider about the concerns identified. Whilst some assurances and evidence was provided, the registered manager and senior leadership team were not receptive to our feedback, and did not provide us with some immediate assurances about changes which were required. Feedback surveys for people and relatives were in place and showed people were overall happy with their care and support.