Frenchay 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.

We assessed all the quality statements within the key question of well led. We found the service was in breach of a legal regulation in relation to good governance.

We received mixed feedback from staff about the culture at Frenchay House. They told us recent changes had affected the aims and culture of the service. Some staff felt there was a positive and understanding culture, but others said they felt unsupported and did not enjoy working at the service. People and relatives told us they felt able to speak up if they had any concerns. The management team were aware of current issues and risks and were taking action to address these.

The service had systems of accountability and governance. These monitored performance and risks to the quality of the service. It had not been possible to action all improvements at the same time, but these were being prioritised and addressed.

The management team had the skills, knowledge, experience and credibility to lead effectively. People, relatives and staff were still getting to know the new leaders. Professionals said relationships with the service had been improving.

The provider valued diversity in their workforce and staff told us they respected each other and worked as a team to support people. The provider had staff initiatives and reward schemes to support staff and recognise achievements. The provider was keen to develop and improve, and there were strong relationships with local networks and schemes to support innovation and lead to better outcomes for people.

This service scored 54 (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 vision, strategy and culture which aimed to provide people with a good quality of life at Frenchay House. However, there had been several recent changes at the service which had meant this had been harder to achieve. The management team were aware of this and were taking actions to address risks and barriers.

At the time of our assessment, staff did not always feel the provider’s vision or strategy were upheld, and they told us communication was not as effective as it could be. The management team told us improvements were being made, for example by introducing task allocation sheets, reviewing staff supervision sessions and ensuring regular staff meetings took place. We saw evidence that the management team had recently shared information about the service’s priorities and action plans with people and staff.

We received mixed feedback from staff about the culture at the service. Some staff felt there was a positive and understanding culture, but others told us they felt unsupported and did not enjoy working at the service. Some staff said they did not raise concerns because they did not feel they were listened to or taken seriously. Some staff told us they did not feel leaders worked with them or supported them on a day-to-day basis. For example, in a crisis or when there were shortages of staff. They felt managers were physically distanced from them because the main office was in the attic of the building. Staff therefore believed managers were not able to effectively monitor their practice or lead by example.

We also received mixed feedback from people and relatives about their experience of Frenchay House. Comments ranged from, “I don’t think much of the home” to “I am one very satisfied customer.”

There had been several recent changes within the management team which had presented some potential risks to the quality of care. People, relatives and staff were still getting to know the new leaders.

During the period of change, staff felt they had not always been well supported by managers. Staff and other professionals felt leaders were not always visible within the service. This meant staff did not always feel they were learning from managers’ experience or knowledge. We highlighted this to the management team during our assessment.

However, the management team were experienced and understood the expectations of their role. They had the skills, knowledge, experience and credibility to lead effectively. The management team were aware of examples of poor culture and had taken action to address issues which could affect the quality of people’s care, or the service provided. One professional noted, “The new manager is settling in, and I feel they will need time and lots of support and encouragement to see if they can motivate the team to become the carers they hope and desire.”

Staff did not always feel they could speak up and that their voice would be heard. Some staff told us they did not feel the culture empowered them to raise concerns or drive improvement. Several staff told us they, “Just wouldn’t bother saying anything anymore.” Before starting this assessment, some staff had given feedback anonymously to CQC because they felt their concerns were not being listened to or actions taken.

The new management team were aware of the need to continue to develop the culture at the service. They had recently run some team building activities and planned to continue encouraging positive changes.

People and relatives told us they felt able to speak up if they had any concerns. They told us they would speak with staff or a manager. Several relatives told us they had raised issues and felt these had been taken seriously and were investigated sensitively.

The service had systems and processes in place to support the sharing of information and obtaining the views of staff, people and relatives. This included meetings, surveys and complaints. A ‘you said, we did’ board was clearly displayed at the entrance to the home to provide updates about changes and improvements.

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. Staff told us they respected each other and worked together as a team to best support people. Comments from staff included, “The team is wonderful, and we do a lot to bond as a team. I try and help [deputy manager] as much as possible I think the world of her” and “Everyone supports each other.”

The management team monitored the culture of the organisation relating to equality, diversity and inclusion. They aimed to ensure all staff had opportunities and took action if there were differences in the experience of staff. Some staff had recently requested flexible working arrangements, and these were being reviewed individually by a senior manager.

The provider had initiatives such as confidential support and reward schemes available to all staff to promote workplace wellbeing and support staff to be able to carry out their role effectively.

The service had systems of accountability and governance and oversight of current and future performance and risks to the quality of the service. Improvement plans were in place and leaders regularly monitored these for progress. There had been a period of time when management changes had resulted in gaps in oversight and changes being made to practice and procedures.

The management team carried out regular checks to check the safety and standard of care. When shortfalls or concerns were identified, an action plan was in place to monitor the progress of improvements. Although audits had identified most of the gaps we found during our assessment, action had not always been taken to make improvements in a timely manner. One professional told us, “In the last few weeks, I do feel that management are making a drive to improve, and they appear to be putting processes in place.

Staff were clear about their role and responsibilities, although some staff were new to Frenchay House and were still learning about the expectations on them. The management team had taken action when the performance or behaviours of staff did not meet expected standards. The registered manager understood the requirements of their role and regulatory responsibilities. Information and notifications were shared with CQC and other external organisations as required.

Staff and leaders understood their duty to collaborate and work in partnership with others to help services work seamlessly for people. People and their relatives told us they had been supported to receive specialist care or treatment when necessary, and staff said they often escorted people to appointments.

The management team were liaising with the local authority safeguarding team to learn and make improvements to the service. This helped to ensure high quality, joined up care was consistently provided.

Some people were supported to access facilities in the local community, and the service was actively engaged in events such as a local flower show and would be hosting a summer garden party.

Staff and leaders engaged with people and families, communities, and partners to take action to continue improving the service. Specialist nurses had recently provided training to share information and skills with staff to improve the service and people’s experience. Staff told us they had good working relationships with other professionals such as GP, specialist nurses and social workers. Professionals said relationships with the service had been improving. One professional told us, “I do see attempts to change from staff and management and recognition that things need to improve. I have witnessed some truly good care for residents, and I do feel that concerns are often raised in a timely manner.”

The service had not always focused on continuous learning, innovation and improvement. There had been recent changes in staff at all levels and this had led to inconsistency in making and evaluating improvements. The management team were addressing shortfalls, although time was needed to embed these changes.

Staff said they did not always feel supported to make suggestions or share their ideas for improvement. One staff member told us, “I just don’t bother going to [management] anymore.” The management team were motivated to make changes and were responsive to our feedback. They felt the provider was supportive and invested in the service to make improvements.

The provider was keen to develop and improve, and there were strong relationships with local networks and schemes to support innovation and lead to better outcomes for people. A management development programme run by the provider supported staff to develop their skills and knowledge in line with a plan for career progression and continuity in the service.