Newton Hall 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 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 provider was in breach of legal regulation in relation governance at the service.

This service scored 50 (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 shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

There was not always a clear or shared direction for the service, and limited oversight from the provider had impacted the development of a positive and inclusive culture. Although members of the management team were visible within the service, they did not always demonstrate the skills, knowledge, or leadership required to effectively support staff and drive improvement. Opportunities for the registered manager to promote and embed a positive culture across the service had not been fully realised. This was partly due to the lack of provider involvement within the home. One staff member told us, “They [management] do try their best, but the head office does not give us the resources we need, so it is always difficult on us. We just have to do our best.”

While people told us they were happy with the care they received and felt staff knew them well and treated them with kindness, the concerns identified did not demonstrate a shared vision or commitment to delivering consistently high-quality care in a safe, well-maintained, and pleasant environment. These concerns included cluttered and unclean areas within the home, shortcomings in medicines management, and a lack of robust governance and oversight systems to effectively monitor and improve the quality and safety of the service.

The provider did not always 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. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

While the registered manager was visible within the service, they did not consistently demonstrate staff received support during peak periods, particularly in the mornings when demand on the service was greatest. This was a key time of day when many people required support with personal care and getting ready for their day, and effective leadership and oversight were especially important. Staff from other departments, including domestic staff, were required to assist with breakfast preparation and support people with personal care. This had a negative impact on the cleanliness of the home, as we found some people's bedrooms were not maintained to an acceptable standard and communal bathroom areas were unclean.

There was limited oversight and support from the provider. The provider had not effectively identified, escalated, or addressed concerns that had been raised by the registered manager. These included ongoing shortages of domestic and kitchen staff, concerns regarding the cleanliness and upkeep of the home, and the need for environmental improvements and upgrades. This lack of timely action and provider-level oversight had contributed to delays in addressing issues that impacted the quality and safety of the service.

The operations manager acknowledged the concerns identified. The registered manager had developed an action plan to address some of the issues found, and the provider had approved certain improvement works. However, more significant involvement and support from the provider remained necessary to ensure improvements were implemented effectively and without delay. This included strengthening oversight arrangements and providing more robust performance management and support for the service management team. Greater provider-level engagement was required to drive sustainable improvements, improve accountability, and ensure people consistently received safe, high-quality care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they felt confident to raise concerns if needed and they would be listened to. One staff member said, “I can speak with [registered manager or deputy manager] if I need to. They have an open-door policy, and both are always available if need.”

People and relatives felt equally confident to raise concerns if they had them. One relative commented, “Yes, I can speak to the manager or any staff really, they always listen to any concerns I may have."

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 were staff from a divergent population who told us they worked well together. Staff told us they felt leaders were supportive and engaged with them. Whilst we identified there were some dissatisfactions within staff regarding the provider involvement, and staffing concerns, there was no indication of inequality towards any staff members. The registered manager was dedicated to supporting all members of their team.

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.

The provider failed to assess, monitor and improve the quality of the service. Nor had they established and operated effective governance systems and processes to ensure compliance with the regulations and to ensure the safety and quality of the service. We saw audits had been completed by the registered manager and sent for review to the operations director. However, these were not effective as they did not identify issues we identified. Although records of incidents were recorded, leaders failed to record sufficient evidence of learning from these incidents to be able to demonstrate understanding of the cause of incidents. The monthly analysis for accidents and incidents contained the same information about the number of incidents recorded, such as falls, incidents reported to CQC which did not give assurances this information was reviewed and analysed properly.

The provider did not understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

The service worked collaboratively with local GP practices and other healthcare providers where appropriate. However, the registered manager had not consistently escalated concerns that would have benefited from specialist clinical input. For example, individuals who had experienced choking incidents had not been referred to a Speech and Language Therapist (SALT) for assessment and support, despite SALTs being qualified to assess and manage swallowing difficulties.

In addition, concerns relating to potential self-neglect were not always escalated to relevant external agencies, such as the local authority safeguarding team, to ensure appropriate oversight and intervention.

A healthcare professional told us, “Advice is offered regarding residents; however, this does not always appear to be cascaded to the wider Newton Hall team as the same residents and issues may be highlighted during the next GP or Mental Health visit.” This feedback indicated professional advice and recommendations were not always being effectively communicated or embedded into practice across the staff team, creating a risk that identified healthcare needs may not be consistently addressed.

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. They did not alwaysactively contribute to safe, effective practice and research.

Systems were in place to identify learning from incidents and accidents. However, there was limited evidence provider level oversight to ensure wider learning was identified, embedded and sustained. Systems had failed to identify the management of learning, improvement, and risk was ineffective. For example, deterioration in people’s physical wellbeing was not identified or escalated effectively nor had the management sought knowledge about people’s specific needs such as diabetes and mental health needs. This meant people would not always receive care, support and treatment in a timely way. A healthcare professional commented about requests made by staff to prescribe medication people experiencing known symptoms of dementia and the advice offered to staff such as the use of non-medicines strategies, speaking to family regarding any information that may help and complete behaviour charts which can be reviewed by the relevant teams however, this does not seems to be taken on board.

Staff we spoke with, and the management team lacked knowledge in the Mental Capacity Act 2005, and safeguarding, and medicine management despite having undertaken the training. As a result, the provider could not fully demonstrate learning and improvement were fully embedded into practice.