Archived: Hilbre 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 since this service was registered. 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 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The manager explained how it was important for them to provide the best care possible to the people living at Hilbre House. Staff understood this vision. Staff were keen to tell is how they felt valued and how they worked well as a team.

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. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders and managers at were available to staff and had the experience and capability to ensure the provider’s strategy of delivering high quality care was delivered.  

Staff spoke positively about how supportive the provider and manager were. One member of staff told us, “I feel well supported. Managers are firm but fair, they are approachable."

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.One member of staff told us, “I feel listened to.” Another told us, “I have no problems speaking with managers.”

People were able to provide their feedback and ideas through a variety of ways such as meetings and surveys. The manager was also keen to tells how she promoted an ‘open door’ policy, so that people, their relatives and staff could approach her at any time.

Relatives were keen to tell us about how they felt able to speak up and raise any issues if required. Comments included, “If I have any problems I can raise them, the staff and manager are approachable” and “I am invited to give feedback and to the meetings, but I can't always go. But if I had a problem I could speak with staff, no issues. I can visit anytime. I feel like I am kept informed."

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 were in place to ensure staff were treated in an equitable way. One member of staff was keen to tell us about how supportive the management team had been of them during a period of illness, “They [managers] were just amazing."

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. However, some processes required further development.

Although audits were effective at highlighting issues, some actions to address the identified shortfalls required further detail. Such as, who would complete the action to rectify the issue and a likely timescale to complete.

Governance processes helped to deliver good quality, sustainable care, treatment and support, and ensured the provider had an up-to-date picture of risk across the service. 

For example, we looked at minutes of staff meetings and audits and found the provider had already identified staff needed to add additional detail to people’s daily care records, to help better evidence the care and support which had been provided.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

People’s care records evidenced appropriate partnership working with external agencies, for example, in relation to managing people’s nutritional requirements and other specific health conditions. We saw staff working with visiting professionals on the day, to help meet people’s care and support requirements.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider demonstrated they were focused on learning and improving. There was evidence of appropriate learning from incidents, complaints and safeguarding concerns. The provider used this information to help drive up further improvements in the service.