Longmead Court Nursing 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 requires improvement. At this assessment the rating has remained 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 oversight and governance at the service.

This service scored 57 (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 transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The home’s Statement of Purpose, a legally required document that sets out the provider’s aims, objectives and the services delivered, clearly outlined commitments to privacy, dignity, independence, choice, rights and fulfilment. These principles were also outlined in the service user guide. However, opportunities to reinforce these principles with staff were missed. Although staff meetings were held regularly, the home’s vision, values, aims and objectives were not discussed, limiting staff understanding of how these applied to their roles.

Staff feedback about the service’s culture was mixed. During this inspection, not all staff felt able to share their views on leadership, indicating a culture that did not consistently promote openness, listening, trust, and compassionate leadership. While some staff described an open and honest culture that supported continuous improvement, others provided less positive feedback.

There was limited evidence of a focus on learning and continuous improvement. Although service improvement plans and audit action plans had been developed, these were not consistently used to monitor progress or drive improvements when issues were identified. This reduced oversight of actions taken and limited the provider’s ability to demonstrate that identified concerns had been effectively addressed and sustained.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

The service had a leadership structure in place, consisting of the registered manager, nominated individual, clinical lead and care manager. There was a positive working relationship between the nominated individual and registered manager, and leaders described how they worked collaboratively to support the day-to-day running of the service. The provider's governance policy included an organisational chart; however, this had not been updated to reflect the current management structure within the service. The supporting leadership roles of clinical lead and care manager were not included, despite these individuals having responsibilities for overseeing and supporting the delivery and quality of care. This meant governance documentation did not accurately reflect the arrangements and expectations for oversight responsibilities and accountability. The Care Manager completed spot checks on the culture within the service and the quality of care provided, with immediate feedback shared with staff. While this demonstrated some monitoring of practice, the findings from these checks were not incorporated into a structured service improvement plan. There was no clear evidence of how identified issues were followed up, monitored, or used to drive sustained improvements in practice. As a result, leaders could not demonstrate how quality assurance activity was used to drive continuous improvement and improve outcomes for people.

The registered manager received regular supervision and support. However, concerns identified during this inspection had not been recognised or discussed as part of these meetings. Although leaders were responsive to the feedback we provided during the inspection and took steps to discuss actions required, there was limited evidence that all concerns had been proactively identified, resolved or learned from prior to our visit.

We saw evidence of succession planning, with staff being supported to develop their skills and progress into nursing roles to help sustain the workforce and meet future service needs.

Staff provided mixed feedback regarding the visibility and presence of managers within the service. Whilst some staff felt well supported by leaders, others reported that management presence within the home could be improved. This indicated leaders had not consistently established a visible and accessible leadership approach across the service.

People did not always feel they could speak up and that their voice would be heard.

The provider had a Freedom to Speak Up policy in place, which was subject to regular review and provided guidance for staff on raising concerns internally and escalating concerns externally where necessary. The policy included details of an independent whistleblowing helpline; however, the contact number was out of date. We also found the policy contained inaccurate information about the service user bands, which outlines the needs of people the service is designed to support.

Staff provided mixed feedback about the culture of speaking up within the service. Some staff felt confident raising concerns and believed managers would listen and act. One staff member told us, “I would report concerns immediately to the senior or manager, complete incident forms where appropriate, and I know the whistleblowing procedure if needed.” However, other staff did not feel there was an open culture where feedback was welcomed and managed constructively. One staff member said, “I am often made to feel guilty for speaking up.”

Leaders told us they had an anonymous reporting system available for staff who did not feel comfortable raising concerns openly. However, the mixed staff feedback indicated leaders had not consistently embedded a culture where all staff felt safe and supported to speak up.

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.

The provider employed a diverse workforce and had an Equality, Diversity and Inclusion (EDI) policy in place to promote fair treatment and inclusion within the workplace. Staff told us staff from different backgrounds worked effectively together. One staff member said, “We are a large number of different nationalities. All the staff, all genders and cultures, have been really supportive.”

We did not receive any feedback indicating discrimination, exclusion or inequality within the workforce. This indicated the provider had fostered a culture that valued diversity and supported equality of opportunity for staff.

he 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, performance and outcomes, or share this securely with others when appropriate.

Although improvements had been made to the systems of governance and oversight, including a system of audits, action plans and an overarching service improvement plan (SIP), they were inconsistently completed, with action plans not always evidencing action had been taken where issues were identified, and the improvement plan not always being updated to reflect ongoing work or how improvements would be measured and monitored to ensure they were sustained and embedded. Systems of oversight had not identified all the issues we found during the inspection. Where systems of oversight and assurance had identified issues such as fire safety, it had not been given sufficient priority and prompt action had not been taken to complete remedial works to ensure people’s immediate safety. Although some issues, for example, with recording, especially around fluid intake, had been highlighted as a concern through internal audits, there was no entry on the service improvement plan to highlight this as a current issue within the service and no evidence of ongoing work to monitor for improvement. Although the registered manager told us all action plans were reviewed by them prior to being signed off as completed, with entries made into the SIP where required, we saw some quality assurance checks completed by other staff members, for example the clinical lead and care manager; including fluids recording and spot checks which had highlighted issues but had not resulted in action plans being created or entries made onto the service improvement plan. External audits were used as an additional measure to strengthen assurance checks; however, the findings had not been used as an opportunity for organisational learning. For example, where audits had identified issues in individual care plans including with Mental Capacity Assessments (MCA) and fluids recording, although we saw immediate action had been taken to resolve individual records, work had not been undertaken to implement wider improvements across the service.

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.

We saw links had been made with local organisations to enrich people’s lives and reduce social isolation, for example a school choir had recently attended the home, and a church service had taken place. A relative told us a church choir had also performed. Resident and relative information boards were in place in prominent locations in communal areas in the home, and displayed information relevant to the people living there, for example literature from the Alzheimer’s society and information about the dementia café. The home had recently implemented a coffee morning, which promoted resident and relative engagement with the clinical lead. We received feedback that this had been a positive step in encouraging open communication. A relative said, “They [clinical lead and nurse] are great. I asked [clinical lead] about something I was worried about; they sorted it. Never have to wait. There is a coffee morning every week. There is cake, tea, and special coffees.” The home had positive working relationships with health care professionals, who visited regularly and gave us positive feedback on their interactions with the provider and staff.

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 always actively contribute to safe, effective practice and research.

As already outlined in the Governance, management and sustainability section of this report, systems of governance and oversight were not effective in identifying concerns, embedding learning, and driving continuous improvement to achieve consistently good outcomes for people.

More needed to be done to develop staff skills around innovation. Although staff members had been assigned the role of ‘champions’ in various topics, including infection prevention and control and safeguarding, there had been no additional training provided to support them to undertake these roles effectively. However, the home had recently rejoined a quality improvement scheme provided by the local authority to improve standards of care and outcomes for people. As this had only been reintroduced in March, more time was needed to embed this into practice and evidence how it had improved people’s care and treatment.