Cherington

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• 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 inspection we rated this key question requires improvement. At this assessment the rating has remained the same. 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 found a breach of legal regulation in relation to governance.

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 shared vision, strategy and culture, but this was not always understood by staff or put into practice. Whilst the vision was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities, people did not always receive a high standard of personalised, empathetic and compassionate care as evidenced throughout this report.

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.

We asked relatives whether they knew who the registered manager was and whether they thought the home was well managed. This is what they said, “There’s too little guidance from the manager of what’s expected. It’s not well-led. The staff aren’t happy, they seem to have gripes with the management, I don’t know what about, but that’s the impression I get.” And, “I feel generally it is well managed given the financial restraints. I don’t know if she gets things sorted. I don’t know if what you bring up goes further than the office.”

Staff provided mixed feedback about the management of the home. An agency carer said, “They explain everything to me.” Many staff felt pressurised to get things done and cited staffing levels as an issue.

Following the inspection, the provider told us they recognised the importance of consistent management presence and that the registered manager would be more actively involved on the floor to oversee care delivery. In addition, the provider’s head of quality would be based at the home to oversee governance and care provision.

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

There was some disgruntlement amongst the staff partly attributable to the different working conditions experienced between agency and permanent staff. In addition to the differences in pay, permanent staff told us they were expected to oversee and guide the practice of agency staff who did not always know people well. One staff member said, “We do have staff meetings, but not very often” and agreed completely with our observation that care was not person-centred, but task based.

The provider had a duty of candour policy, and the registered manager understood their responsibilities to be open, transparent and honest when things went wrong.

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.

One staff member described a diverse staff working group and said, “We have Africans, Polish, we are all together for the best of the residents. We just manage.”

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.

During the inspection we found several areas of concern including staffing levels and deployment of staff, staff training, risk management, lack of person-centred care, lack of dignity and respect for people, accessible information, and a lack of management oversight at the home. A range of audits were reviewed including health and safety, equipment, environmental audits, the provider’s contingency plan and internal audits completed by the provider in the safe and well led key questions. None of the concerns we found at this inspection had been identified as part of the provider’s auditing systems. We provided detailed feedback to the registered manager and provider as part of this inspection. We have received assurances with regard to an increase in staffing levels, management oversight of the home, staff training and provision of meaningful activities for people, and we shall review progress against these actions at our next assessment.

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 collaboratively for improvement.

The provider had received support and guidance from healthcare professionals and continuing support from the local authority’s quality and marketing support team. The latter commented that improvements had been slow and inconsistent but following the recent involvement of a quality lead from the provider and the implementation of a service improvement plan, improvements had been made in some specified areas since October. This team continue to support the service as they work to make further improvements. The findings of this assessment will be shared with them.

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.

The home is registered for the service user band of learning disabilities or autistic spectrum disorder. At the time of this inspection, there was no-one living at the home with a learning disability or autism. Since the home is registered to support this group, we expect staff to complete training in line with the Oliver McGowan Code of Practice or similar training. This is to ensure the workforce has the right skills and knowledge to provide safe, compassionate and informed care to autistic people and people with a learning disability. The training records showed staff had completed this training, but a staff member had little understanding of what they had learned. When asked about their understanding of Right support, right care, right culture, the registered manager had no comprehension of what was meant by this, so was unable to demonstrate how any model of care might align to this current best practice guidance.

Issues found as part of this assessment had not been identified by the provider to enable learning to take place or for actions to be taken.