Weavers Court Care 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. This is the first assessment for this newly registered service. This key question has been rated good.

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 statement of purpose which included information about the service’s 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.

People and their relatives had opportunities to give their views and opinions during meetings with staff and management. They were kept up to date with the events within the service through the meetings.

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.

The provider had processes in place such as team meetings which were facilitated regularly and involved staff on improvements they planned to make within the home.

The manager had also kept their knowledge up to date to ensure care was delivered in line with good practice and national guidance.

Audits on quality of carewere conducted regularly, and appropriate action was taken in response to concerns

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

The provider had a Whistleblowing policy and procedure in place. Whistleblowing is the term used when a staff passes on information concerning wrongdoing. There was a culture where staff felt safe and confident to raise concerns without fear of reprisal.

The manager was open about lessons learnt and actions taken to prevent recurrence. They understood duty of candour and their responsibilities. Regular staff and management meetings were being held.

We reviewed complaints and found they were all investigated and closed in a timely manner. Appropriate action been taken to aid learning and prevent re-occurrence.

The service had also received compliments from families, relatives and friends. One relative told us, “The management has changed but they were really good in the process. It is very good and well run and [Person] has got the room [they] chose. They asked [them] which room [they] wanted.”

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.

Regular staff meetings were held with each of the staffing groups to share their views and experiences and for the registered manager to cascade information about things happening in the service. Staff meeting minutes were maintained to ensure that all staff had access to the information they needed.

The 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.

The provider’s quality assurance arrangements monitored the quality of care and people’s experience through its internal auditing processes. A wide range of audits and checks were carried out to monitor the quality and safety of the service and to identify how the service could be improved. These included areas such as risk assessments, care records, daily records, medicines charts and staff training to ensure they provided care and support to people to the required standard. However, areas identified during assessment in relation to (PAT) testing and processes to notify outside professionals and family in a timely way had not been completed. These shortfalls were acknowledged, and appropriate actions were taken to resolve and improve these. The management team were transparent and open throughout the assessment.

Any learning identified was discussed with appropriate people, for example, staff, residents and relatives through communication channels such as meetings and reviews.

We also saw clinical governance meetings where clinical matters were discussed and reviewed, and lessons learned considered.

Data was used to identify trends and patterns in key areas such as accidents and incidents. This information was used to help the management team drive improvement. Satisfaction surveys were also undertaken along with observations of practice.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accident, incident and falls were accurately reported and robustly reviewed, with clear analysis for trends and themes and actions taken in a timely manner following each event.

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.

Staff at all levels had opportunities to make suggestions about service improvement through staff surveys and meetings.

The manager kept up to date with local updates. The manager was committed to learning and improvement regarding the people that lived at Weavers Court and the environment. They were receptive to feedback from people who use the service and relatives and took action to improve the quality of the service.

The manager analysed incidents and accidents to identify themes or trends to reduce the risk of avoidable harm. For example, in relation to falls.