Hartshill 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.

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 service was in breach of legal regulation in relation to governance at the service.

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 did not have a clear shared vision, strategy and culture based on consistency and engagement. They did not always support staff to understand the challenges and the needs of people.

There had been significant changes in the leadership and staff team which had led to instability and concerns about previously identified standards of care not being maintained. Whilst new managers were clear and consistent about their vision for the home, they acknowledged there needed to be more clarity around roles and responsibilities. Staff also needed more confidence to challenge their own practice and that of their colleagues to promote consistency in standards and improve outcomes for people. One staff member commented, “At the moment the biggest challenge is getting everyone working together so that we aren't failing on the same things that we have been failing on.”

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders had not always had the skills, knowledge, experience and credibility to lead effectively.

There was no registered manager at the time of our inspection visit. The provider had very recently appointed a new manager who was in the process of preparing their application to become registered with us, CQC. The new manager had previous management experience and had already identified and prioritised improvements that needed to be made. This included in the areas of medicines management, care planning and staff training.

The provider had also very recently appointed a deputy manager and unit lead who were settling into their new roles. A further vacancy for a unit lead was being recruited into at the time of our inspection visit. The new management team demonstrated a shared commitment to improving standards at Hartshill Care Home but needed time to be fully inducted into their roles and consolidate their understanding of their responsibilities.

Staff spoke optimistically about the new managers and told us there were definite improvements in the leadership of the home under the new management team. One staff member told us they had raised concerns about working patterns in their section and commented, “They listened and made changes." Another staff member told us, “It feels more positive now across the team. I've not heard anything bad that staff can't approach the manager, and I think that’s a good sign.” A third staff member commented, “It has obviously not been amazing when you have managers coming and going and everyone has their own set of rules. The manager we have got now has really tried to get the place right and she definitely cares about the place and the residents."

The new manager told us the provider was available to them and responsive to their requests for support. They commented, "I do feel supported. Anything I ask for, they are always in contact with me. They will listen and they will take on board. The home has had such a turnover of management, nothing has been able to become embedded.”

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

Staff felt confident to raise concerns with the manager or others within the provider’s leadership team. One staff member told us, “I’ve seen the difference the manager is making. I would and I do feel very comfortable to speak out.” Another staff member said, “It’s much better now with the new managers, I feel like they listen.” A third staff member told us they understood the whistleblowing policy and commented, “If it is a serious concern, I don't think anyone would keep quiet about it and you can report it to other bodies."

Members of the management team understood the importance of providing staff with opportunities to raise concerns and being seen to act in response. They told us how addressing concerns about working rotas had benefited staff morale and was improving consistency of care provision in the home.

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.

Staff told us the managers promoted an inclusive environment and did not share any concerns about discrimination within the service. One member of staff told us, “The managers are good, and they treat everybody fairly. I hope these ones stay because they listen. I had a personal issue which I raised with the manager. They were supportive and they listened.”

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 manager and staff had undertaken a range of audits prior to the inspection. However, these audits did not identify significant issues identified during this inspection, as detailed under the ‘safe’ key question. The checks and audits had failed to detect and address safety deficiencies within the physical environment, fire safety and infection control practices. Audits had been signed off by the provider’s representative but with no improvement or mitigation of risks.

Where the provider had delegated responsibility for tasks such as auditing or checks, the responsibilities were not clear and there was no oversight to ensure these were being completed in line with the provider’s own policies.

Although the provider addressed these concerns during the inspection, their internal audits and governance checks had not previously identified them so they could be addressed in a timely manner.

The provider had not always understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They had not always shared information and learning with partners or collaborate for improvement.

External health and social care professionals told us it had been difficult to establish effective partnership working at Hartshill Care Home because of inconsistency in the leadership of the home. One healthcare professional told us, “The issue we find with this setting is they do not retain managers very long. I can honestly say in 2 years I have dealt with 3 separate managers, and it is never easy to review any progress as it feels like you just start again with the new management.” However, there was positive feedback about the new management team and improved communication channels. One healthcare professional told us, “The recent change of management has reflected in a proactive environment where concerns have been listened to, and actions appear to be happening.”

Prior to our inspection we had received some feedback from relatives that concerns had escalated because they had not been addressed in a timely manner. One relative told us, “The staff here are lovely, but they miss things that are important to people. Silly things and it just upsets you.” The new manager recognised communication was an area for improvement and was introducing improved systems for people and relatives to provide feedback and be more involved in care plan reviews. One relative commented, “[Manager] has said she was going to change things but that it wouldn't happen overnight.” The manager had made a commitment to respond to any concerns raised.

However, there was some evidence of good partnership working. Records evidenced staff consulted relatives when decisions had to be made about people’s care needs. We saw one example where staff in the home had encouraged healthcare professionals to consult with a relative who held power of attorney before carrying out a planned procedure. At the relatives wishes, they deferred the procedure, whilst waiting for a second opinion by a specialist.

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 new management team appeared eager to improve practice and drive improvement in the home. However, some of the concerns we found during our inspection were historic and the provider had not taken consistent action to identify and respond to risks as they occurred. The provider needed to create additional and more robust checks to give themselves assurance they were monitoring the service effectively and continuously identifying when improvements were required.

The new manager had identified learning for staff as a priority and was working in partnership with other agencies to provide staff with further training opportunities. However, we received feedback that due to a lack of time during working hours, some staff completed their mandatory training in their own time at home. There was no process to ensure all staff had equity in access to equipment to support their learning or to identify when strategies or adjustments needed to be introduced to support individual learning styles. The new manager acknowledged this was an area for improvement.

The provider and the new management team were very responsive to our feedback and took prompt action to address the immediate concerns we identified.