David Gresham 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 for this newly registered service. 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 82 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

The registered manager had established an exceptional shared culture and vision at David Gresham House, where people were valued as individuals and the service genuinely felt like home. People spoke warmly about their experiences, with 1 person explaining, “I feel at home here. It’s a big thing to give up your own home. I have found that remarkably easy here”, while a relative said staff, “Go above and beyond.”

This positive culture was evident in the genuine relationships between people and staff, who chatted, laughed and shared interests, creating a welcoming and inclusive atmosphere. The registered manager actively promoted this ethos by working alongside staff, supporting them to understand people’s individual preferences and ensuring these were reflected in everyday life, such as preparing meals to meet individual choices, even where this meant cooking separately for 1 person.

Staff described the service as, “Like a family between staff and people” and demonstrated a shared commitment to providing care because they genuinely cared about people. The registered manager reinforced this vision through regular staff meetings, informal supervision, practical observation and discussions about policies, professional conduct and duty of candour. They encouraged staff to take ownership of their learning and responsibilities, including recognising and rewarding staff who fully engaged with policies. This hands-on, values-led leadership ensured the service’s vision was not simply something expressed by the registered manager, but was understood and consistently reflected in the attitudes, relationships and actions of the wider 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.

Relatives spoke highly of the registered manager, telling us they felt there were experienced and capable. One relative told us, “I wanted to speak to [registered manager] one day and there was instant access (to her). She resolved things straight away and she promised to send me information later and she did. When there are social events she participates.”

Staff also felt the service was well managed. They said they felt supported by the management team. They told us, “I am happy here and we are a good team. I am happy with management”, “Management are great. They’ve helped me a lot. They are there when I need them” and “I feel very supported. I wish I’d found this job sooner.”

The registered manager supported staff to share ideas and enabled them to put these into practice. A staff member told us, “Two years ago the registered manager asked me if I needed anything and I said a greenhouse so she bought me one. She asked me again last year and I said a greenhouse again so she bought me another. We grow all stuff we use in the kitchen and people help with this. This year, I’m going to ask for raised beds.”

The registered manager understood their responsibility to notify CQC on any incidents or accidents resulting in an injury to a person as well as any safeguarding concerns.

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

Staff said they would have no hesitation speaking up. One told us, “I would definitely raise something if I had any concerns.”

Staff had the opportunity to raise concerns, suggestions or share ideas through staff meetings. These were held regularly and from the minutes we read we saw there was good attendance. Where care did not go to plan, the registered manager understood their need to follow duty of candour and apologise.

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 registered manager ensured all staff had equal opportunity within the service. They told us, “If a staff member cannot attend a staff meeting in person, I give them the chance to attend remotely.” This meant staff could feel included even when not in the service.

The registered manager went on to tell us, “I try to be really fair. I am very black and white. My door is normally open and I will always make time for staff, listen to them and make a decision that works both ways.”

Staff undertook equality and diversity training, which helped them understand how they should treat each other and without discrimination which promoted an inclusive culture within the staff team.

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.

The registered manager understood their responsibility to continuously monitor the quality and safety of the service. They did this through a series of audits and the provider’s governance arrangements.

Audits were carried out on medicines, care plans, risk assessments, mental capacity compliance, recruitment files and health and safety. Where actions were identified, these were recorded and allocated to individual staff to complete. Responsibility for some auditing was shared amongst the senior staff team, which meant oversight of the service was shared.

In addition, the provider carried out its own checks through walkarounds and care plan audits. This provided a further level of oversight, enabling the provider to monitor practice, review the quality of care being delivered and identify any areas where improvements were needed.

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

Partnership working created opportunities for people to take part in community life, access support and enjoy social contact both within and outside the service. The provider maintained an established volunteer network and links with community organisations and health professionals, bringing together support for people’s social and health needs.

Volunteers supported activities, refreshments and community outings. Appropriate induction and introductions helped prepare them for their roles, and their contribution was recognised through a volunteer tea party. People valued the opportunities this partnership provided. One person told us, “They organise outings and they have a very good volunteer back up, e.g. for coffee mornings. We go on various excursions. When we are out we always have 1 member of staff per resident.” This demonstrated that community opportunities were supported by practical arrangements enabling people to participate safely.

Community links enabled 1 person to attend choir practice and others to attend coffee mornings, while maintaining connections with the local church. The partnership with the community centre also brought nursery children into the service and provided access to a community garden where people could relax and socialise. These relationships offered different ways for people to participate, including opportunities for social contact within the service as well as activities outside it.

Collaboration with external health professionals and agencies supported timely, coordinated care that responded to people’s individual health needs. Engagement with Skills for Care, registered manager forums, internal management meetings and the Surrey Care Association provided further opportunities to exchange information and learning.

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.

The registered manager promoted their staff and encouraged them to learn. They told us, ”I am always encouraging staff to sign up for courses and I put through recommendations for staff to do specific training, like catheter training. It is important to me to retain my staff. I don’t want to use agency, so I need to keep the staff force happy and to develop them where possible.”

The registered manager shared information from external incidents to aid learning and development within the staff team. They told us, “We used the recent (incident) and did a lessons learnt session and case study. We also have a ‘hot topic’ every week ranging from pressure care, infection control, lessons learnt topics, communication, etc. This has proven to be a good way of passing information onto the team and have a team members discussion with topics of interest.”