Vine House Older Persons Residence

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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

This means we looked for evidence that home 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.

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 and leaders did not always ensure that the direction and culture of the home was shared and delivered consistently between leaders and staff.

The home had experienced recent internal management changes. This, together with a change in care and medicine systems, had impacted both the leadership and theconfidenceof staff. This was confirmed by staff and the provider.

Changes were being made with delegation of governance tasks, and a new manager had recently been appointed and was undergoing employment checks prior to starting. Feedback we received highlighted concerns over how these changes had been managed and implemented, which had impacted the oversight of the home and the culture of the senior team.

Evidence and feedback suggested much work has been done to address the leadership approach in the home but was acknowledged by leaders and observed by the inspection team that further work was required to embed this and ensure a proactive work environment for staff.

Leaders demonstrated a focused and positive approach to ensure that people receive good quality care. Values were evident within the home through staff meetings and care planning. Staff completed Equality and Diversity as part of their core training. Ethnicity, religion, and sexual orientation were captured within people's care plans. Managers and staff understood the diverse needs of the people they supported.

Leaders did not always understand the context in which the provider delivered care, and support.

The provider was aware the turnover of managers in a relatively short time, had an effect on staff morale and confidence. The senior team had worked hard to keep things going and reduced the impact on people living at the home.

The provider assured us; a new manager had been appointed and was awaiting confirmation of employment checks. The provider told us the improvements being made to auditing and governance as well as improving the skills of the senior team would be supportive of the prospective new manager.

People told us they liked the leaders and saw them frequently. People told us they liked the provider and were pleased they saw him weekly at least. People and families applied words such as “kind.” “caring.” and “fun.” when talking about the personalities of leaders.

People felt they could speak up and that their voice would be heard.

Staff felt they could speak up about most things and named the managers and team leaders they would go to, if needed. Staff did not raise any concerns around speaking up to protect people. We were told by people and their families they could speak up easily and would be heard. One person said, “The communication is actually really good I can get hold of the staff, but I can also get hold of the owner.”

There were opportunities in place for staff to speak up in the form of one-to-one supervision sessions and a policy of managers being visibly present 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.

The provider and leaders ensured equality of opportunity and experience for the workforce was in place, for example, adjustments to work patterns to accommodate religious events or needs. The home has policies which support equality and diversity. Including making reasonable adjustments for pregnant people.

The provider ensured that protected characteristics of those they supported were also considered as part of this approach. Care planning captured how these diverse needs and characteristics impacted their care needs and what adjustments were needed to support them.

Governance and accountability were not always reliable and effective. Governance frameworks were not always robust or consistently applied, leading to shortfalls in oversight of some areas.

There was a limited number of quality assurance systems, audits and processes in place to monitor the quality of care provided. They also relied on having a registered manager in place and there had been a reliance on the registered manager monitoring their own work.

Internal audits had failed to identify gaps in care plans, lack of some guidance for staff in relation to some practice, for example, clear guidance to support a person whose needs were changing. In addition, the auditing processes had not picked up shortfalls in recruitment records and the records required to meet the providers obligations under the mental capacity act.

The provider told us they received reports from registered managers but did not routinely sample details or record the outcomes and actions from those reports. During transitions between managers, staff told us it generally fell to other staff to monitor day to day practice in addition to their other duties, resulting in monitoring not always happening. The provider told us he led the team whilst new managers were recruited and inducted. However the turn over of managers had resulted in monitoring not always taking place effectively. The most notable exception to this was medicine auditing, which was in place.

At the time of our visit the provider told us they recognised they were not able to produce evidence of effective auditing systems. They created an action plan and shared it with us, outlining all the improvements they were making to the governance of the home.

An electronic care monitoring system had been implemented, however staff told us they had very little training to use it. We found staff were not aware of the system features to run reports. It was acknowledged that this was a valuable feature and would help identify trends and save time having to go through each person’s daily records to gain oversight. Following our visit, the provider set up further training for staff in the features and use of the system.

Management had not fully ensured they, and staff, understood their responsibilities relating to people's information, records and confidentiality. As part of their induction and training, all staff had completed General Data Protection Regulation (GDPR) training. Secure electronic systems were used so that staff could access information they needed to support people effectively. However, a communication book in use at the time of our visit contained detailed personal information. This was raised with the provider who arranged for staff to use the book to signpost other staff to more secure records in people’s individual files.

The provider did not always understand their duty to collaborate and work in partnership, so homes worked seamlessly for people.

The home mostly worked in collaboration with other partners, however, sometimes information about people’s care and treatment was kept in different places so it was not easy to understand the care and treatment people had received or when professional advise had been sought and acted on. For example, we were shown 2 different care plans for a person held in the same system but different locations.

Health professionals gave mixed views of the partnership working and, whilst generally satisfactory, there was concern the changes in managers in recent years had been a barrier to good communication in partnership working.

The provider was aware of the concern and was in the process of upskilling other staff to be better able to cover if there are future gaps in registered managers being in post.

The provider did not always focus on continuous learning, innovation and improvement across the system. Identifying and implementing ways to improve was inconsistent.

The provider was undertaking changes in leadership structure, new delegated roles for senior staff with the aim of improving quality assurance processes and facilitating system changes.

For example, the need for decision specific Mental Capacity assessments, to be completed by the provider and staff at the home, had in part, been identified but remained an area that not been actioned. Feedback received that there were a number of governance areas to address and that these would take time to complete.

People we spoke to were happy with the care they received and with staff’s approach to support. However, did feel the turnover of managers was something they felt could be improved.

The provider had learnt from issues raised at our visit and other issues found when he reviewed the situation. The provider had taken the issues and had immediately started to address them. This had also been the case following a recent fire safety report. The provider told us he was confident that a more robust auditing system would support himself and his team to pick up issues sooner and act on them.