Hallmark Angmering Grange Luxury Care Home

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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. This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant 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, oversight, leadership and culture of the organisation.

This service scored 46 (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 and strategy. They had processes in place to monitor the culture of the service. However, this was not always effective.

Improvements were required in relation to the culture of the workforce. Staff described how staffing levels, favouritism and poor communication from the management team impacted their ability to do their job. They expressed concerns about the poor culture of collaboration, where people and staff were not always listened to or communicated with, to help promote learning and improvement. Staff reported concerns about the management team not always leading by example and monitoring practice against the values of the organisation.

Improvements were required in governance of the service to ensure it was robust and effective. Audit processes needed strengthening to help leaders identify problems and the actions required. We looked at a range of audits, and these did not always identify our findings during this assessment or demonstrate appropriate actions had been taken. While the provider had an action plan in place, it had not identified all of the issues found during the assessment. The provider has since taken additional actions to address the areas highlighted. However, it will take time to embed in the service.

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.

Most staff described a negative culture within the service. They told us leaders were not always open, honest, approachable or compassionate. Staff said they did not always feel listened to or supported and described a culture where concerns were often dismissed, communication was poor and blame was common when things went wrong. Comments included, “It depends on the leader. My leader is open but not honest”, “There has been a consistent reply of ‘the door is there if you don't like it here’ or ‘maybe you should get a job that’s not in care’”, “The residents are made promises to get them in that cannot be upheld. Then this is blamed on the care team who are doing their best and are set up to fail” and “There is a blame culture. Despite managers verbalising that they have an open-door policy, when concerns are raised, they are often met with dismissal.” Leaders told us the service had an action plan in place which included implementing new wellbeing initiatives for staff and providing additional training for leaders. However, these actions had not yet resulted in consistent improvements to the culture experienced by staff.

Most staff told us leaders did not always communicate with them in a positive or effective way. They told us they did not always feel their views and feedback were valued. Comments included, “I have asked for emails sent out to be more positive. They are always sent out using negative language”, “If we raise any concerns or queries, we don't have a quick response. You need to insist on a response by sending another email”, “Sometimes they listen but don't always act” and “Sometimes management will arrive to the home early to see the night team. Feedback is encouraged but it’s not always clear that it’s been taken on board, listened to or actioned.” Leadership was not always effective in ensuring compliance or driving improvement. For example, the issues found in staff files around induction paperwork, support and performance management were not always identified or appropriate actions taken.The provider had an action plan in place which included training, development and mentoring for leaders to ensure they are capable, inclusive and compassionate in their roles. However, this will take time to be embedded in the service.

The service is required to have a registered manager. At the time of our assessment, the registered manager had left the service. The provider had existing leaders to support with the management of the service, such as a deputy manager and heads of department. In addition to this, a new regional team was in place to oversee the service while they were actively recruiting for the registered manager post.

The provider had systems in place for staff to share concerns. However, this was not always effective. Leaders did not always foster a positive culture where staff felt they could speak up and their voice would be heard.

Most staff told us they could not speak up with leaders and when they did, they did not always feel listened to. They shared concerns about leaders not always respecting confidentiality which had negative consequences for them. Comments included,“I have reported [bullying of a staff member] to management but these team members are protected. Now I have received hostile treatment due to no consequences of their behaviour” and “I do not feel I can voice my concerns openly. I have raised concerns before and been thrown under the bus by management. The people that the concerns were raised about were immediately told I raised a concern about them. I then had them ostracising me and bad mouthing me to residents and other staff members. Concerns are very rarely listened to. Most are swept under the carpet or completely ignored.” We were not always assured the service had a positive culture of honesty and openness where staff felt they could speak up was fully embedded.

The provider had a whistleblowing policy. We received conflicting information about their whistleblowing processes. All staff told us the process to raise concerns was with either leaders at the service or the provider’s “Hi Nye” reporting system. “Hi Nye” is the providers whistleblowing process for staff to report their concerns directly to the nominated individual. However, staff were concerned these processes would not allow for anonymous reporting and were worried about punitive measures. One leader told us there was no forum for reporting concerns anonymously. They said staff could report concerns externally to the safeguarding authority or the Care Quality Commission. However, the provider told us there was an internal forum for staff to report concerns anonymously. This demonstrated improvements were needed to ensure whistleblowing processes were not only in place but understood, accessible and trusted by staff to raise concerns without fear of negative consequences.

While the provider had an action plan in place, it had not identified all of the issues found during the assessment. The provider has since taken additional actions to address the areas highlighted. However, this will take time to embed.

The provider had policies and processes in place to value diversity in their workforce. However, this was not always effective. Leaders did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had an Equality, Diversity, Inclusion and Belonging Policy. However, this was not always effective. Staff described their experiences of discriminatory behaviour, bullying and unfair treatment. Comments included, “Management sweeps most complaints under the rug or will throw you under the bus for reporting something.”, “Staff are not treated fairly and equally” and “Overall, the morale is very low.” Records reviewed did not consistently demonstrate that concerns relating to equality, diversity and inclusion were identified, monitored and acted upon consistently. This meant leaders could not be assured that all staff were treated fairly, consistently and in line with the provider’s values.

The provider had started to implement changes to resolve these issues including reviewing staff allocations and providing mentoring for leaders. However, these actions were not yet embedded in practice and had not led to consistent improvements in staff experience.

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.

Leaders did not always promote a positive culture where staff felt able to speak up or confident their views would be heard. Staff described experience of discriminatory behaviour, bullying and unfair treatment with some reporting they were afraid to raise concerns. Whistleblowing processes were not always accessible or trusted and staff expressed concerns about potential negative consequences of speaking up. Staff told us they were blamed when things went wrong and that learning was not always shared in a supportive or constructive way to promote improvement. Concerns relating to people’s safety were not always documented in line with the providers policies and processes. This demonstrated the culture within the service was not consistently open, transparent or focused on learning. The provider had not identified all of the issues found during this assessment, indicating governance systems were not always effective in recognising and responding to risks.

Leaders did not always demonstrate a clear understanding of the providers processes and systems, for example we received conflicting information regarding staffing level calculations and whistleblowing arrangements. This lack of clarity further demonstrated that oversite of the leadership team was not always effective.

The provider did not always have effective quality monitoring systems to ensure all regulatory requirements were met. Leaders carried out a range of audits and checks. However, some concerns found during this assessment had not been identified by their internal audits processes or effective actions taken. This included concerns around safeguarding, safe and effective staffing, communication and culture of the service. This meant improvement was required to ensure governance systems were effective and thoroughly embedded, to ensure people were safe and received high quality, consistent care.

Although the provider already had an action plan in place, this had not identified all of the issues we found during this assessment. They have subsequently taken further actions to address this. We identified a breach of regulation for governance relating to oversight of safe and effective staffing, auditing processes, leadership and culture of the organisation. We will check for sustained improvement at our next assessment.

The provider understood their duty to collaborate and work in partnership. However, staff and leaders did not always follow processes to ensure services consistently worked seamlessly for people.

People told us they were supported to access health and social care services. Staff worked with a range of health and social care professionals which included the GP, district nurses, dentists and local authorities. There was also engagement within the wider community for activities such as various pet therapies, street parties and garden explorers’ initiatives where visiting children complete activities alongside people living at the service.However, feedback from health professionals demonstrated communication with the service required further development, to achieve a seamless approach. They told us there were sometimes difficulties in getting hold of staff or not having responses to messages. Some professionals told us there was sometimes a breakdown of communication within the service. A professional said, “There are still times that guidance given for supporting one individual is not always considered for another person with similar concerns or behaviours. There are also times when shared information can differ between care staff, mostly if liaising with a staff member who does not normally work in that specific area of the home.” We also identified instances where some people had not always been supported in line with their care needs. This meant that while partnership working was present, it was not consistently applied or fully embedded in daily practice.Although the provider already had an action plan in place, this had not identified all of the issues we found during this assessment. They have subsequently taken further actions to address this. However, this will take time to be addressed and embedded in the service.

The provider had systems in place to focus on continuous learning, innovation and improvement for the organisation and local system. However, this was not always effective.

Discussions with leaders and staff demonstrated they recognised the importance of learning lessons and continuous improvement to ensure people received care and support that was consistently safe and effective. However, we identified leaders and staff had not always followed the providers policies and processes. This meant the providers systems were not always effective at identifying or addressing areas of improvement. Action plans were in place; however, these did not contain all of our findings throughout this inspection. We identified shortfalls which led to a breach of regulation. This demonstrated quality performance had not always been effectively assessed which meant opportunities to learn lessons and drive lasting improvements had been missed. The provider has since taken additional actions to address the areas highlighted. However, this will take time to embed in practice.