Montrose 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 meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (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, 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.

Leaders and managers shaped the culture by engaging with staff, people, their relatives and others important to them and with other stakeholders. They genuinely welcomed feedback, even if it was critical, and demonstrated what action had been taken in response. People were involved in or consulted about reviews of concerns, accidents, incidents and adverse events and in planning to prevent similar incidents in the future. Leaders were focused on providing a home like environment, supporting staff to deliver safe care with compassion, dignity and respect whilst empowering and enhancing people’s wellbeing. Feedback from staff, people and relatives confirmed a strong culture of inclusion led by the registered manager and deputy manager. Staff told us they received positive support from leaders and worked together with a shared purpose to deliver high‑quality care.

The provider’s core values of integrity, accountability, teamwork and continuous improvement were clearly reflected in people’s experiences. People and their relatives spoke warmly about the leadership and the staff team. Comments included, “They are a good team; they seem to like each other and look out for each other. They seem to be in a job they like. They are all very approachable”.

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.

Managers and staff we spoke with expressed their passion for the home and for what they were aspiring to achieve – good quality care with positive outcomes for the people who lived there. Everyone who worked at Montrose Care Home had a part to play in this, which was appreciated and acknowledged by the management team.

People’s relatives felt the service was well-led. Comments included, “Service appears well managed. I have often talked to the manager and the deputy. Both are very approachable” and“The manager is willing to talk through things and [they] know all the residents very well.”

We received overwhelmingly positive feedback from staff about managers at every level. Staff told us they were supported at work, encouraged to question practices and suggest new ideas or initiatives to help continually improve their practice. Staff were also supported in their personal lives. A member of staff told us, “Both manager and the deputy are hands on, often helping on the floor and with the residents when needed. The office door is always open, and I feel like I could approach either of them if I had any concerns or worries. I feel like I am listened to and respected within my job role. I also feel like they both encourage me when I wish to do more, take on extra responsibility. They make sure I can cope with added tasks.”

The registered manager was passionate about the home and was aware of their role and responsibilities. They spoke positively about the support they received from the provider and told us they felt well supported by the director; they had a good working relationship and could contact them at any time.

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

The provider had whistleblowing policy in place and procedures for staff to actively raise concerns, which were effectively embedded. There was a positive culture of speaking up. Staff surveys and team meeting minutes evidenced staff were given the opportunity to speak up and drive improvements. There was also evidence of action taken in response to feedback from staff. All the staff we spoke with felt confident to actively raise concerns, without fear of detriment. Leaders were open to feedback and staff felt supported and encouraged to speak up and raise concerns about the quality of care. Staff had opportunity to raise concerns anonymously. Last year staff took part in anonymous performance feedback for the registered manager’s appraisal, which identified manager’s strengths and commendations as well as areas for development and growth. The registered manager told us, “Staff know that if there is something that needs to be discussed, that this always takes place. Confidential helpline is available.”

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 had an equal opportunities and equality and diversity policy. People were supported by a diverse workforce from different cultures and backgrounds. Leaders supported work towards an inclusive and fair culture by improving equality and equity in the team and ensuring equality of opportunity and experience for the workforce within their place of work, and throughout their employment. All but 1 staff which responded to our feedback request, felt they were treated fairly and with respect.

The registered manager engaged with staff to involve them with the running of the service. They had an open-door policy, staff meetings, and worked alongside staff so they could speak openly. Staff morale was high, and staff spoke positively about how they worked as a team and were supported. Comments from staff included, “I really enjoy being part of our small team. The colleagues are friendly and hardworking people” and “I feel valued as a member of staff. The owner [name] shows appreciation by giving us good regular pay rise and ‘thank you’ gifts. We had a very generous December bonus and a meal for all staff.”

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 provider had effective oversight and knowledge of the service. Systems were in place to monitor and manage safety and quality across the service. Regular audits were completed, enabling the registered manager and deputy manager to maintain standards, identify areas for improvement and implement targeted action plans to address any issues to support continual development. They were used to drive improvement within the service. Staff we spoke to had clear understanding of their role and responsibilities, were highly motivated and had confidence in their leaders and managers.

The nominated individual was a visible presence in the service supporting the registered manager and strengthening the oversight and accountability at all levels. They regularly monitored compliance with quality standards, to ensure that action plans, lessons learnt etc were implemented effectively and improvements were driven collaboratively. The registered manager told us, “[Name of nominated individual] visits on a Tuesday morning to ensure that everything is working well. [They] do my one-to-one supervision. We also have weekly sessions with [them] and the manager of our sister home [name], which are very useful and I take a lot from these. The manager of our sister home and I liaise with each other which is a good support system.”

The registered manager was fully aware of their legal responsibility to be open and honest when things went wrong. All leaders were open and responsive throughout the inspection process. The registered manager understood their responsibilities under the duty of candour. The duty of candour means to be open and transparent, and it sets out specific guideline's providers must follow if things go wrong with care and treatment.

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

The provider was transparent, collaborative and open with all relevant external stakeholders and agencies. Staff worked in partnership with key organisations to support care provision, service development and joined-up care and to improve people's experiences, health, and wellbeing. The provider established effective processes to ensure partnership working with people, relatives and health professionals was maintained. Care records showed regular communication and meetings with a range of health and social care professionals. During our visit we observed how managers and staff engaged well with healthcare and other professionals and healthcare professionals felt the service was well-led. A healthcare professional described the managers and care staff team as “well organised, all members of staff know the residents individually and they work as an excellent team.” We received positive feedback from relatives about partnership working. Comments included, “I am very happy with the management. [Manager’s name] is very nice, approachable, understanding. [They] always make time for me if I need to talk.”

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. They actively contributed to safe, effective practice and research.

The service demonstrated a strong commitment to learning, improvement and innovation. Leaders encouraged reflective practice and supported staff to review what was working well and where improvements could be made. Feedback from people, relatives and staff was actively sought and used to drive positive change. The provider monitored outcomes and used this information to identify trends, share learning and strengthen the quality of care.

The provider measured and reviewed the delivery of care against good practice guidance. The registered manager was able to easily monitor people’s care from the electronic records and identify any areas that needed to be addressed and raised those with staff. There was a clear system to oversee falls, accidents and incidents. Concerns and complaints were investigated in a sensitive and confidential way, and lessons were shared with all staff and acted on.

Leaders actively encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. Staff said they were able to share ideas in their supervision meetings, staff surveys and staff meetings. Comments from staff included, “The office door is always open, and I feel like I could approach either of them if I had any concerns or worries. I feel like I am listened to and respected within my job role.”

The provider ensured good practice was shared and acted on throughout the service and within the wider organisation. The registered manager attended regular managers’ meetings with the nominated individual to discuss best practices and share lessons learned widely with other managers.