The Garth Care Home with Nursing

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 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 inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

This service scored 36 (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 have a statement of purpose which provided details on the aims of the service to be person centred, and promoting people’s ‘active participation’, this was not reflected in the reality of the care and treatment being provided. The provider and registered manager’s gaps both in the wider knowledge of providing a regulated service and of people’s individual needs were a barrier to the service achieving the aims and direction indicated in the statement of purpose.

The provider had employed a care consultancy team to oversee and improve the governance and management of the service.

We observed staff providing care focused tasks which were not identified or challenged by the registered manager or other staff working at the service. We were not assured the culture of the service was focused upon improving the quality of care and outcomes of people living at the service.

The provider and registered manager did not fully understand the context in which they delivered care, treatment and support. Where concerns were identified by visiting professionals the understanding of what actions to prioritise and take was not always evident, and this had led to people continuing to be placed at risk of poor or unsafe care.

The registered manager told us they carried out daily walkarounds, but these had failed to identify what we found on inspection. There had been a failure by the management team to identify and act on where risks were present or on poor care.

The provider has employed a care consultancy to take on and develop the systems of management and governance in the service.

People did not always feel they could speak up and that their voice would be heard.

Staff said they could raise concerns with the management team and relatives felt able to speak up and felt the provider listened. However, people were not encouraged to provide feedback and there were no effective mechanisms to ensure this happened.

We were not assured people living at the service were able to speak up regarding the way they were cared for.

A whistleblowing policy was in place and staff were aware of the policy.

We did not identify any issues with the recruitment practices of the provider and found there was a diverse workforce. There was an equality and diversity policy in place.

The provider did not have an open, proactive and positive culture towards safety. They did not listen to concerns about safety. Where concerns over the care being provided had been raised by visiting professionals the provider had failed to identify the actions needed to address the concerns. Lessons were not learnt to continually identify and embed good practice.

The provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

Accidents and incidents were documented; however, information was not clear or accurate showing differing accounts of incidents to what was recounted by people in the service or what was witnessed by other professionals. The clarity in the records needed to effectively detail, review and monitor the frequency of accidents and incidents in the service was not there. This meant opportunities to learn lessons from incidents and take action were missed.

There was no effective mechanism to gather and then act upon feedback from people in the service and their family members. This meant that opportunities to learn from people’s experiences and improve the outcomes for people were being missed.
 

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

Health and social professionals told us they did not always feel appropriate actions were taken in a timely way to address concerns. Whilst improvements were made the provider did not always prioritise effectively meaning people were exposed to continued risk of the potential of poor care.

The provider did not focus on continuous learning and improvement across the service. They did not encourage staff to use creative ways of delivering equality of experience, or outcomes improving quality of life for people in the service. The lack of effective systems, governance and management meant there was no drive to improve the safety of the care and support being delivered. People continued to have poor experiences of care, with a lack of action to improve people’s outcomes.

The provider did not have oversight of how care was delivered. This meant opportunities to analyse and review accidents and incidents for themes and trends did not occur. Learning was therefore not identified or shared with staff. This meant improvements to the service and the care people received were not always considered or implemented.