St Nectans Residential 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 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.

Leaders were available and approachable to people and families, but staff did not feel supported. There were systems in place to monitor the quality of care, however these were not fully effective to consistently drive improvement.

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 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.

Staff spoke to us about the vision of the service. One staff member said, “We are really doing well now, we had a bit of a tough time a year ago or so, but the provider is investing in us and it’s going well.” Another said, “(Name) is doing a really good job, we feel supported and happy in our work.” Staff said that the manager and provider were approachable and that they feel well supported. However, since our assessment process commenced, anonymous feedback has been received that shows that some staff are unsettled, and that work was required to ensure staff felt supported and valued. This was feedback to the provider who has taken immediate action by introducing new support systems for staff to access.

The manager and staff understood and supported people’s cultural and spiritual needs. People were treated equally, and their individual needs were met in line with their preferences. The management team knew people well and also worked alongside staff to support and promote good practice. All the staff were positive and proud of the care delivered to people at St Nectans.

The service aimed to give people consistently good care and staff worked together to try and achieve this. Individual staff supervision and team meetings were used by the provider to remind staff about their organisations underlying core values and principles.

The staff were positive about the leaders in place. During our assessment, we received negative comments regarding the overall leadership of the home. These were currently being investigated by the provider and changes implemented.

Staff told us that the manager was “Visible and helps out on the floor.” Another staff member told us, “We have a good leader, who shares with us and has time to listen.” The deputy manager was committed to improvement and was open and transparent regarding the improvements made and those that were on going. We were told that the focus of the service was to ensure people were safe and happy, and that any learning was taken forward positively.

There were systems and processes in place to support staff development and progression within their roles. They talked of how they were supported to gain qualifications and extend their role, for example becoming a senior care staff member. Senior care staff were supported to be become medicine givers and received support and training. Spot checks, competencies and values-based supervisions took place.

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

Staff were not always confident or free to speak up. Staff told us they would raise concerns that were related to people and their care to ensure safety. However, they would not raise other concerns as they did not feel they would be listened to and feared losing their job.

The senior leader told us they had an open-door policy where staff could talk to them at any time. There were also staff meetings and supervision. However, due to the lack of support and trust reported by the staff team, these were not always effective at this time.

The provider had up-to-date whistleblowing policies and procedures which were in line with current guidance.

The provider and senior leader understood their responsibilities under the duty of candour. The Duty of Candour is to be open and honest when untoward events occur.

We have received notifications as required. During our assessment we found that the management team were open and transparent. They admitted when things had gone wrong and demonstrated how they had used these to make improvements. They told us of the work they had done to improve.

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.

Mental health and wellbeing of staff had been discussed during the assessment due to concerns raised. The provider felt that since the change of management in 2024 there had been support available to ensure staff felt supported through changes. During this assessment, further support systems have been introduced because of recent concerns raised regarding favouritism and staff being unfairly treated.

The home was proud to be inclusive and supported both staff and people that used the service. The deputy manager said the staff team was multicultural and everyone was respectful of each other.

Staff felt they were treated as individuals and their needs were taken into consideration, such as shift times being re-arranged to fit in with family commitments if required.

The provider had procedures in place to promote staff well-being and worked to provide flexible working conditions if required. There was a formal recruitment process and equality, diversity and inclusion policy in place to guide equitable and fair recruitment and selection procedures. Staff were encouraged to undertake training in equality and diversity.

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.

There was a quality assurance framework in place, however, this had not identified the shortfalls and concerns found during the assessments such as staffing, DoLS applications, inconsistent rotas, and weight monitoring overview. There was a lack of oversight in certain areas, for example, the management of distressed behaviours, and the use of medication to manage these behaviours. This was because the documentation completed by staff did not always reflect the use of de-escalation techniques and the effect of these techniques before administering medication. Whilst a senior leader knew who was at risk of losing weight and who had lost weight, not all staff had that knowledge as there was no monthly overview of peoples’ weights, therefore there was a risk of undetected weight loss and gain.

These issues were acknowledged and acted on during the assessment process.

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.

Families and staff told us that appropriate health and social care professionals were contacted appropriately when required.

Staff and leaders told us they worked in partnership with key organisations to support care provision, service development and joined-up care. Staff worked with various external agencies including, GPs, community mental health teams, Tissue viability nurses, social workers, and local authorities. Staff told us how they would contact relevant external professionals to meet people’s needs. The staff team told of how they made referrals, and we saw information in care plans to reflect this.

The feedback from professionals was positive, they told us that the staff were knowledgeable about people’s needs. One health professional said that the communication from staff could be improved, especially regarding recent changes to their health. This was shared with the management team.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people.

Whilst there were auditing systems in place not all were analysed to improve outcomes and encourage learning. Lack of management oversight meant that longer term trends were not captured, for example, weight loss and complex distressed behaviours. Accidents and incidents were recorded and then discussed with the staff team but there was no written record of these conversations. The supervision overview shows staff have supervision 6 monthly, however good practice guidance recommends that supervisions were at least 3 monthly, giving staff the opportunity to raise concerns or best practice with managers regularly. This may have captured staff feedback and prevented staff from not feeling listened to. On viewing the training programme, we identified that not all staff had received the necessary training in learning disabilities and autism. We have asked the provider to ensure this training was undertaken. This has been confirmed by the provider.