Restgarth 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.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained 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.

At our last assessment, we identified 1 breach of the regulations relating to governance.
At this assessment we found not enough improvement had been made and the provider remained in breach of the regulation.

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 not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Managers, and staff, told us the manager and deputy worked together well and had shared values. However, new systems, introduced to drive improvements had not been sufficiently embedded to ensure people received safe and consistent care.

Managers told us there was a need to improve the culture of the service to ensure staff worked in line with organisational values. Systems to monitor staff culture were being introduced. For example, unannounced spot checks at night had been completed so managers could gain an understanding of how care was delivered during the nighttime.

The provider did not have 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 did not always have the skills, knowledge, experience and credibility to lead effectively.

Actions to drive improvements following our previous assessment had not had the necessary impact or had not been sustained. Although audits were now being completed these were not robust enough to identify issues identified at this assessment.

Staff were generally positive about the management, however some felt there was still more to do. Comments included, “It’s been difficult, lots of things to work on, we are getting there but it doesn’t change overnight” and “It’s been better, I still don’t feel confident because it’s all new, the stability is not established.”
However, relatives were generally complimentary about managers. Comments included, “There is now more steady management, it has been difficult, things have improved” and “The management is definitely approachable.”

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

Most staff told us they were confident raising issues and felt they were listened to. However, others told us they felt undervalued. One commented, “We are struggling, we have told them [management].”

However, staff meetings were being held. Minutes showed staff were actively asked to feedback about any organisational changes.
 

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they were treated fairly at work. Most staff said morale had improved although one told us there was still some ‘friction.’

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The providers governance systems remained ineffective. Audits for monitoring the service had been introduced but these were not well embedded. Oversight of data collected about the frequency and timing of falls had not been effective. Daily records had not been audited and so incidents when care had not been provided had not been identified.

While some improvements had been made since our previous assessment, the areas where the improvements had not been made or sustained were those most likely to have a significant impact on people’s health and well-being. We were concerned that any increase in people’s needs might not be identified quickly in order to mitigate risk of further deterioration.

Since our previous assessment there had been improvements to the oversight of the service. A manager had been recruited, and they were supported by a deputy manager and the provider. The deputy manager told us they worked well with the manager, they commented, “We have built a strong foundation, she listens and we are putting processes in place.”
 

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.

Since our previous assessment the service had worked closely with other agencies to drive improvements. Leaders had been open and transparent, sharing information appropriately to foster good outcomes for people. However, we remained concerned systems had not been well established within the service.

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. They did not always actively contribute to safe, effective practice and research.

Records did not always contain the necessary detail required to support learning. For example, an incident report stated, ‘during this episode they hurt others.’ There was no information about who the ‘others’ were or how they had been hurt.