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 changed to 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.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 61 (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.

During the assessment we were told some tasks were being completed for the convenience of staff and not in line with people’s preferences. Systems to monitor staff culture had failed to identify this. At our previous assessment we had seen unannounced spot checks had been completed at night. These were no longer being done meaning there was no effective monitoring of the culture of night staff. We discussed this with the provider and manager who told us 2 key members of staff had recently left the service, and this had impacted negatively on monitoring systems. However, we were concerned there was a lack of understanding about the importance of providing person-centred care at all times. Once this issue was identified by the service immediate action was taken to ensure the practice did not continue. The manager told us they were recruiting for a new head of nights.
Staff told us they were motivated to work to improve the service and lift the rating. One commented, “All staff are working so hard, it breaks our heart, it's a beautiful home. Residents are lovely people. I have positive feelings about the home.”

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

Although we found the service was on an improving journey we identified there remained room for improvement. Systems to ensure care plans and risk assessments were regularly updated had not been effectively embedded.
The manager was continuing to build on their knowledge and was being supported by a registered manager from a sister home. They were also receiving advice and guidance from an external consultant and attending a leadership course. While these were positive actions they indicated the manager did not yet have all the necessary skills to lead the service without additional support.
However, the manager was driven to make the necessary improvements and progress their own professional development. Relatives and professionals told us they had confidence in managers. Comments included, “[Manager] is trying hard to uplift the home. I think if we can all work together, we will get there” and “I have no doubt that [manager] wishes to do the best for residents and does take the time to get to know them and reflect that in their care approach.”

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

People and their families had been asked for their feedback via questionnaires. We reviewed a selection of these and saw the responses were largely positive. However, there was no evidence any actions had been taken in response to the feedback. One relative told us they did not always feel listened to commenting, “I am increasingly confused about what has and has not happened because I am sometimes given significant amounts of information by staff when I arrive to visit, then subsequently receive different information when I try to clarify it with management.”

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 service employed some staff from overseas via a sponsorship scheme. A manager had responsibility for overseeing these arrangements. A member of staff told us “[Manager’s name] is very approachable.”
Records showed 1 member of staff had raised concerns about unfair treatment at work. This was followed up by the manager and appropriate action taken.

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 remained areas where improvements were still needed. Care plans and risk assessments had not been updated following changes to people’s needs or monthly as planned. Leaders had failed to recognise the departure of key staff could potentially destabilise the service and had not taken any action to mitigate the risk.
Some improvements had been made to how the service was monitored. Audits were being completed regularly and systems to help ensure there were no omissions of care were more robust.

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.

A visiting professional told us they felt the provision of care had improved. They commented, “They are better at telling us when things go wrong. They will take advice and follow guidance.” When people’s health deteriorated referrals were made for support from the appropriate agency.

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 manager had recently started a manager course to develop their skills and knowledge. The provider was working with the local authority and an external consultant to drive improvements in the service. A registered manager from the providers sister home was also supporting the service and mentoring the manager.