Herewards House

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 inspection we rated this key question requires improvement. At this assessment the rating has remained the same. 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 and notification of notifiable incidents.

This service scored 62 (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.The staff, people and relatives spoke positively about the provider and the registered manager. People and relatives agreed the staff and the management team showed a positive and compassionate culture that supported them and each other. They said, “I do think that the service is managed well and run well. I can't fault them. The manager is approachable and I can talk to them. We have had no issues at all so far” and “The manager is very easy to talk to, in fact, they all are. I am very happy with [person’s] care and I have no complaints about anything.”The provider and the staff team demonstrated a shared responsibility for promoting people’s wellbeing, safety, and security. The staff team and the provider used regular communication to share and discuss any matters or what was going on in the service.Any changes were discussed together with staff and/or other relevant parties to make those changes. The provider worked with staff to ensure equality and diversity were promoted, and the causes of any workforce inequality were identified, and action was taken to address these.One professional added, “Yes, [senior staff] know their [people] really well. There's a gentle friendly atmosphere and a positive can-do culture.”

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 managed the service with integrity, openness and honesty. The registered manager understood the requirements of how to deliver care, treatment and support and embody the culture and values of their workforce and organisation. The provider worked with the staff team to support their professional development to ensure they had the skills, knowledge, experience. The provider encouraged integrity, openness and honesty in the service to ensure any issues or concerns were addressed quickly. Staff said, “My manager is approachable, professional and supportive” and “My manager is supportive and we do have a good team spirit.” Staff felt listened to, supported and the registered manager was approachable. Staff all worked together well and were positive about the leadership in the service that contributed to better outcomes for people, their relatives and staff team. Staff told us they enjoyed working in the service. The management team were visible to the staff team, people and relatives, and professionals. They praised the staff team saying, “The staff are a very good team. They are good to work with and they take information we provide on board and appreciate our support. They like the fact that we work as a team, that’s our main strength. We are happy with our staff performing and caring for the people we have.”

The provider fostered a positive culture where people, their relatives and staff felt that they can speak up and that their voice would be heard. Staff’s feedback was taken into account to support any improvements. The management team encouraged staff to raise any concerns and promoted the value of doing so. Staff were confident that their voices would be heard, and they were happy to approach the registered manager or senior staff for support. There was a culture of speaking up where staff could raise concerns and would be supported, without fear of detriment. When concerns were raised, the provider have investigated those. The management team was open and transparent with people and relatives if something went wrong.The management team and staff worked together to promote people's wellbeing, safety, and security and we observed a supportive staff culture. It was clear people who use the service were important to the whole staff team. People and the staff team had good relationships with each other. We also observed staff and the managers were respectful and kind towards people and each other. The registered manager promoted a positive, caring, transparent and inclusive culture within the service. The staff team were motivated to provide care and support to people as their needs and health were changing.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for staff who worked for them. The provider valued and respected diversity in the workforce. They knew how to take action to improve if there were any disparities in the experience of staff with protected equality characteristics. The registered manager communicated with staff and they shared any ideas or suggestion to ensure staff were included and were able to contribute to the service. Staff felt positive about the provider and their support. They were confident their concerns and ideas would be taken into account for any changes to review and shape services. They felt supported, treated fairly and looked after by the managers. The management team worked alongside staff delivering care so they could understand any issues staff encountered. This approach also encouraged an inclusive and equal workforce and mutual respect amongst staff. The management team used effective and proactive ways to engage with and involve staff, with a focus on hearing the voices of staff. The working environment was inclusive, and staff’s wellbeing was considered. This ensured the service had a positive culture which supported better outcomes for people.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Provider’s quality assurance systems did not identify concerns we found during this assessment.

The oversight of the recruitment process and selection was not robust. We found missing recruitment information for staff suitability and the policy did not reflect the requirements of the regulation. The registered manager did not always ensure management of medicine and records were safe and proper. We found issues with medicine management, and this was not identified during provider’s quality assurance checks. Oversight of the training needed improving to ensure consistencies in staff’s learning, compliance, and skill development so that people continued receiving safe and effective care. When incidents, accidents and complaints occurred, the registered manager could not always demonstrate how they proactively looked at and recorded trends and themes. This would help them identify areas of concern, different strategies for support and take action to prevent reoccurrence and safeguard people. We observed some activities were held and people engaged well. But we also observed on both days when people were only sitting in one place and a lack of engagement was visible. This meant people could be at risk of social isolation and a lack of regular meaningful engagement to support their wellbeing.The registered manager did not always ensure accurate and complete records were maintained or updated when necessary to support effective management of people’s care and treatment, staffing and the service. We found a number of care plans missing for specific needs of people but this was not identified using provider’s quality assurance system to ensure required records were in place. There was a risk staff would not have guidance how to support people with specific needs in the safe way. People’s consent and decision records needed reviewing to ensure people’s involvement was evident. When people needed support with emotional wellbeing, the steps for timely reassurance were not always clearly recorded. This could potentially delay effective support and positive outcomes for people.Services registered with the Care Quality Commission (CQC) are required to notify us of significant events and other incidents that happen in the service, without delay. This is important as it means we can check that appropriate action had been taken to ensure people are safe. During this assessment, we found the registered person did not notify CQC of reportable events including police incidents, serious injury, outcomes of DoLS referrals and allegations of abuse. The registered manager needed to improve how they monitored these events and also inform other external agencies accordingly.The provider completed audits but these did not always support the oversight of specific areas of the service. For example, staff tested the call bells to check they were working. But they did not carry out any further audits to review response times for any risks to people’s safety and delays in supporting them. The last audit for infection control and cleaning noted it was acceptable, but it only covered communal areas. There was little information if people’s rooms were cleaned. There was no indication of what ‘good’ or ‘acceptable’ standards were.This meant systems and processes required improving to ensure issues were proactively identified in the future. This was to ensure people remained safe and ensured compliance with fundamental standards.

For other areas of the service, the provider had an oversight of the service provided and ensured people received the care and support they needed. They used tools such as observations and feedback from people, relatives and staff to monitor, assess and improve the quality of the service. There was an emphasis on continuously improving the service and meaningful learning was applied across the whole staff team.

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.Where necessary, external health and social care professionals had been consulted or kept up to date with developments. The registered manager and team leader told us how they worked with people, their families, professionals to ensure people received the care and treatment they needed. We received several responses from professionals, and they were all complimentary of the provider, the staff team and working relationships. One professional added, “We care for several care homes, and they are really excellent care home mainly because their staff are outstanding in effort, skills, knowledge of [people] and they care.”Staff and the managers were open and transparent, and they collaborated with all relevant external stakeholders and agencies to ensure they achieved positive outcomes for people. Provider encouraged partnership working with key organisations to support care provision, service development and joined-up care, as well as, keeping up with any updates in the health and care sector.

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 provider told us they were involved in a hydration project which was about the introduction of structured drink rounds. The provider told us they received an award in reducing urinary tract infections requiring antibiotics or admission to the hospital.Professionals said, “[The staff] are very open to any suggestions or reflection about any cases or feedback”, “Throughout the years [Herewards House] have demonstrated strong sense of respect and accountability at ensuring optimal outcomes for [people]” and “Staff from Herewards House regularly attend…training sessions carried out by [the external team] and actively participate in these sessions. [Staff] have a positive and transparent attitude and are always willing to learn.”Staff had meetings with opportunities to discuss items, issues or feedback arising from the running of the service. This meant staff were able to discuss important aspects of the service and identify areas needing attention together with the management team.The provider told us they communicated with staff to share information and act on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. The registered manager told us how they oversaw and managed behaviours and performance of staff as and when needed. The staff team were motivated to provide care and support to people as their needs and health were changing.

Where we identified shortfalls during this assessment, the provider was responsive to our findings and started working on areas of improvement.