Atholl 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 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 requires improvement. At this assessment, the rating has remained requires improvement.

​The provider was previously in breach of the legal regulation in relation to the governance of the service. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 54 (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 and engagement. Leaders did not always demonstrate a clear understanding of the challenges and needs of people using the service and their communities.

Staff demonstrated values of kindness, respect, and person‑centred care in their day‑to‑day practice, and people were treated with dignity and supported as individuals. Leaders described expectations for person‑centred practice and partnership working. However, the provider did not demonstrate a clearly articulated or consistently understood shared direction across the service. Relatives described variable experiences of transparency, engagement, and communication from management, including limited proactive communication and unclear processes. As a result, while positive values were evident in care delivery, the absence of a consistently shared and embedded culture at leadership level reduced assurance that people’s rights, lived experience and voices were always central to decision‑making across the service.

Not all leaders understood the context in which the provider delivered care, treatment, and support. They did not always embody the culture and values of their workforce and organisation.

Leaders and staff demonstrated compassion and commitment to people supported, and there were strong individual examples of inclusive, person‑centred practice that promoted human rights, dignity, independence, and community inclusion, particularly for people with learning disabilities. However, leadership practice was not consistently effective across all levels, and relatives described variable experiences when issues were escalated, including limited follow‑through, unclear decision‑making and inconsistent communication from senior leaders.

As a result, while capable and compassionate leadership was evident in individual practice, it was not consistently embedded or demonstrated across the service.

This meant leaders could not always be sure that people’s voices and rights were reflected in decisions across the service.

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

The provider had mechanisms in place for people and relatives to raise concerns, and compliments and feedback demonstrated that people felt comfortable praising staff kindness, commitment and day‑to‑day support. Front‑line staff were approachable and responsive when issues were raised at a local level, and some concerns were addressed promptly once identified.

However, complaint records and relative feedback highlighted recurring themes of delayed responses, limited follow‑up and inconsistent communication when concerns were escalated, with outcomes sometimes dependent on persistence or individual advocacy rather than clear, trusted processes.

As a result, while people could raise issues and provide feedback, confidence that speaking up would consistently lead to timely action, learning or change was not fully assured across the service.

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 provider employed a diverse workforce and supported inclusive working practices, with staff from different backgrounds contributing positively to care delivery and feeling able to build trusting relationships with people using the service. People and relatives provided positive feedback about staff kindness, commitment and cultural sensitivity, and communication and care approaches were adapted to respect people’s language, culture, and individual identity. This supported an inclusive care environment and demonstrated that workforce diversity was recognised and valued in practice.

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.

The provider had governance structures in place, including audit schedules, operational meetings, manager reports, and improvement plans, which demonstrated awareness of quality and safety requirements and an intention to improve practice.

Leaders told us governance systems were in place and being strengthened. However, these systems were not consistently effective or embedded, and complaint trends, incident review arrangements and learning processes did not reliably demonstrate that information about risk, performance and outcomes was analysed, acted upon, and used to drive sustained improvement.

As a result, governance arrangements did not consistently provide assurance that quality, safety, and sustainability were being effectively overseen, with improvements often dependent on individual oversight or reactive action rather than robust, system‑led governance.

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.

The provider worked with a range of external partners, including healthcare professionals, safeguarding teams, housing providers and families, and escalated concerns where appropriate.

However, relatives and records showed that information sharing and coordination between services were not always timely or well‑managed, with gaps occurring between health, social care, and housing partners and limited follow‑through when issues were raised. A relative told us, “The issues are what happens in between the different services… that’s where issues arise.”

As a result, partnership working supported people on an individual basis but was not consistently proactive or robust. This meant services were not always seamless and sometimes relied on individual or family advocacy.

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.

The provider had taken steps to review practice and introduce improvements, including operational meetings, audits, improvement plans, and individual examples of creative, person‑centred support that aligned with right support, right care, right culture.

However, learning was not consistently embedded or used to inform service‑wide improvement, and repeated themes in complaints and operational issues indicated that learning was often reactive rather than proactive. A relative said, “How do they expect to implement improvements if they never proactively ask for feedback?”

As a result, while individual innovation and improvement were evident, the provider could not demonstrate a consistent culture of continuous learning that reliably improved equality of experience, outcomes, or quality of life across the service.