Dunwood Manor Nursing 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 good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 providers values were kindness, respect and integrity and they told us these were reinforced through supervision and staff meetings. When recruiting new staff, the process not only checked applicants understood the role and were familiar with caring, but that they were caring. They believed caring could not be taught but the skills needed for practical caring could be and would invest time in that should an applicant show they were kind and respectful.

The manager had used innovative ways to demonstrate the negative impact of gossip in the workplace. This had shown how a comment can change as it passed from person to person and encouraged staff to treat people with kindness and respect and speak with management if they had any concerns.

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 had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

There had been changes to the registered manager and clinical leads at Dunwood Manor and the most recent post holders had been there for a very short time when we inspected. The new manager was applying to become registered and was still completing their induction and the clinical lead was beginning to make changes and address shortfalls they found in the service. A relative reflected on the changes, telling us, “[Manager] and [clinical lead] are new, but a comment worth making is that like with previous manager level changes we are not kept informed of departures or arrivals. As a result, the continuity of issues raised with previous managers suffers.”

We spoke with the manager, regional manager and the service support manager who had been working from Dunwood Manor while no manager had been in place. The system of cover while the post was vacant had thoroughly covered the duties of the post, but staff feedback was there had not been strong leadership as a result of the changes. One staff member told us, “Poor choice of managers and clinical leads. Change things without consultation and do petty things instead of looking at the bigger picture.” Another staff member said, “Staff morale has been low due to constant inconsistencies with management,I do feel this is improving and have appreciated the changes and improvements they have made these past 2 months.” Finally, another staff member told us, “The management team of [manager] and [clinical lead] are finding their feet, and I am confident they both will do an excellent job.”

Relatives reflected, “Changes of personnel are always unsettling for the staff, residents and families of residents, so I hope [manager] and [clinical lead] will stay because my sense is that they will maintain high standards.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider had a ‘Raising concerns, freedom to speak up and whistleblowing policy and procedure’ in place. This gave a clear process for staff to follow should they wish to speak up about concerns they have about a colleagues conduct for example. The manager also told us there were posters around the service giving staff an email address they could address concerns to, or they could go directly to the manager with any concerns.

Staff mostly believed they could raise concerns with the management team or directly with the provider. For those staff who did not feel comfortable raising concerns directly with the management team, or who had concerns about the management team could email the providers ‘Freedom to Speak Up Guardian’ directly. Staff were also advised they could contact outside agencies such as safeguarding or police.

Most staff members told us they would speak to the management team however a single staff member said, “There are posters around the home if anyone wants to raise a concern. This is not an anonymous email, managers know who has sent it.” The management team confirmed this was the case, however only the speak up guardian would see the staff members email address and name if included in their email. The manager allocated the investigation would be made aware of the concern only and not the identity of the staff member who raised it.

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.

Staff had completed training in promoting equality, diversity and inclusion. The staff team was diverse, there were staff from many different countries, some on sponsorship. A staff member told us, “Being a foreigner and part of Dunwood’s mixed-ethnic crew, I never experience discrimination. However, there are several areas where I believe that communication needs to be improve and consistent for everyone. The roles' duties and responsibilities need to be more precise.”

A person receiving a service at Dunwood Manor spoke no English, however, communication was supported by translators, translation applications on phones and relatives. In addition, staff members had, without being asked, learned useful words and phrases in their language to enable them to provide more person centred support.

The providers values of kindness, respect and integrity supported the inclusive culture seen at Dunwood Manor.

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 completed a range of audits to monitor the quality of the service. When areas of improvement were identified, actions had been taken to improve. However, auditing had not always identified the shortfalls we found in relation to risks to people’s health, the environment, and concerns around infection prevention and control.

When we inspected, the manager had yet to start completing audits. These were carried out by a service support manager and by the providers clinical auditor. The manager was still completing their induction and was receiving training in areas such as auditing prior to commencing them. Areas they had identified for improvement included a need to add a medicine to a behaviour care plan along with strategies to try first, and a repositioning chart included in a person’s care record when they move independently.

Actions were allocated to staff within audits and completed by the target date.

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.

The manager and clinical lead understood the need to develop links with the community. They had plans for the future involving developing their provision to ex-servicemen and women to engage with a specific group in the community. They also recognised that active community participation may not always be possible so would work to bring the community into the service. For example, a local minister led a communion service for some people when we were inspecting.

The provider already had positive working relationships with local health and social care professionals.

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.

Learning was taken from accidents and incidents and safeguarding’s. This was disseminated amongst the staff team through team meetings, daily stand up meetings and handover meetings. In addition, learning was added to peoples care plans to inform staff of any changes.

Staff competed training in relevant areas and on commencing in post, if new to a caring role completed the Care Certificate. The Care Certificate is a set of 15 standards designed to equip health and social care workers with the necessary knowledge, skills, and behaviours to provide safe and compassionate care.

Feedback from staff, people and relatives had been sought and reviewed to obtain their views and used to gauge satisfaction levels and shape future service development.