Northfield Care Centre

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 good. 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 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since the last inspection, management oversight at the service had not consistently maintained the standards of care expected. Governance arrangements had not been effective in identifying, monitoring and addressing issues in a timely way. However, the provider had recently implemented changes to the management team and leadership structure.

The current management team told us they were developing plans of working with staff to develop a more positive culture and support the delivery of safe, consistent and person-centred care. They had developed an action plan and had already commenced implementing improvements. The management team demonstrated an understanding of some the concerns identified and the actions required to address them. They recognised that further work was needed to embed these changes and ensure they resulted in sustained improvements and positive outcomes for people.

Leaders had an understanding of many aspects of the service; however, governance and oversight arrangements had not always been effective in identifying and addressing areas where improvement was required. During the inspection, we identified concerns relating to staffing, infection prevention and control, medicines management and quality assurance systems, which had not always been recognised through the provider's own monitoring processes. Whilst there was a leadership structure in place, oversight systems had not consistently ensured that risks were identified, assessed and acted upon in a timely manner.

People, relatives and staff spoke positively about the registered manager of the service and described them as approachable and supportive. The regional manager was open and transparent throughout the inspection and engaged positively with feedback, demonstrating an understanding of the areas requiring improvement. Leaders demonstrated a willingness to learn, reflect and drive improvement. They had identified areas requiring further development and were taking action to strengthen governance arrangements, embed quality assurance processes and improve outcomes for people. However, further work was required to ensure governance systems operated consistently and resulted in sustained improvements to people's care, safety and experience of the service.

People did not always feel they could speak up and that their voice would be heard. We received mixed feedback on staff reporting that they felt confident in speaking up with any concerns they had. Staff said the registered manager listened and was supportive, but they had less confidence in the senior leaders who they said didn’t listen. One member of staff said, “We bring things up, but no action is taken, everyone thinks it’s unsafe which is causing staff to leave and low morale.”

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 equality and diversity training, demonstrating the provider's commitment to promoting an inclusive culture. This helped staff to understand and respect people's individual backgrounds, characteristics and experiences, supporting the delivery of person-centred care and helping to create a positive environment for both people using the service and staff.

The provider had governance and oversight arrangements in place; however, these were not always effective in identifying, monitoring and addressing risks to people's health, safety and wellbeing. During the inspection, we identified concerns relating to safeguarding, risk management, record keeping, compliance with the MCA and infection prevention and control. These concerns had not always been identified through the provider's own quality assurance processes, which meant the provider could not consistently demonstrate that people were receiving safe, effective and high-quality care.
The provider had undertaken quality monitoring activities, including audits and management walkarounds. However, these had not always been effective in identifying the concerns found during the inspection and required strengthening to provide greater assurance regarding the quality and safety of care delivered. For example, environmental concerns and aspects of care delivery identified during the inspection had not been consistently recognised through existing oversight processes.
The regional manager acknowledged that governance and oversight arrangements had not always been fully effective and was open and transparent throughout the inspection. They demonstrated an understanding of the challenges facing the service and were aware of the areas requiring improvement. Leaders told us action plans had been developed to address identified concerns and engaged positively with feedback provided during the inspection.
Leaders demonstrated a willingness to learn, reflect and drive improvement. However, further work was required to ensure governance and quality assurance systems operated consistently and effectively, and that improvements were embedded and sustained to achieve positive outcomes for people using the service.

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 provider worked in partnership with partners such as the local authority and health professionals to share information. We received feedback from partners about the shortfalls in the service and about some of the improvements the service had been making.

The provider did not always demonstrate a culture of continuous learning, improvement and innovation. Whilst a service improvement plan was in place, quality assurance and governance systems had not always been used effectively to identify, monitor and address concerns in a timely manner. As a result, some of the issues identified during the inspection had not been recognised through the provider's own oversight processes and only came to light during the assessment. This limited the provider's ability to drive continuous improvement and provide assurance that risks were being identified and addressed at the earliest opportunity.
Staff told us morale was low and that there had been a number of staff departures. They said this had placed additional pressure on those remaining and had impacted on their ability to consistently deliver the quality of care they wanted to provide. This indicated further work was required to strengthen oversight arrangements, support staff and ensure learning and improvement were embedded throughout the service.
The provider had not yet fully embedded systems and processes designed to improve the quality and safety of care. As a result, the provider could not always demonstrate that improvements had been sustained or that they had led to better outcomes for people using the service. The provider was receptive to feedback and demonstrated a commitment to improving the quality of care.