Holly Grange House 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.

This is the first inspection for this newly registered service. This key question has been rated 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.

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.

There had been changes in the registered provider and the service was now dual registered under 2 providers. Staff told us the change in provider had resulted in new systems and processes and not all staff felt this had been positive. This had resulted in some staff leaving the service, which, coupled with high levels of staff sickness had meant an increased use of agency staff to fill gaps on the staff rota.

Whilst permanent staff were committed and motivated to provide high standards of care, they demonstrated frustration that low numbers of permanent staff and policy changes meant they could not always achieve this. One staff member commented, “Right now, it’s all a bit of a mix as everything is changing from the old owner to Care UK. I think we will get there, but at the moment it’s all a bit confusing.” Another staff member told us, “One of the problems is things change and communication isn’t good. You don’t know things have changed, why they have changed or what that means. You sort of find out by default.”

Leaders acknowledged the challenges faced by the staff team during the transition period and recognised a stable workforce would improve the culture within the service. The provider’s quality development manager explained, “As you know we are transitioning the paperwork, so we are working through everything.” They assured us recruitment and absence management were key priorities for improvement to ensure staffing capacity reflected occupancy levels and people consistently received person-centred care that promoted positive outcomes.

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.

The manager had been registered with us, CQC, for 8 months at the time of our inspection visit. The registered manager had leadership qualifications and demonstrated a good knowledge of the regulations. However, this was their first managerial role and due to staff vacancy and sick leave, there had been extended periods when they did not have a deputy manager to support them. The registered manager acknowledged this had been a challenging period particularly with the transition to a new provider, high staff turnover and the implementation of new policies and procedures. They said a new deputy manager, although recently appointed, was having a positive impact on the day-to-day management of the service.

Staff told us the registered manager was kind, and that they recognised the difficulties and challenges leaders faced with staff recruitment. Comments included, “(Registered manager) is approachable”, “Yes, I feel I can talk to the manager. I think she is supportive” and “She is doing her best. She's always promising it will get better. These things take time.” However, other staff felt not all the leadership team, who worked on behalf of the provider, were supportive and understood or responded to their concerns.

Senior staff had delegated responsibilities, for example to carry out supervision meetings with staff. The registered manager acknowledged that due to having to cover gaps on the rota, some delegated tasks were not always completed within expected timescales.

The registered manager understood their responsibilities under the duty of candour. They told us, “Always be open and honest and never be afraid to apologise."

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

We received mixed feedback from staff about whether they felt listened to when they raised concerns or shared feedback. Some staff said they felt free and confident to raise concerns. One staff member told us, “I can say in all honesty I feel able to raise anything. I don’t think we are stopped from speaking out. I think our manager does their best.” Another staff member said, “They are approachable in the office, and they do listen.” Other staff said they were not always listened to. One staff member told us they felt staff meetings were a ‘tick box exercise’ and commented, “At staff meetings, it feels like they are just trying to fill a form in as opposed to actually listening to what's going on.”

Staff told us they did not have regular individual supervision meetings which gave them a private and safe space to review their work, discuss challenges and share any concerns with their line managers. One staff member told us, “I don’t think I have ever had a supervision.” Another staff member said, "I haven't had a supervision in a very long time.” A third staff member commented, “I can’t remember the last time I had supervision, but I know I can go and talk to [registered manager] at any time.”

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 had relevant policies in place and staff had received training in equality and diversity.

Where a health need was identified, the provider took reasonable steps to introduce adjustments so the staff member could continue to carry out their role. This included reducing or flexing working hours to support the staff member to manage their health condition. No staff raised any concerns about discrimination within the service.

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.

The provider had oversight of the service and following their own assessment of the quality of care provision at Holly Grange House Care Home, had identified standards needed to improve. A detailed service improvement plan (SIP) had been implemented and was regularly audited by the provider’s quality improvement manager. Where improvements had been made, their effectiveness was monitored to ensure processes were consistently applied and embedded in staff practice. The provider’s SIP and the evidence gathered within this inspection demonstrated improvements in infection control practices, medicines management and staff knowledge and understanding around specialist and modified diets.

However, some improvements continued to remain a work in progress or had not been addressed effectively during governance processes. For example, the monitoring of risk management strategies, the robustness of agency staff inductions and ensuring staff had regular meetings to discuss their work challenges and development opportunities.

Feedback from people demonstrated varying experiences of living at Holly Grange House Care Home which had not always been identified or addressed by managers or senior staff. For example, audits of call bell response times had not addressed people’s concerns about the responsiveness of staff when they needed assistance.

The provider also needed to improve daily oversight of staff practice, particularly when there were high levels of agency staff who did not know people well and therefore required increased levels of direction. Checks and audits needed to focus on people’s everyday experiences to ensure equality in access and positive outcomes for everyone living in the home.

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 had established pathways to support people’s access to other health and social care providers.

Relatives described good relationships with managers and staff and felt able to approach them when they had any questions or queries. One relative said, “I’m not backward in coming forward and I know they’ll work with me on it. I’ll just go up and have a chat.”

The provider had links with local schools to support intergenerational engagement in the home. Further activities to promote engagement with the local community included a ‘blue light breakfast’ for the emergency services and health care professionals and a monthly friendship café for local people to meet others and form new social networks.

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.

The management team understood the need for continuous learning to drive improvements within the service. There were detailed plans to improve the service with support from the provider’s quality team. However, some processes were not always operated effectively to support these plans. The provider was in a period of change and transition and needed to build confidence and capability within the staff team. For example, during conversations with staff it was clear there was a lack of clarity about some processes that had been introduced by the new provider. One staff member told us, “We need to get the basic bits right and then we can build. I don’t think we learn together. The sharing of information just isn’t there.”

Whilst we identified areas for improvement at this inspection, leaders were responsive to feedback and demonstrated a commitment to improving the quality of care. Some actions were immediately taken in response to our feedback.