Thomas Edward Mitton 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 inspection the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service remains in breach of the legal regulation in relation to good governance. The provider had not always ensured their systems were effective or ensured oversight of quality, safety and management of risks.

This service scored 36 (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 shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not fully understand the challenges and the needs of people and their communities.

The culture at the service was not positive. People were not being supported to have good outcomes and were at risk of social isolation as staff were not engaging with them in positive or meaningful ways. After meals, staff shut the shutters in the kitchen area giving a clear message that people were not to speak with them. Staff spent a lot of time in the office areas of the service away from people. The service was not decorated to look like a home and was visibly worn in several areas. Our findings in multiple areas at this inspection as discussed through the report led to a negative culture and poor experiences for people. People were at risk of reduced positive outcomes and experiences as a result. A relative said, ‘‘I am trying to think of something positive to say but I cannot think of anything.’’ Another relative told us, ‘‘The service is supposed to be proactive and get [family member] better but the way things are it does not feel like that.’’

However, people and some relatives were positive about their or their family member’s care. One person said, ‘‘Everyone is helpful and polite, and I have had no bad experiences so far.’’ A relative told us, ‘‘The staff go above and beyond and for us and [family member] it is a really good service.’’

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

There had been several changes in senior management and clinical staff at the service over recent months. This has had an impact on how people’s care and support is reviewed and managed. Staff told us the lack of senior management had been frustrating at times as there had not been a key point of contact for issues to be managed. We were not shown evidence of audits completed at provider level. We could not be assured leaders were fully capable as audits were not picking up on the multiple issues we identified at this inspection as discussed throughout this report. People, relatives and staff were not being effectively included in the running of the service including discussions and involvement about their care and support. One person said, ‘‘Who is the manager? I have never met them.’’ A relative told us, ‘‘It is frustrating and confusing trying to work out who is in charge and overseeing things. Nothing ever seems to move on, and we are never given feedback when we raise things.’’

However, people and some relatives told us they were more positive about the new service manager. Staff also felt the management team were kind and compassionate and supported them well. A relative told us, ‘‘I think things are on the up with [service manager] starting. There has been more commitment to communicating with us more frequently.’’

People did not always feel they could speak up and that their voice would be heard. People were not asked for feedback in meaningful ways or regularly to give them opportunities to speak up. Whilst relatives felt confident to speak up, they were not always assured their concerns were listened to. One relative said, ‘‘We raised concerns but never hear back as to if anything happens and things seem to stand still.’’

However, information about how to speak up was readily available for people, relatives and staff. People approached staff and asked them for support with no concerns. Staff felt confident in speaking up to management. A relative told us, ‘‘I feel confident anything I raise will be taken seriously.’’

The provider valued diversity in their workforce. However, they did not always support staff to be the best they could be at work. Staff were not being supported to have competency checks or supervisions about their training to make sure it was effective. It was not clear how staff were being supported to have equal opportunities to be involved in discussions about their job roles and the service. However, staff felt well supported and told us they could approach the management team to have discussions about any help they needed in their job roles. The provider’s recruitment process was fair and equitable.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Audits were being completed to govern and monitor the quality of the service. However, where audits had been complete, actions taken as a result were not specific or clear meaning audits were not effective. Specific audits in areas such as monitoring people’s experience, daily and therapy records or staff training and knowledge were not in place. Some actions identified in audits, for example in relation to staff needing more knowledge about safeguarding were not taken in a timely manner. We asked to see more information from audits that had not been shared with us during the inspection however these were not sent to us. Audits and governance measures had not been effective in picking up on the multiple issues we identified at this inspection as discussed throughout this report.

The service manager and regional manager were responsive to our findings and started to show us how they would implement more effective ways of auditing at the service. However, we could not be assured this would have happened were it not for our inspection.

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.

Due to the lack of audits of areas of the service such as people’s care records we could not be assured professionals would always be contacted in a timely manner if people needed this support. People had less opportunities to access their local community than what the provider and staff team wanted. This was an area that continued to be focused on for improvement. One relative told us, ‘‘They need a certain type of staff member to take [family member] out and about and they are rarely available, so they do not go out.’’

However, we saw evidence staff did contact and work well with professionals such as GPs. The provider worked with partners such as commissioners when people started using the service. People had been supported to access the community and enjoyed this on the occasions where it did happen. One person indicated they enjoyed going out when we asked them. A relative said, ‘‘[Family member] is becoming a lot more confident getting out and about thanks to the help of the staff team.’’

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

The provider was not encouraging learning as audits and governance measures were not effective in identifying where improvements were needed at the service. Areas where known improvements were needed were not being actioned in a timely manner. Improvements we identified at this inspection in relation to care plans, risk assessments, staff engagement and people’s experiences had not been picked up on by audits and governance measures in place. Relative’s comments included, ‘‘It is a tricky situation for us, and we sometimes feel like we are fighting a losing battle trying to move things forward for [family member].’’ And ‘‘There is little understanding about how [family member] needs to be treated and as a result we can’t be sure things are going to get better.’’

The service manager and regional manager started actioning and implementing improvements during our inspection. We could not be assured this would have happened were it not for our inspection. However, it did give us some assurances that issues would be considered, and improvements would be made at the service based on our feedback.