Tall Trees

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 service, due to a change in registration. 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 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 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. Overall people and their relatives were very positive about the service. One relative told us, “We are confident when we visit that things will be OK. Our visits are unannounced, and we never get the feeling that staff are anxious about what we will find or how we will react.”

The registered manager and provider were open and honest throughout the assessment. They were aware of improvements that were required at the service, such as to the environment, and were actively addressing these.

Improvements were needed to address the workforce inconsistencies which included the management approach, morale, culture and team working. There was mixed feedback from staff around the leadership style in the service from management and colleagues in a senior role. Some staff described an ‘us and them’ approach of management and leaders and not a ‘whole home approach’ within the workforce.One staff member said, “I believe that the management team at Tall Trees urgently needs additional training in leadership and communication, to foster a respectful, collaborative, and supportive workplace.” Another staff member told us, “Managers should speak to staff with respectand dignity and encourage staff so they can offer good quality care and not get scared when managers are around.” The registered manager was professional and receptive to our feedback from staff and gave assurances that the inconsistencies described would be addressed.

Staff did not always feel they could speak up and that their voice would be heard. There was mixed feedback from staff about being able to voice their concerns. Some staff felt able to share their views and that they would be listened to and their experience of working at the service was positive. Examples included,“The team and managers are supportive. We can always ask for help or advice when needed.” However, this was not everyone’s experience, for example, another member of staff told us, “Managers are not visible and leading by example… they don'tappreciate anything we do, they are alwayslooking for faults.” and “No, I don’t feel valued by managers, but my colleagues are really supportive and caring.”

The provider had systems for gathering feedback and because of our feedback outlining staff concerns held meetings and clinics with staff to enable them to speak up and share any concerns in a safe space. However, further work was needed to embed a positive culture where all staff felt they could speak up, and their voice be heard. For example, the documentation of staff meeting minutes did not always demonstrate collaborative working and a two-way conversation between staff and leaders.

An effective system was not fully in place at the time of our assessment to ensure there was workforce equality, diversity and inclusion. Some staff said that teamwork and communication was not always effective and many staff spoke of a lack of equality impacting morale. Although the provider held regular meetings with staff who understood the need to treat people and each other as individuals with respect and inclusion, they advised they alongside the management team would be reviewing their existing processes in response to our feedback about communication, workforce morale and culture in the service to make the necessary improvements.

The provider and registered manager undertook a series of audits to assess and improve the quality and safety of the service. However, existing quality assurance systems had not identified the issues we found in this assessment, including assessing risks to people, the management of safeguarding incidents and culture in the service. The provider ‘s existing governance systems included clear accountability, risk management, and performance monitoring with a range of audits completed to check service performance and the quality of care.

The registered manager acknowledged areas where practice had fallen short and showed an enthusiasm and willingness to learn and improve service delivery. There was evidence of a passion for meeting the care needs of people with complex health needs and a desire to build the service further.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners; however, this collaboration did not always lead to improvement. Staff engaged with healthcare professionals but did not consistently work effectively with all relevant external partners. Partners told us referrals were not always made in a timely manner which hindered communication and limited effective joint working.

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. However, this did not always transpire to effective learning in the service. The registered manager of the service was experienced and dedicated to improving the service, however there were inconsistencies as included within this report.

The provider and registered manager were receptive to the feedback we gave them as part of the onsite and offsite assessment process and valued this. We were encouraged by their commitment to addressing the inconsistencies found. They shared with us how they were using the feedback to make improvements to the service including implementing systems to embed the changes. Areas identified were added to the action plan for the service and we received updates on the progress of these actions.