North Hill 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.

This is the first assessment 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.

The service was in breach of legal regulations in relation to governance.

This service scored 62 (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.

People and visiting relatives were complimentary of the culture of the service which they described as kind and caring. Relatives’ comments included, “I have recommended this place to a number of people. It is the best here” and “The atmosphere is brilliant when you think about how poorly most people are”.

Staff were well motivated and keen to support people to do things for themselves. Staff were attentive, providing support compassionately and at a relaxed pace. They told us, “It’s a brilliant place to work”, “I love it here”, and “There is a culture of kindness in the staff team. I wouldn't be here otherwise”.

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. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

The service did not have a registered manager, and the clinical lead had been absent for a significant period of time. A new manager had been appointed and was in the process of applying to become registered. The manager had limited previous experience but had been successful in motivating the staff team and was developing a better understanding of their responsibilities.

The provider had recognised prior to the inspection that the manager needed additional support. An operational manager role had been introduced to support the manager and offer regular guidance and support. An experienced registered manager had been appointed to this role and had begun visiting the service regularly. The provider and the new operations manager attended the inspection to support the manager. All leaders were open and honest throughout the process and took action in response to feedback provided.

People and their relatives were complimentary of the manager’s approach and the staff team’s compassion. They told us, “The manager has stayed late and come in at weekends to check on us” and “Having looked at 10 homes, I am happy with my choice”.

Staff spoke positively of their leaders who they described as caring and supportive. Staff comments included, “The manager is lovely”, “The manager is nice. Really good, really supportive”

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

People and their relatives were comfortable raising issues with the manager and staff told us the manager listed to and acted upon feedback provided to improve people’s experience of care. Staff comments included, “I have no issues about going in to see [the manager] about anything, [they] are very approachable” and “New owner is down every Monday and walks around the home with the manager. They are available if we need them.”

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 were treated fairly, and the diversity of the staff team was valued. Staff requests for flexibility and adjustments to working practices were looked on favourably and made where possible.

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.

Governance systems were ineffective and had failed to ensure compliance with the requirements of the regulations. Processes had not ensured recruitment practices were safe or that staff received regular supervision and staff competencies were monitored. Audits had failed to identify gaps in care plans relating to people’s specific health needs. Medication record discrepancies had not been promptly investigated. Improvements to some areas of the environment were required.

Prior to the inspection, the local authority’s quality team had identified issues with governance arrangements. The provider had accepted change was needed and a new governance and auditing process had been introduced. The manager now had access to several tools designed to monitor performance and drive positive change. However, these audits had not yet been completed. The lack of effective operational quality assurance systems meant the provider was in breach of the regulation relating to governance.

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 service worked effectively with health colleagues to ensure people’s needs were recognised and understood. Information was shared promptly and appropriately with GPs and community services and advice provided was acted upon. When people were admitted to hospital the service shared information about people’s needs, preferences and wishes.

The provider focused on continuous learning, innovation and improvement across the organisation and local system.

The provider had recognised and accepted that current governance arrangements were not sufficiently robust. They acted promptly on feedback from both the local authority’s quality assurance team and the commission and had made changes designed to increase the effectiveness of audits. Plans had been developed for the reintroduction of formal staff supervision and assessments of competence.

The provider had identified additional management support was needed and recruitment of an additional clinical lead and a deputy manager was underway.

The new manager had taken steps to limit the environmental impact of the service and arrangements had been made to maximise the recycling of waste.