Mill Court 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 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 regulation in relation to oversight and governance at the service.

This service scored 43 (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 always ensure the service followed a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people, staff and their communities. This did not evidence the registered manager and provider engaged effectively with staff to ensure the service was working strategically and in line with a shared vision. Some staff felt the registered manager did not work with the staff team well so they could demonstrate a shared responsibility for promoting people's wellbeing, safety, and security. This did not always ensure there would be a positive and compassionate culture that supported people, their relatives and staff. Staff said, “Not all [staff] work together well – there is [staff] who do not talk to people nicely when under pressure. I have told the manager, but [they did] nothing” and “The way [the registered manager] talks to us sometimes, we do not even get a good morning – [the registered manager] just passes…they need to change the attitude, [the registered manager] just screams, does not talk. We had another manager from another home, and [they] were very calm.”

Staff told us they had handover meetings to discuss people, their care and issues. Staff had not had regular meetings to review the service and discuss different topics. The management team informed us after the site visit that more staff and senior staff meetings had been organised. The staff did not feel the registered manager maintained regular communication with the whole team to ensure they were able to share and discuss any matters or what was going on in the service. The management team told us, “If someone raises any issues, [clinical development nurse] speaks sensitively about any issues. A few staff came in and said things could be different. But it was good feedback that staff have taken on board and staff feel supported, we get the best out of them.” The management team were open and transparent about the learning from recent manager changes and changes they needed to make moving forward.

The provider and the registered manager did not always understand the context and oversight of delivered care, treatment and support. The provider did not always ensure the registered manager demonstrated the skills, knowledge, experience and credibility to lead effectively. They did not always do so with integrity, openness and honesty. The staff team were motivated to provide care and support to people as their needs and health were changing. However, there was a lack of consistent oversight and support from the registered manager and the providerto ensure they promoted a positive, caring, transparent and inclusive culture within the service. Staff told us the registered manager’s communication style was not friendly and they described it as ‘screaming’ at the staff. Staff did not feel they could raise any concerns or private matters due to fear of repercussion. Staff did not have much relationship with the registered manager to work cohesively. This did not demonstrate they had been a compassionate, caring and inclusive leader. This meant the provider and the registered manager did not always embody the culture and values of their workforce and organisation that could contribute to better outcomes for people, their relatives and staff team. Staff described how they tried to ensure people were safe, looked after and respected as much as possible. They showed enthusiasm in supporting people and each other. Staff said, “I am enjoying it in Mill Court, I really love the residents and my colleagues” and “Everything is OK, I love this place and the job – just give 3 carers downstairs and 2 upstairs.” Staff showed motivation to support people and worked together to achieve positive outcomes for them. We fed back to the management team to ensure staff were supported and listened to. They told us they had an open-door policy and would welcome any feedback to support the service. They also told us they had implemented so called recognition cards to promote Appreciation, Celebration and Excellence (ACE cards) in the service and were open to people, staff, relatives and visitors. The management team said this worked well in other provider’s services. This would help enhance staff morale and teamwork feeling appreciated and recognised.

The registered manager and provider did not always foster a positive culture where people, their relatives and staff felt they can speak up and that their voice will be heard. There was Speak Up process and Speak Up champions appointed to support staff and people raising concerns. From evidence and feedback collected, the leaders had not always been acting with openness, honesty and transparency. Some staff told us they would like to be listened to more, and they did not think the registered manager promoted empowerment. Some staff also told us about the positive relationship they had with their colleagues. Staff said they did not feel they could raise concerns with the managers as they may not be listened to. They said, “We do feel there is a culture of fear so colleagues say we will lose our jobs if we report. It makes everybody scared” and “I have previously written emails to [the registered manager] and [they did not respond]. You can raise a concern, and nothing is done. Sometimes I have residents complaining when they have told [the registered manager] their concerns, [the registered manager] does not act.” The communication between different staff or teams could be also improved and better organised. This would ensure when concerns were raised, the leaders investigated them properly and lessons were shared and acted on positively. The provider and the registered manager did not always embody the culture and values of their workforce and organisation to ensure people did not experience poor care and that it did not have negative impact on staff. We spoke about freedom to speak up with the management team. They told us how they had been supporting people and staff to share any issues or concerns they may have. Most people and relatives described the service as well managed, with an approachable senior staff team. Some people noted they were not sure who the manager was as they kept changing. People said they had meetings, and while not all suggestions were taken up or actioned, people said they felt listened to and respected. One person said, “Everyone seems to get on, which makes for a good atmosphere.”

The provider and the registered manager did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for staff who worked for them. Policies and procedures were not always reviewed to ensure these supported and reflected staff needs and their responsibilities. Staff were not always able to share ideas or able to contribute to the service and its development and improvements. Most staff supported each other, however some of them also felt support and engagement from the registered manager could be improved to help them understand any issues or disparities staff encountered. We were not assured the working environment was always inclusive, staff’s roles clearly established, and that staff’s wellbeing was considered consistently.

Some staff told us their diverse needs were considered, and they were grateful for it. But other staff also said, “I would speak to my superiors and community lead – we hear a lot of complaints from residents, and they say nothing gets done. You talk, you lose your job” and “I think that all was [registered manager’s] impact on staff because they were always blamed or praised by [the registered manager] creating a conflict between staff and senior staff… but all is changing, and I think it’s going to be good. Yesterday was a very very busy day which was managed without stress or argument.” After our site visit, the management team provided information on actions taken and some changes implemented. Some staff already reported positive changes, as well.

The provider and the registered manager 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, or share this securely with others when appropriate. The provider’s quality assurance systems did not identify concerns found during this assessment. The provider did not always maintain an effective oversight of the quality of care being provided, risk management and mitigation, staff practices, recruitment checks, knowledge and competency to support people. Audits had been carried out, however they were not always detailed and thorough. There were issues picked up in the provider’s audits which we had identified during our assessment. For example, information missing in people’s care plans and PRN protocols. However, this also indicated action had not been taken in a timely manner to address those issues and gaps. The provider needed to make further improvements to ensure environment contributed to effective support for people with dementia. When incidents, accidents and complaints occurred, the provider could not always demonstrate how these were proactively looked at trends and themes. This meant the registered person did not consistently assess risks to the health and safety of people. Insufficient action had been taken to mitigate identified risks. The provider gathered feedback from people and relatives but it was not clear how the feedback was meaningful and useful to the service development. The provider also gathered feedback from the staff team. The action plan was provided but our evidence showed the staff were not always supported or valued in the service. The provider’s system did not always work as statutory notifications were not always submitted to inform CQC of incidents such as outcomes of DoLS referrals and an allegation of abuse. Accurate, complete and legible records were not always maintained or updated when necessary to support effective management of people’s care and treatment, staffing and the service. For example, one person had dry, painful legs, but there was no pain management plan or skin integrity care plans in place. The pain and skin concerns were not being actively monitored or addressed, and there was no documentation or photographic evidence of the skin condition. Care plans should be developed for both pain and skin integrity to ensure the person’s needs were assessed, managed, and regularly reviewed. The management team provided us with updates on actions taken to improve these areas and support staff so they could continue caring for people effectively. We were informed a new home manager and deputy manager had started working at the service. People and relatives were positive about the service and thought it was managed well. They added, “Yes, nice manager, nice staff, and the other residents are friendly too”, “All very friendly and helpful people” and “They are pretty good at laying things on for relatives, one of the best was bringing in an outside speaker on ‘dementia’. This was really good, and very good to share our experiences with other relatives.”

The provider did not always ensure the registered manager understood their duty to collaborate and work in partnership, so services work seamlessly for people. The registered manager did not always share information and learning with partners or collaborate for improvement. The staff team noted they communicated with different professionals to seek support and advice. Staff used internal systems to report, record and refer people for further clinical support. However, evidence we collected did not always demonstrate the registered manager and staff understood their duty to collaborate and work in partnership with other services to ensure continuity in people’s care and to achieve the best outcome for people using the service. For example, one person was diagnosed with a respiratory condition and was prescribed medicines to aid it. The person’s records noted they may ask repeatedly about seeking medical support. The plan of care needed clearer guidance for staff on how to support them consistently as our observations showed that they did not get the level of reassurance they needed. Although another medical appointment was arranged, it took some time to complete it. This did not ensure the service worked collaboratively and shared information with partnership services to ensure people’s risk of harm was mitigated. One professional noted their experience working with the service. They said, “I believe residents and relatives meetings do take place to gather feedback. I do not believe professionals are asked for their feedback. Previous manager was not particularly responsive to recommendations and offers for support… be good to see how the new manager takes learning from recent stream of concerns and section 42 enquiries to implement change in the home.”

The provider and the registered manager did not always focus on continuous learning, innovation and improvement across the organisation and local system. The registered manager did not always use their policies to focus on continuous learning and improvement from incidents, reportable events, audits and information gathered at the service. Staff did not have opportunities to discuss items, issues or feedback arising from running of the service. This meant staff did not always have the opportunity to discuss important aspects of the service and identify areas needing attention. This demonstrates the registered manager did not always involve the staff team to use their policies and procedures for effective and meaningful learning, measuring outcomes and impact or the services provided. The management team provided us with information of the changes they had started to implement to support the staff team and work together better.

The staff team were motivated to provide care and support to people as their needs and health were changing. However, we received a mixture of feedback from staff. Some staff felt supported by the registered manager and senior staff. However, others noted not all staff and people had a voice or opportunity to share their ideas. Some staff felt the management needed improvements regarding their insight and awareness of what was going on in the service and the quality of it. From staff’s feedback and our findings of issues, the provider and the registered manager did not always encourage staff to speak up with ideas for improvement and innovation and actively listened and engaged with them. Where we identified shortfalls during this assessment, the management team was responsive to our findings and started working on areas of improvement.