Housing 21 - The Watermill

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 assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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.

Feedback from staff about the culture of the home was varied. Some staff felt there were disparities in how they were treated and raised concerns about working practices. They told us while they were confident to raise concerns, they did not always feel they were taken seriously.

Other staff felt the home was well managed and organised. One staff member said, “I think the care is good compared to other homes, I wouldn’t want to work somewhere if the care was bad. I would have a loved one here if they needed to be here.”

People and relatives spoke positively about how the home was managed. One relative told us, “It’s well run. It’s well organised. When we drive away, we don’t worry about [person]. We know they are safe and well cared for.” A person who was at the home for a short term stay told us, “If I need care in the future I would come back here because they are all very nice. I am very happy with the service I have received here.”

The registered manager shared with people, relatives and staff information about improvements being made at the home, or any success stories. A newsletter was regularly produced which gave information about training, events, and any improvements made at the home.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation.

Relatives spoke positively about their family experiences. One relative said, “I can go home and I can relax, I know [person] is safe. I can’t praise them enough. I know he is safe and he is always clean. One hundred percent, it’s a fantastic home, it couldn’t be better.” Another relative said, “The staff are wonderful. They always do what they can for people. They are always pleasant and professional. We all have a laugh together. I can’t praise them enough. Leadership is excellent.”

The registered manager had a good understanding of their regulatory responsibilities and had notified CQC of incidents and events as required. They were receptive to feedback provided from both partner agencies and as part of this inspection.

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

We received mixed views from staff about whether they felt able to speak up and share concerns. Some staff felt their views were not listened to and their feedback was not valued. One staff member said, “There's a lot of negativity as some people don’t feel listened to by the office. I have felt supported, but I know a lot of people do struggle that they aren't listened to.” Another staff member said, “We have team meetings so you can say what you think, but they don't do anything. I just feel it’s brushed away.”

We discussed this feedback with the registered manager who acknowledged staff concerns. They told us they would discuss with senior staff and consider how improvements could be made. Following the inspection, they shared with us responses they had received from staff in a recent survey and told us they had shared with staff how improvements would be made. We will check this at our next inspection.

However, feedback from staff reflected concerns primarily about matters relating to staffing and not people’s care. Staff told us they were confident to raise concerns about people’s care, with 1 staff member commenting, “I feel comfortable to raise concerns. If nothing was done, I would have a word with [name of registered manager] about it, I feel confident she would deal with it. I know other people have been to her in the past. She seems friendly and approachable.”

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 told us they were a diverse team who worked together well. One staff member shared an example of how the registered manager had checked in with them after a colleague made a comment in relation to their sexuality. They told us this reassured them that their diverse needs were supported and that poor conduct would be challenged.

The provider offered support to staff in relation to their diverse needs. For example, staff had access to lesbian, gay, bisexual, transgender (LGBT+) support networks. There was also a prayer space available in the staff room which the staff team could access.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were systems in place to maintain oversight of the home and drive any necessary improvements. Regular checks were carried out on the environment, equipment, incidents, accidents and medicines. The registered manager undertook a range of audits to monitor the quality of care provided and reviewed the experiences of people living at the home. Completed audits were then shared with the provider’s quality team and used to create action plans. These detailed where changes or improvements were needed to improve quality and safety.

We saw governance systems were effective, as the majority of concerns we have reported on under our safe key question had been identified by the registered manager and/or provider and action was being taken to address these concerns. Areas of concern within the safe key question that were not known to the registered manager and/or provider, were acted upon immediately once escalated by us, which showed systems in place to respond to risk were effective.

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 staff and management teams worked in partnership with local agencies to ensure people’s health and wellbeing needs were met. Staff made appropriate referrals when people’s needs changed and followed professional guidance to deliver safe and effective support.

The management team maintained open communication between people, professionals and relatives. This helped to ensure people’s needs were understood and met in a timely way.

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. They actively contributed to safe, effective practice and research.

The registered manager and senior staff across the organisation regularly carried out reviews to identify positive practice and highlight any areas of concern. Most of the concerns we identified at this inspection were already known to the management team, and they recognised that work needed to be done to improve communication with the staff team.

Feedback had been gathered from people and their relatives as well as staff, and this was used to make improvements to the home. The registered manager also analysed records relating to incidents and accidents to reduce the risk of reoccurrence as well as identify any themes or learning which could improve people’s experience of care.