Options The Old Vicarage

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• 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. 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 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not always a positive culture at the service. Relatives told us they did not feel the management team had always been transparent. A relative explained how they had raised concerns and these had been ignored. Another relative told us they had not been supported by a manager when an important meeting was taking place with external professionals. Their comments included, “I have felt managers were defensive”, “I felt intimidated when I contacted the staff” and “It felt like I was treading on eggshells when I contacted the service.” Some staff explained they had not always been empowered to make decisions. Relatives and most staff told us there had been recent improvements in these areas. Comments from relatives included, “I have seen a willingness to improve” and “Communication has been better recently.” However, some staff felt further transparency was needed. They told us they did not always feel supported.

Staff had raised concerns about issues with pay and information about their terms and conditions. The provider had addressed these concerns and organised for human resources teams to meet with staff to discuss and solve any problems they experienced.

Staff told us they enjoyed working with people who lived at the home and had good relationships with them. Their comments included, “I love the residents and I love doing activities with them”, “I enjoy my job. All the residents and staff get on well with each other. I like learning from the residents” and “I really love working here and the staff are all supportive. We come together to make things work.”

At the time of our assessment, the registered manager was absent from work. The provider had arranged temporary management cover. Some staff told us they felt unsettled by this situation. The temporary manager was due to leave shortly after the assessment but had agreed to stay on because the registered manager was still away. However, there was no fixed plan or timescales for the management arrangement.

Relatives told us they had found some managers ‘defensive’ and it was hard for them to express their views. A relative explained, “I felt the manager was always interrupting me when I spoke.” They told us they felt better supported at the time of our assessment and that improvements had taken place. However, they said they were concerned about the future. A relative commented, “Things have improved but it is early days.”

Most staff told us they found senior staff and managers supportive and helpful. Their comments included, “Managers are professional and we have been given more structure”, “[Manager] is nice” and “I feel very supported by the manager and senior staff.” However, some staff explained they found changes in the management style and structure difficult to understand. They told us they felt communication needed to improve.

Some staff felt they were not free to speak up. Comments from staff included, “It often feels like concerns are raised but not properly addressed or followed through” and “Staff do not feel comfortable speaking up because they do not feel meaningful changes will be made.”

Before our assessment, we received several anonymous staff concerns sent directly to CQC. We discussed these and the feedback from staff with senior managers. They explained they understood some staff lacked confidence speaking up directly to managers or senior managers. They had introduced different processes to help enable freedom to speak up. Some staff told us they felt this had worked well. For example, they explained the manager had an open-door policy and they were able to speak directly to them. The provider had also arranged for senior managers to visit and speak with individual staff. They discussed the whistle blowing processes in staff meetings and provided information about how staff could raise concerns anonymously.

Some staff told us they felt there was not workforce equality or opportunities for staff from ethnic backgrounds within the organisation. We discussed this with a senior manager within the organisation. They told us about various strategies within the organisation designed to promote staff equality and give everyone opportunities. They also told us there were groups who worked together to celebrate different cultures and diversity.

Managers completed training to understand how to support staff in an inclusive way and to value their individuality. The organisation supported staff flexible working arrangements and provided an employee assistance scheme to support staff wellbeing. Staff told us they were supported to have time off when needed. A member of staff explained that managers and the organisation had supported them to return to work after hospital treatment. They said that they felt well treated and enabled to work at a pace that was right for them.

There were effective systems for monitoring and improving quality. Staff and managers undertook a range of audits. When issues were identified through audits, complaints or other sources, the provider had responded to these. They developed an action plan with clear targets. They worked towards meeting these. Managers involved staff and senior leaders to ensure everyone could contribute to improvements.

Staff used a mixture of records and systems from the previous provider and the new organisation. The provider was in the process of updating records. This included work to bring records in line with the rest of the organisation. Records were accurate, clear and up to date.

The provider worked in partnership with external professionals. Staff liaised with health and social care professionals to ensure people’s needs were met. Managers within the organisation had regular meetings to share information and ideas. The provider had worked closely with the local authority to address areas of improvement they had identified.

There were systems for learning and making improvement. The provider offered a range of training for staff and access to guidance about best practice. Staff attended regular meetings and supervision sessions with managers to discuss their own learning and development.