Christopher Grange Residential Care

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 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 under the provider. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The provider was in breach of legal regulation in relation to governance and leadership.

This service scored 32 (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 shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. For example, the provider and registered manager didn’t always understand what day-to-day life was like in the home or what people needed. They lacked oversight of poor practice, a lack of support for staff and areas for improvement.

The providers systems and processes failed to effectively assess, monitor and improve the quality and safety of the service and learning had not taken place following safety events. Staff told us the culture did not always feel positive or focused on person‑centred, high‑quality care. Some staff said they lacked confidence in raising concerns as they didn’t feel they would be listened to.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty. For example, although a registered manager was in post our findings demonstrated significant gaps in their leadership capability. Shortfalls in supervision arrangements, staff training processes and day‑to‑day managerial oversight meant staff were not consistently equipped to fulfil their roles safely, and risks were not always identified and mitigated in a timely way.

Leaders were not consistently visible or accessible to people and staff, and they did not have the required knowledge or effective systems to ensure the workforce felt supported, confident or safe in their practice. Routine checks on quality such as audits and observations of staff practice were infrequent or absent. As a result, emerging issues were not identified early, increasing the likelihood of harm.

Overall, leaders did not demonstrate sufficient awareness of the cultural or operational issues within the service. This limited their ability to safeguard people and promote a positive working environment. After our follow‑up visit, the provider submitted an action plan outlining the steps they intended to take to address these concerns.

People did not feel they could speak up, and their voice would be heard. For example, the provider did not actively seek feedback from people and staff. The provider had not created opportunities for staff to raise their concerns in line with their own policy such as through regular team meetings and supervisions. Staff told us they did not always feel the provider listened to them. One staff member told us, “They don’t listen, even if we were to raise an issue nothing would change, we are dangerously understaffed, but nothing is being done, only now you are here they have put extra staff on.”

The provider did not always value diversity within their workforce or work towards an inclusive and fair culture that improved equality and equity for staff. For example, some staff told us they did not feel valued and described limited support when they experienced personal circumstances affecting their work. One member of staff said, “There is no support for staff; we are not listened to.”

Staff experiences indicated inclusion was not embedded consistently across teams. People told us they were not always confident their views would be heard or acted upon, which discouraged open communication and reduced their sense of belonging.

However, the provider employed a diverse staff group with a wide range of backgrounds and experiences.

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. For example, there were failings in leadership and governance of the service.

Care records were not accurately maintained and kept up to date with people’s current and changing needs to ensure effective delivery of care. There were inconsistencies in information about people’s needs and risks, and examples where key information was missing including best practice guidance on how to safely meet people’s needs.

Audits and checks were not completed at the required frequencies resulting in missed opportunities to identify areas for improvement such as risk, delivery of care and staff performance. The registered manager confirmed care plan audits were not completed. Both the registered manager and provider told us they carried out daily walkaround checks, despite this neither maintained any records detailing the areas checked or their findings.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not share information and learning with partners or collaborate for improvement. For example, the provider did not demonstrate how they consistently collaborated with others. The provider only sought advice from a relevant professional to mitigate the risks regarding podiatry care after prompting from CQC. Furthermore, the provider had not shared potential safeguarding information with the local authority.

However, one health partner spoke positively about their experience working with the provider and with the staff team. Staff told us how they worked in partnership with health professionals to support people’s health needs.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. For example, governance and quality assurance systems did not demonstrate learning and improvement. The provider did not encourage creative ways of delivering equality of experience, outcome and quality of life for people through safe, effective practice and research. The management team recognised their systems for measuring quality at the service had not supported reflective practice to promote continuous learning and improvement.