Archived: Bethany Homestead

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

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 Inadequate. At this assessment the rating has remained 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 service continued to be in breach of legal regulation in relation to governance and the failure to maintain effective oversight of safety, safeguarding, medicines management, and the quality of care being delivered. Although, leaders had begun to take action, governance systems remained reactive and had not yet led to meaningful or sustained improvements. Staff lacked confidence that their concerns would lead to change, and repeated issues continued to place people at risk.

This service scored 50 (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 or culture that reflected transparency, inclusion, and equity. There was a noticeable gap in how the service communicated expectations to staff, particularly around upholding dignity, responding to people’s needs in a timely way, and fostering consistent accountability. Although some policies were in place, these had not translated into consistent practice across the team.

However, the registered manager and deputy manager were working to reinforce values of dignity, responsiveness, and shared responsibility. Performance management processes had started, and daily safety and well-being checks had been introduced to support closer monitoring. These actions show commitment, but a shared understanding of culture and values had not yet been fully established across the workforce.

Not all leaders demonstrated the skills, knowledge or presence to lead effectively or embody the values of the organisation. Senior care staff were observed walking past call bells without responding, and staff feedback indicated that senior roles were often limited to administrative or medication tasks, with little practical involvement in care delivery. This contributed to low staff morale and poor oversight of care standards. The registered manager was visible and approachable and had identified performance concerns that were being addressed. The deputy manager had taken on a more active role and was working to strengthen accountability. The provider had been made aware of the service’s challenges, but inclusive and effective leadership was not yet present at all levels of the service.

People did not always feel confident that they could speak up and be heard. Some staff told us they had raised concerns around staffing or care practice but had seen little change. There was also a pattern of repeated concerns, such as sensor mat issues, missed care, or delayed responses, that staff had identified but had not been addressed until highlighted by inspectors. Staff described the registered manager as approachable and open to feedback. The deputy manager was also seen responding quickly when issues were pointed out. These signs were encouraging, but the culture of speaking up had not yet matured into one where concerns routinely led to meaningful change.

The provider did not always demonstrate strong attention to equality and inclusion within the workforce. Some staff described a lack of consistent support, supervision, or recognition. Senior roles were not always fulfilling their responsibilities in a way that enabled all team members to feel valued and supported. There was limited evidence that inclusion and diversity were actively promoted in day-to-day practice or reflected in leadership behaviour. However, we saw respectful interactions between staff of different backgrounds, and staff said they worked well as a team. The provider had not received complaints relating to discrimination, and training in equality and diversity had been completed by staff. While the culture was not discriminatory, more proactive work was needed to build an inclusive and supportive environment for all.

The provider did not have clear governance or oversight to ensure high-quality care. The provider had not implemented effective systems to assess, monitor and improve the quality and safety of the service. The provider's audits were limited in scope or not routinely followed up with action. For example, medicine audits focused only on stock counts and failed to identify issues with as-required medicine protocols or incomplete cream records. There were no structured reviews of falls data, sunburn incidents, or missed repositioning, and safeguarding alerts were not always submitted. Although the registered manager had made some improvements to the safety of the environment, they had introduced governance tools such as daily well-being and safety checks, these had not been implemented properly and were not effective. The provider's governance systems continued to be reactive following feedback from outside agencies and did not identify issues to be preventative; the provider failed to have systems to achieve sustainable quality improvement.

The provider did not always collaborate effectively with external professionals or partners. For example, there was a delay in escalating concerns regarding a broken pressure mattress, making appropriate safeguarding referrals and seeking guidance on photosensitive medicines. Some visiting professionals raised concerns about communication gaps or difficulty getting updates. However, the provider did work with external clinical teams such as district nurses and the community medicines team,and this had led to improvements in some areas such as palliative care. The deputy manager was engaging with professionals and working to improve partnership working. While these efforts showed promise, the service was not yet consistently collaborative in approach.

The provider did not consistently focus on learning, improvement or innovation. Repeated issues from previous inspections, such as call bell delays, poor medicines practice, and inconsistent documentation were still observed during this visit. There was little evidence that lessons were learned from incidents, audits, or staff feedback, and practice remained inconsistent across the service. The registered manager had started to implement governance systems and although these actions reflected a desire to improve, the systems for learning and continuous improvement were not yet developed or embedded. The service remained in the early stages of building a culture of reflection and innovation.