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

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 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 provider was previously in breach of the legal regulation in relation to governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 36 (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. They did not understand the challenges and the needs of people and their communities. The provider and manager did not share with staff a clear vision of how the service was to be managed. They had not implemented a set of values and systems for staff to work towards or ensured that all staff worked in a person-centred way. People and staff were not involved in decision making, implementing systems or included in improving the service. This meant people received care that was provided by staff carrying out tasks which had not been organised or supervised to ensure safe care had always been provided. For example, people did not always receive food they preferred or required to maintain their safety and staff did not have all the information they needed to provide for people’s current needs.The manager described to inspectors their plans to improve the service, they told us, “I have shared my vision with staff via staff meetings, training, champions, introducing NVQ for staff, apprenticeships, monitoring staff performance from supervisions to professional discussion and sanctions and expectations for staff to adhere to contract of employment by fulfilling training so much so that the matrix is above 90% and we encouraged staff to learn a skill they interested in by being champions , empowering staff with “Employee of the month” recognition.

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 and social care experience to lead effectively and understand what good care looks like.

The provider did not have a clear system of oversight of the service to ensure people always received person-centred care that met all of their physical, social and psychological needs. The provider had not taken responsibility for the implementation of the type of leadership they envisioned to create a positive culture and values at the service.

The manager had not been able to implement systems to act upon stakeholders’ recommendations and outcomes, for example: safeguarding outcomes to improve staff and knowledge in dignity and respect.

The new manager told us they were building a team of staff that would be willing and capable of making the changes required to improve the culture and care provided, but this would require the input and support of the provider.

People did not always feel they could speak up and that their voice would be heard. Some staff had gone to outside agencies to report concerns as they did not feel able to speak up internally due to fear of reprisal, for example staff had raised concerns about staffing levels at night. The new manager held team meetings to discuss concerns, however, staff did not always feel able to raise concerns or be included in how to make improvements.

The provider 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 people who worked for them. The service had a diverse workforce in place; however, staff did not always feel they were treated fairly when they raised concerns. Staff told us of situations where they believed there was a breach of their confidentiality. We saw staff records being stored in open offices. There were policies in place to protect staff from discrimination; the manager gave us an example of how they would address discrimination and bullying. There was no system in place for the management of staff well-being, this meant staff were not always confident to provide people’s care or develop their communication skills.

The service 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. We were not assured clear governance processes were in place to evidence good quality assurance and management oversight. The governance systems failed to assess, manage or mitigate risks relating to water and fire safety, and health and safety, placing people at risk of harm from accessing unsafe areas, equipment, cleaning products, infection and in emergency situations. The provider failed to have adequate systems in place to assess, monitor and improve the quality and care provided. This meant staff did not have enough information to know how to provide safe care that met people’s needs, for example, risk assessments, care plans and handovers did not include all of people’s current information; people were at risk of not receiving care that met their needs.

The provider failed to have systems in place to ensure staff had the skills, supervision and support to develop their roles to provide ongoing safe care or have the confidence to raise concerns to the management.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. For example, not all relevant information was shared with the safeguarding team, this resulted in not all recommendations being implemented. The manager told us there had been lessons learnt from not working closely with district nurses in the past and they were working towards forming better relationships with the district nurses’ team.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. For example, where outcomes from safeguarding alerts had not always been included in improvement plans, and had not been implemented. This meant staff had not received the training they needed to improve the communications skills and people continued to experience poor care. The provider did not have a reliable system to identify or take action from complaints, incidents, safeguarding outcomes or feedback from other agencies. Their action and improvement plan did not reflect the issues that had been raised, or how they planned to make improvements across the service. This meant people continued to not receive safe care that met their needs and staff continued to not receive the support they required.The provider told us they had improved since the employment of the manager last year, they said their improvement has been tenfold on electronic care records, medication, people’s wellbeing, socialising, environment and safety.