Bowden Lodge

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 good. At this assessment the rating changed to Outstanding: This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 93 (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 had a very clear shared vision, strategy and culture. This was based on transparency, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

There was a positive atmosphere and culture in the care home which focused on highly effective care and support for people. The values of empowerment, individuality, respect, inclusiveness and authenticity were embedded into everyday practice. The registered manager told us, “Priory’s vision [the provider] is to support people to ‘Live their life.’ This is promoted through the company and fed through to staff teams and colleagues through newsletters, weekly briefs and at site level through open discussion, meetings, supervisions and displayed on posters. We also hold 5 values which we reflect on as a standard operating procedure to embed each day when supporting our service users. These are striving for excellence, being positive, putting people first, acting with integrity, being supportive. People spoke highly of the culture in the home. One person said, “The manager is 100%, will be sorry to ever leave here.” Another said, “There is nothing to improve.”

People who used the service were highly involved in developing the shared direction and culture of the service. They attended monthly in house meetings; we saw minutes of these they were well attended and gave people a voice to be able to share their thoughts and have positive discussions. There was also a regular regional meeting held, which gave people opportunities to meet other people who lived in different services to share good practice and cultural improvements. We saw some new activities had been provided following feedback at meetings to improve people’s experiences and well-being.

The care and support we observed being delivered, was extremely person-centred. Staff spoke exceptionally positively about the culture of the service. One staff member said, “Staff morale is very good, we are extremely well supported.”

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. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Staff spoke positively about the registered managers compassion and how they had supported staff at challenging times. The management team were dedicated, passionate and focused on delivering excellent care and support for people to achieve their best possible outcomes. The registered manager understood the requirement of duty of candour. This is their duty to be honest and open about any accident or incident that had caused or placed a person at risk of harm. The service notified the relevant authorities, including local authorities and CQC where required.

Staff were encouraged to further develop their skills and professional development and could access the priory academy which supports career pathways and provides information on how to gain qualifications and experience within an identified route. The registered manager told us, “This also allows for employees to request funding for additional courses they would like to complete for continuous professional development.”

The management team were extremely motivated and enthusiastic and were constantly looking for areas they could improve and develop.Staff spoke highly of the management and felt valued and respected. A staff member said, “We work well as a staff team, we support each other.” Another said, “We are all very well supported by [manager].”

People and relatives had confidence in the whole staff team. One relative said, “The manager and all the staff are very approachable and sociable.” Another said, “The manager is lovely. There is nothing to improve, they [staff] are all lovely and we are so grateful.”

The provider fostered a positive culture where people knew they could speak up and their voice would be heard.

There were policies and procedures in place to support staff to speak up if they had concerns about care and support. Staff said they were confident any concerns were addressed, and they were listened to.

There was regular engagement with people and their relatives, and they felt listened to.

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 were supported fairly and there were policies in place to ensure equality, diversity and included was promoted in the workplace. Staff told us the registered manager was very flexible and accommodating to any personal needs and supported them to remain at work. Staff said protected characteristics were considered and reasonable adjustments were made where required. Staff felt valued and included.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment, and support. They always acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate. The provider had robust quality monitoring systems in place, which identified areas for improvement. For example, the service was recruiting an additional domestic. The standard of cleanliness within the service was to a high standard, this was maintained by a dedicated domestic, who was responsible for cleaning all the communal areas. This enabled staff to concentrate on supporting people with their own rooms. However, it had been identified that additional domestic hours were required and the registered manager was recruiting for a second domestic so the hours would equate to a full-time post to ensure this standard was maintained.

Any areas identified by the quality monitoring and audits which required improvement were added to the providers action plan. The management team were continuously looking at ways to make improvements to enhance the quality of life for people who lived at the service and had a track record of ensuring excellent outcomes for people. The provider had a director of quality, and quality improvement leads. The quality improvement lead for the service regularly visited to ensure the standards were maintained and to support the registered manager.

The registered manager completed daily walk rounds to ensure people were supported appropriately, staff were carrying out their roles as expected, and the building was safe and well maintained. People were involved in the governance, which was discussed at their monthly ‘Your voice’ meetings where they were encouraged to express their views on any improvement required. Discussions at these meetings ensured people were knowledgeable about the home, were aware of changes and improvements taking place so had direct involvement in shaping the service. For example, some people took part in making decisions about the decoration of the service, choosing colours and furnishings.

Relatives’ views were also sought, an annual quality satisfaction survey was sent out with pre-paid return envelopes, this increased the amount of returned completed questionnaires and gave opportunity for relative to be involve. This helped staff and leaders improve how the service was run and presented.

Team meetings were held monthly within the service. These were chaired by the registered manager or deputy. The registered manager said, “Within these meetings, we review governance, environment, service user’s needs, changes, medication, environment, health and safety, training, staffing etc. These meetings also allow for colleague feedback and discussions of any other topics in which may need addressing within the service. The team meetings are helpful as they also involve admin, maintenance and housekeeping therefore ensure full inclusivity of the team.” Flash meetings were also held twice a week; any actions form the monthly meetings were followed up and discussed to ensure actions were addressed or any changes recorded.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

The staff team worked exceptionally well with health and care partners, and they followed advice and guidance to ensure good outcomes for people. The registered manager explained how they had successfully worked together with health care professionals to move people on to supported living, the next stepping stone to living independently. These were extremely positive outcomes for people as many had spent most of their lives in hospitals or secure units. Staff told us a person who moved on last year will contact the service to speak with staff and is really pleased to tell them how he is doing and enjoying living independently. Another person was currently working towards their goals to move out. The registered manager said, “[name] is doing really well, they have achieved many of their goals and will not be long before they were ready to move on, this is a great achievement for them.” One person had also been supported to retake their driving test and had been successful in getting their licence back.

People had been able to establish links with the local community, including a gym and specific community groups. Staff supported people to use local buses to be able to access the local area independently. Where people were not able to use public transport the company vehicle was available to use. One person explained how staff had helped them use the bus independently, staff had firstly met them in Sheffield to get the bus back to the home to assist them to became familiar with the route and they were now getting the bus on their own.

Health care professionals told us they were working with people to transition from secure units to the service, and the support and involvement of the staff team was exemplary. One professional said, “They [staff team] have assessed people in a timely fashion and requested all relevant paperwork, such as Care Act assessments, Mental Capacity Assessments and Support plans and risk assessments/ care plans from the wards. They have provided a caring response for patients who are vulnerable and been observed to offer reassurance and transition visits.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always 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 was continually looking at ways to improve the service by learning lessons and sharing good practice. We were shown several examples where the registered manager had reviewed and analysed events in detail to learn lessons. One example was regarding sexual safety, the serious incident review was exceptionally detailed it included persons details, risks, back story, incidents, actions, post incident review and post incident actions, lessons learnt. The director of quality also conducted a staff meeting following the review, to give staff a chance to discuss their thoughts and feelings as the incident had affected staff, any actions which came out of this were addressed. The staff we spoke with all said they found this meeting extremely helpful and really appreciated the director getting involved and listening to their views. One staff member said, “The period this relates to was a very stressful time for staff and other people living at the home, the lessons learnt was really good and helped staff deal with the outcome.”

Accidents and Incidents were regularly reviewed within the governance meeting held monthly. This was shared with the staff team including any changes to support plans following incidents, and any changes to the risk management. The registered manager completes a monthly incident analysis which identifies any trends and themes and how people can be supported or monitored to prevent from happening again. The registered manager said, “During governance meetings colleagues may also discuss recent incidents to ensure best practice is being followed. Staff also have opportunity to discuss further at their one-to-one meetings to reflect on how these have been managed or how they can improve on incident management in the future. Debriefs/safety huddles are also completed.”

The provider held monthly managers meetings, and monthly regional governance meetings. These were attended by registered managers from services in the region. They shared good practice, lessons learnt and new initiatives, improvements, and relevant research. For example, an ongoing issue is recruitment, staff retention, and use of agency. This was discussed at each governance meeting to look at innovative ways to improve recruitment, retain staff and prevent use of agency, which can have a detrimental effect on people. Ideas were discussed to speed up recruitment process with ensuring a full recruitment history is promptly obtained from applicants. The provider also promoted a clear career progression pathway to enable staff to obtain qualifications and seek promotion and therefore retain staff.