Clarence House Care Home

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 has changed to 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.

The service was in breach of legal regulation in relation to good governance.
 

This service scored 46 (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 always understand the challenges and the needs of people and their communities. Systems and processes at the service had not ensured that leaders and staff had a shared vision and culture that benefitted people receiving care and support. Feedback from staff regarding the service was mixed. Some staff felt supported and able to offer feedback about the service, but others did not. Staff told us, “I think some staff are happy, and some are not” and “Sometimes you can tell [the leadership team] things and it changes, but sometimes not." Some staff at the service felt there was inconsistency with how their feedback was managed.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leadership within the service did not demonstrate an understanding of all issues within the service or how to manage these. Staff reported a culture within the service in which some staff felt supported, and others did not. There had been a number of changes within the management team of the service prior to the assessment. Following the site visit the provider took action to strengthen the leadership and staff team within the service. These changes will take time to implement and embed.

People did not always feel they could speak up and that their voice would be heard. The provider did have a whistleblowing policy which directed staff on how to speak up and all staff knew how to raise concerns both within and outside of the organisation, however staff had mixed feedback about their confidence in raising concerns. Staff shared concerns with us that they did not always feel their concerns could be acted upon or that they would be listened to.

The provider did not always ensure all members of their workforce felt valued. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Feedback from staff was mixed, whilst some said they felt supported others reported that they did not. Some staff reported an environment with cliques and referenced feeling bullied. One member of staff referred to feel discriminated against. The systems and processes in place at the service had failed to recognise and address these issues within the staff team.

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. Although governance systems and auditing tools were in place, these systems had failed to recognise or address multiple issues found during the assessment. Care plans contained contradictory or out of date information about people’s needs. Issues were identified with the safety of the environment and staff, and people and their relatives raised concerns with inspectors regarding staffing levels. Governance tasks were delegated to members of the staff team. However, systems to quality assure this had not been effective in ensuring issues were identified and acted upon quickly. Although the provider did take some immediate steps to implement improvements and strengthen the leadership team within the service, these improvements will take time to implement and embed.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. Prior to our assessment of the service, we received some negative feedback about the service from external professionals regarding a number of issues including staff knowledge, errors in care plans and the recording and monitoring people’s fluid intake. An action plan was in place to address these concerns. However, these issues remained at the time of our site visit. Relatives did not always feel informed about the care of their loved ones.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. Processes were in place to monitor the safety and quality of care delivery. However these processes had failed to identify the issues found during the assessment. When concerns were brought to the attention of the provider, these were acted upon quickly. However, deficiencies within the governance of the service had prevented early detection, correction and learning from issues.