Bell House Care Home Limited

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 requires improvement. At this assessment the rating has changed to 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 was in breach of legal regulation in relation to good governance.

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’s core values were not embedded throughout the service. There was a culture whereby staff implemented practice, such as unnecessary restrictive practices, which were not compliant with legislation and best practice regarding maintaining people’s human rights, or support people with equality and engagement. People were not supported to make choices regarding their care or maximise their independence. Values were not discussed with staff in supervision sessions or team meetings. Following our assessment, the provider told us they plan to include core values in staff discussions to drive improvements.

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.

There was a significant lack of oversight. At the time of assessment, the service had no registered manager. Leaders failed to identify shortfalls in quality of care. For example, restrictive practices and unsafe medicines management. Leaders failed to maintain registration responsibilities, such as submitting notifications to CQC, for notifiable events such as safeguarding concerns. Leaders did not have effective oversight of notifications, accidents, incidents and safeguarding concerns, to identify patterns, trends or areas which required improvement. People and relatives provided mixed feedback regarding visibility of leaders in the service. One person told us, “I don’t know who the manager is.” The provider has advised us they plan to improve governance systems to strengthen oversight of the service. Staff spoke positively regarding leaders in the service.

People did not always feel they could speak up and that their voice would be heard.

Although staff advised us, they felt able to speak up to leaders, robust systems were not in place to support staff and people to do so. Staff were not aware of whistleblowing procedures and contact information was not available for people to escalate concerns, for example, contact details for CQC. Staff provided positive feedback regarding their ability to speak up to leaders. One staff member told us, “I feel able to speak up and raise concerns.” People provided mixed feedback about the visibility of leaders in the serve, and whether they felt able to raise concerns. One person told us, “It is well run here.” Another person told us, “I would not know who to complain to.”

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.

Although there was a diverse workforce in place, robust systems were not in place to support safe equality, diversity and inclusion. The provider did not ensure there were safe recruitment processes in place or ensure staff were supported and competent to fulfil their role.

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.

The provider failed to maintain secure, accurate and complete contemporaneous records for people in the service and did not follow their own internal policies regarding good governance, medications and safeguarding. Although some audits were completed by leaders, these failed to identify key concerns regarding medication management, environmental safety, IPC concerns and care plans. Contemporaneous records had not been completed by staff, leading to a risk of inaccurate information being recorded for people, for example, regarding nutritional intake. Care plans lacked important significant information, pertinent to enabling staff to appropriately support people. The provider failed to ensure they met their regulatory responsibilities, by displaying their rating in the service, completing notifications or updating the scope of their service.

The provider’s failure to identify key governance concerns, demonstrated a lack of effective auditing and oversight processes, contravening policy and professional standards, which placed people at risk of harm. Following the assessment the provider has told us they are implementing systems to strengthen governance within the service.

The provider did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider did not always make appropriate referrals to support people to receive safe care. The provider failed to make appropriate safeguarding referrals to the Local Authority or notify CQC of notifiable events. We received feedback from several professionals who advised communication from the service was poor.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

There was a lack of robust systems in place to support overall learning and improvement at the service. The provider failed to identify key areas of improvement required through use of auditing and oversight tools, including safe staffing, training or identifying a culture of poor practice. Although staff advised us there were discussions around learning from incidents, there was a lack of analysis of findings in audits, or patterns of concern, to drive service improvement. Staff practice did not support people to receive care which was equitable or improve outcomes or their quality of life. Following the assessment the provider has told us they plan to implement measures to identify key areas of improvement required in the service.