Bamburgh Supported Living

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 inspection we rated this key question good. At this inspection 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 provider was in breach of the legal regulations in relation to good governance.

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 and culture based on transparency and engagement. The provider had not embedded a shared culture that placed people at the centre of their care and support at all times.

Documentation did not always reflect compassionate, respectful or person-centred language. People's needs were frequently described in terms of their ‘behaviour’, rather than demonstrating a trauma-informed understanding of communication, distress or unmet needs. Care plans did not consistently reflect what was important to people. The provider could not demonstrate a clear and consistent approach to delivering person-centred care.
 

Not all leaders understood the context in which the provider delivered care and support. They did not always embody the culture and values of their workforce and organisation.

The provider had not ensured leaders at all levels had the skills, knowledge, experience and credibility to lead effectively. Oversight of the service was not sufficiently robust and concerns identified during the inspection had not been recognised or addressed by leaders. The provider could not demonstrate effective monitoring of leadership practice to ensure leaders promoted safe, high-quality and person-centred care.
 

Staff did not always feel they could speak up and that their voice would be heard. Whilst policies were in place to provide guidance about whistleblowing, we received mixed feedback about how well staff felt the provider listened and responded to issues raised. This meant staff did not always feel their voices were heard.

The provider valued diversity within its workforce. Policies and procedures were in place to promote equity throughout recruitment processes. The provider was able to demonstrate that staff had access to development opportunities, including training and professional qualifications, to support their career progression.

The provider did not have robust systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider had not identified or addressed shortfalls in the leadership, culture and governance of the service prior to the inspection. The service was not consistently well-led and leaders did not always promote a culture of person-centred care. Shortfalls in care documentation had not been identified through the provider's oversight processes. This meant there was a risk people's needs, preferences and risks were not consistently understood, monitored or met.
 

The provider understood their duty to collaborate and work in partnership with healthcare partners. Information was shared appropriately with health professionals and other agencies to help ensure people received appropriate input and support. We received positive feedback from health professionals about their experiences of working with the service. Comments included, “The service has demonstrated a willingness to work collaboratively with professionals” and “Staff are very helpful, knowledgeable and supportive.”

The provider did not always focus on continuous learning, innovation and improvement. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people.

Whilst the provider promoted opportunities for reflection through regular staff and management development days, we found feedback and incidents were not robustly analysed to identify areas of development or improve people's experiences of care. The provider could not demonstrate how learning was embedded across the service to improve practices.

Following our feedback, the provider told us they were implementing a service improvement plan and provided evidence of how key areas would be prioritised and addressed going forward.