White Rock Nursing 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 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 governance at the service.

This service scored 62 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff told us there was an open culture where they felt confident to speak up. They said morale was “good.” There had been new ownership during the previous year and all the staff we spoke with said this was a positive experience. Staff told us the management team were visible and would regularly support staff on the floor if needed during the day. One staff member said, “The manager, the deputy manager, the nurses, and even the owner. They are always coming round and asking, ‘how are you?’, always saying ‘can I come and help with this?’ They are always ready to help straightaway.”

The registered manager and deputy manager told us they led by example, which included having a presence on the floor, rather than staying in an office. The registered manager said, “I'm very lucky with the staff team here. They are very supportive, willing to learn, they listen, and they know they can talk to us.”

Regular staff meetings took place. Staff told us if they were unable to attend the meeting, minutes were provided. Staff told us they were encouraged to speak up during meetings.

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 highly of the management team and the provider. They told us the management team were “very good” and “easy to talk to.” One staff member said, “[Registered manager] is a good manager and very supportive. [Deputy manager] is the same. We [staff] do not feel like if we say anything it’s not a good thing. They are open and we are open. Their door is always open.”

The registered manager had worked at the service for many years. They were open and transparent with us and listened to and responded to our feedback in a responsive way.

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

All staff we spoke with knew how to raise concerns. Whistleblowing information was readily available for staff to access if needed. One staff member said, “I haven’t had to do this. But, yes, I would feel confident to do so.”

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.

The staff team was diverse with many staff from overseas. Staff told us they felt included and considered themselves part of the team. Comments included, “It’s friendly here, I feel supported. I can approach [management team] any time. If I need a day off at short notice, [they] will be flexible. I go home to [country name] every couple of years and they are flexible to make me able to go.”

The registered manager said they had recently included staff and people using the service in a ‘round the world trip’, where overseas staff brought in food and items from their own cultures to show and share with others. They told us, “We ended with the UK in a pub. It was really fun. We had a Romania day and learnt a dance in front of the residents. We try hard to appreciate the diverse nature of the staff group here.” They told us they supported staff with any cultural needs such as fasting if requested.

The provider did not always have 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 because it was not always recorded.

We were not assured the provider always operated effective systems and processes to identify and drive improvement. Although regular audits were carried out across all areas of the service, they had not identified the multiple shortfalls we noted at this inspection. For example, medicine audits had not identified conflicting medicine room temperatures, record keeping issues or the use of generic PRN protocols. Governance reviews had not identified that choking incidents had not been formally reported and therefore not formally investigated. The conflicting guidance on the handover sheet and pots of thickener had not been escalated by any staff and the providers system had not ensured records were always up to date and contemporaneous.

The issues we noted with environmental safety checks had not been identified. For example, audits had not been effective to identify the concerns we found with the unlocked sluice door and window restrictors. Water temperature checks were carried out, but when temperatures exceeded recommended limits, there was no record of actions taken. Although monthly, weekly and daily checks were completed throughout the service, documents evidencing this were not always dated and signed.

Processes for consent and best interest decision making had not ensured all relevant decisions had been consistently considered. The provider’s oversight of the service was not consistently effective at identifying areas for improvement.

However, throughout the inspection process, both on-site and following the inspection off-site, the management team were open, and transparent and listened to and acted on our feedback immediately. There was an improvement plan in place, and we saw this was regularly reviewed and updated. We saw no evidence of adverse impact on people using the service because of the governance issues we raised. We received unanimously positive feedback from all health professionals we spoke with or received written feedback from. People and their relatives all spoke highly about the whole service.

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

The service had a good relationship with the local GP service and teams of other health professionals. One health professional said, “As a team, we cover 19 residential and nursing homes and respect that they are all different, but we would have to say that the team at White Rock really do stand out as a home that delivers exceptional care. They have embraced working in partnership with the care home assessment team to deliver the best care possible.”

The registered manager said “We have good relationships in the community. The local school children come in at Christmas and Easter and sing to people. We go to the local dementia allotment weekly; we’ve just started an allotment. We have an annual garden party for people and their families.” The service had worked with a local college to accept students on work placement.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Although choking incidents had not always been formally reported, other Incidents and accidents were reported, investigated, and analysed for trends. Lessons learned were shared with staff during staff meetings and during daily handovers. The management team responded to feedback in a proactive way, during and after the inspection.

Staff received regular training and updates, training compliance was high and all the staff we spoke with said they felt trained to carry out their roles. For example, a staff member said, “They [registered manager] supported me to do my OSCE (objective structured clinical examination) and get my UK nursing registration. I’ve done so much training here for my role.”

All the staff we spoke with told us they were routinely asked for their feedback and suggestions. One member of staff said, “[New owners] coming in; it's better. They have brought in some good things, we are more modern now, the new care planning system is good and the new medicines system will be better for us.”