Miles House - 4 Hentland Close

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 regulations in relation to promoting dignity and good governance.
 

This service scored 57 (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 or consistently applied vision, strategy or culture that promoted transparency, equity, dignity and human rights. Although the provider had set organisational core values, some staff we spoke with did not know or understand these, and leaders did not always model or uphold them in practice. The service was not consistently aligned to its values. For example, they had not ensured the environment was safe or that people’s dignity was promoted. This meant the provider could not demonstrate a shared direction or culture that supported high quality, person centred care.

Leaders did not always understand the context in which the service delivered care, and they did not consistently model their values or ensure these were embedded in day to day practice. They had not done all they could to protect people from avoidable harm and had not reported all potential safeguarding concerns as required. Staff were not always focused on ensuring people’s days were inclusive or outcome focused. Leaders did not always make use of available support networks to improve the quality and safety of care, which contributed to gaps in oversight and inconsistent practice. Despite these concerns, the registered manager was open and responsive to feedback during the inspection and assured us they would use this as an opportunity to learn and improve the service. Staff described the manager as approachable and told us they were confident action would be taken when they raised concerns.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The provider had systems and policies in place to support staff to raise concerns, and staff we spoke with were aware of the whistleblowing policy and felt confident to escalate issues to the provider or management. Staff told us they understood how to raise concerns and felt their concerns would be listened to. One staff member said the registered manager frequently emailed the whistleblowing policy to remind staff of the process.

The provider valued diversity in their workforce and took some steps to promote an inclusive and fair culture. Staff told us they were treated fairly, and policies were in place to support equality, including those relating to harassment and maternity, so that reasonable adjustments could be made when required. Most staff had received equality, diversity and inclusion training to help them understand and support the diverse needs of colleagues and people using the service.

The provider did not operate effective governance systems. Audits were not effective and did not identify areas for improvement or the shortfalls we found during our visit. They failed to maintain adequate oversight of the service. This meant they did not recognise or address emerging risks, including shortfalls in staff training. The provider did not ensure that digital information was processed in line with GDPR, as images were retained that were not necessary for the purpose of care and compromised people’s privacy and dignity. Staff had not received learning disability and autism training at a level appropriate to their roles, and had only completed basic training, which did not meet legal requirements. This contributed to inconsistent practice and placed people at risk of not receiving care aligned with best practice guidance. Following our visit the provider confirmed they were arranging appropriate training for staff. Although staff mostly documented accidents and incidents, there was no evidence that debriefs took place to learn from them or prevent recurrence. The provider gathered some feedback from people but did not have systems to collect or act on feedback from professionals or to formally evaluate performance. There was no clear plan in place to improve the quality and safety of the service, and policies did not always reflect current guidance or support the delivery of safe, person centred care. The provider acknowledged there were areas for improvement and expressed their commitment and willingness to address these.

The provider did not always understand or fulfil their duty to collaborate and work in partnership with others. The registered manager had not attended relevant forums or local network meetings, which limited opportunities to share information, learn from external partners, or contribute to joined up approaches to care. However, they did work with other professionals with regards to day to day care of people living at the service.

The provider did not have effective systems to support learning, improvement or innovation. There was no policy in place for learning when things went wrong, and leaders did not have sufficient oversight of how care was delivered to identify shortfalls or drive improvements. Quality systems were not effective in identifying continuous improvements, and people and relatives were not consistently involved in shaping or developing the service. This meant the provider did not have a clear or proactive approach to learning or ongoing improvement.