Nest Healthcare

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• 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

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 remained requires improvement. This meant the service 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 regulation for good governance as the environmental risk assessment had gaps and was not robust.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We scored the service as 3. The evidence showed a good standard. The service 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 complimented the leadership and felt they were competent and available when they needed them. Staff felt that leaders were supportive and approachable. Leaders were visible throughout the service.  

Leaders had continued to focus on the quality of their service. The admissions permitted had not experienced any significant safety concerns, although people did express concerns with the quality of the service being offered. The service did not have community meetings, which meant people had limited options for ways to provide feedback outside of their one-to-one sessions.  Staff told us people could approach them to talk about any concerns or feedback.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, 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.

Managers had embedded a more effective governance process and, with further admissions, had been able to monitor the effectiveness of their changes. This included an audit schedule, and team meetings to share information. The service had implemented appropriate audits, and this was no longer a breach of regulation.  

However, not all previous breaches had been addressed. Managers told us that early treatment exit plans were still in development and had not yet been embedded into practice. There remained issues with the quality of the ligature risk assessment. There were gaps and the grade of the risk was not always completed.  

Managers missed opportunities to engage with people who used their service and to capture feedback about the quality of what was being delivered. All 5 people accessing the service gave negative feedback about the service.  

Managers ensured staff had access to supervision to discuss their workload and practice.  

The service knew what events required a notification to the local authority and CQC.  

The service had a duty of candour policy in place, which staff were aware of, and this was no longer a breach of regulation.  

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.