Boldmere Court Care Home Also known as 1-341197990

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 remained the same.

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 the systems in place to oversee the safety and quality of care provided.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The home had been taken over by a new provider 6 months before our assessment commenced. The provider had a shared vision, strategy and culture which they were working to introduce to the staff team. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement. However, they did not always understand the challenges and needs of people living at the home.

We saw that work was needed to reduce the risk of unnecessary restraint being used in some instances. The provider told us they wanted a culture of restraint used minimally and as a last resort.

Staff told us the changes being introduced by the provider were positive. Some staff we spoke with were particularly positive about new training that was being introduced as our assessment concluded. They told us they felt it would help staff better understand the needs of people living with dementia.

Work was underway with the staff teams to learn about the values of the provider and instill them in the care provided to people.

The provider had a leadership team which was quite new and developing at the time of our assessment. The registered manager remained in post in transition from the old provider to the new one. We found inconsistencies in the capacity and capability of the leadership team.

There were aspects of care and planning that were understood and managed well by the leadership team. For example, they had conducted a detailed assessment of environmental safety. This had resulted in a good overall knowledge of what areas of the home needed to be prioritised to ensure people’s ongoing safety. The area in which leaders showed less understanding was around restrictive practice. At the time of our assessment, they had not obtained a robust understanding of how restraint was being used in the home. They could not evidence an effective culture of least restrictive practice. The provider gave assurance following our concerns that understanding and minimising restraint had been prioritised.

The leadership team were visible and staff told us they were easy to approach. Overall, the staff we spoke with told us they felt optimistic about the changes the new provider was introducing.

People did not always feel if they spoke up that their voice would be heard. Much of this feedback was about the food offered to them. The staff we spoke with told us they felt confident to raise concerns and that they would be listened to. However, some of them also said they had previously raised concerns about people’s meals and this had not resulted in change. We also saw one example where it was not clear that a staff member felt safe to speak openly about events which had occurred.

Some relatives we spoke with also told us they were not confident that sharing concerns would result in the changes requested. Other relatives told us they were happy with the responsiveness of staff when they had had questions or concerns.

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.

Staff told us they felt supported by the new provider and management team.

Staff spoke positively about each other and told us they felt they worked well as a team. No staff we spoke with had concerns about bullying or harassment at work.

The provider 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.

Many of the concerns we identified during our assessment had not been detected or highlighted by the governance systems in place at the time of our assessment.

For example, systems had not ensured records detailing incidents were consistently detailed. Systems to review staff timeliness and responsiveness had failed to identify the lack of data from the care call bell system.

Although it was known staff were using physical restrictions for some people, the use of this practice had not been reviewed in a timely way.

Reviews of policies and procedures had failed to identify the gaps in guidance needed for unwitnessed falls and head injuries.

Checks of monitoring records had not identified the lack of detail in food records for some people.

There was no clear system in place to ensure people at risk of dehydration were having their fluid consumption checked.

Overall, we found the provider responsive to our concerns and observations. Action was taken to address many of the concerns quickly. However, time would be needed to make sure the changes introduced were successful and enable managers to identify any further improvements needed.

The registered manager did share data with external agencies as needed and in line with local arrangements.

Although there was need for improvement in ensuring people consistently received emergency care when needed, we did see other areas of good practice. The provider understood their duty to collaborate and work in partnership with other services.

The registered manager’s work regarding a particular health condition had resulted in external recognition. The staff team worked with a wide range of other services and health professionals to try to improve people’s care. These included the community mental health team, the Speech and Language Team (SALT) the Tissue Viability Nurses (TVN’s) occupational therapists, as well as consultants, GPs and the local pharmacy.

The local GP service provided weekly scheduled visits to maintain oversight of people’s health conditions.

The provider did not always focus on continuous learning, innovation and improvement across the organisation. They did not always actively contribute to safe, effective practice and research.

Systems to identify and share lessons learned were in place. However, they had not always been effective. For example, there had been 3 instances in the year prior to our assessment where people had been exposed to hot drinks spillages. The hydration and nutrition policy and procedure did not include guidance on how to minimise the risk of scalding from hot drinks.

More work was needed to ensure that people and where necessary their loved ones were at the heart of learning and development to improve care.

The provider had reviewed the training provided to staff and was in the process of introducing more learning sessions in focused areas.

The strategy for future training was to increase the amount of face-to-face training offered to staff. Staff we spoke with about this welcomed this change.