Archived: Blakehill Healthcare Bristol

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 good governance and notifications of incidents.

This service scored 43 (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 share and embed the vision, strategy and culture within the service based on transparency, equity, equality, diversity and engagement. They did not always understand the challenges and the needs of people and their communities. The values of the service had not been embedded into the organisational culture. Staff we spoke with told us the values were discussed during induction, but they were no longer familiar with what they were. However, staff could give examples how they worked to deliver person centred care. Leaders did not ensure there was a planned strategy focused on learning and improvement. For example, a service improvement and development plan. Staff told us they worked well together. One staff member said, “I have good colleagues.”

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. Leaders did not always have the skills and experience to lead effectively. There had been a number of changes of management and senior staff over the last 12 months. This meant leaders and senior staff were continuing to develop their skills and experience. This included staff responsible for delivery of supervision and quality assurance. Systems and processes were not always fully understood by senior staff to be entirely effective. Governance systems did not ensure leaders were knowledgeable about issues and priorities for the quality of services. People and relatives were not always clear on the senior staff structure. A relative said, “I don’t know the manager.” However, there were some positive comments. A relative said, “Since the company has moved to a new system and management, the service is much better.”

The provider had systems so people could speak up. However, these were not fully utilised to effectivity develop the service. A complaints policy was accessible to people in their service user guide. People and relatives said they were happy to use this process and felt issues got addressed. A relative said, “I have had complaints and concerns in the past and these have been dealt with to my satisfaction. I am confident that a lot of things will now improve.” However, records of complaints showed some were not investigated, actions taken or learning shared. Whereas other complaints had been effectively resolved.

Staff told us they felt comfortable to speak up and could share their views in supervision and staff meetings. A staff member said, “Every concern we give them [managers] they work on and improve the care.” People and relatives had raised a number of compliments with the provider about staff, these were shared with care staff. One compliment was recorded, ‘[Name of service user] is really happy with the care provided by the carers and appreciates the support.’The provider planned to send out questionnaires to gain feedback from people, staff and relevant others. Previous feedback sought through this method were not available to review. Therefore, it could not be demonstrated if any actions of improvements had been made in response.

The provider did not always ensure diversity in their workforce. Therefore, the staff team was not fully reflective of the people and community they supported. However, the provider had an equality and diversity policy. We received positive feedback about the balance of gender of carers. Staff had been recognised through a carer of the month scheme. Staff told us their personal circumstances, such as caring responsibilities and how these were considered.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The provider’s governance arrangements did not effectively review and assess the quality and safety of the service. Governance arrangements did not identify shortfalls in care planning, risk assessments, medicines management, record keeping and notifications. Audits completed showed general statements for an area had been met but did not give specific information of what had been reviewed or identify areas for improvement. For example, medicine audits did not detail whose medicine administration records (MARS) were reviewed or what had been specifically observed.

Notifications were not always made. We found 2 notifications had not been submitted to CQC which is a legal requirement. Systems did not always identify and review information effectively around safeguarding concerns, incidents and accidents. Governance systems had not identified this. The provider had an action plan. However, this plan only included areas identified through an inspection of another of the providers locations. The plan did not include any areas identified specifically for the service location from previous audits. A business continuity plan detailed the mitigation of risks for unforeseen circumstances such as adverse weather and data loss. A separate plan detailed the risks around workforce sustainability due to a full reliance on overseas sponsored staff. The provider had not displayed their CQC assessment rating at their location as required. However, the provider completed this by the end of the site visit.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. We were not provided with any professionals contact details who worked with the service to obtain feedback, as requested. Information was not always shared with CQC or the local authority as required. For example, in relation to safeguarding concerns. The provider had not developed many working relationships with external agencies and within the community. However, a newsletter had been sent to people to share key information and updates. This included themes on complaints and compliments, staff training and recognition.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research. The provider was unable to demonstrate a positive learning culture through incident and accident management. Governance arrangements did not robustly demonstrate actions taken and improvements made. For example, not all incidents were logged within the providers online system. Some incidents needed confirmation of actions taken and if the incident was still outstanding. Patterns and trends were not effectively identified to ensure risks did not reoccur. For example, people’s medicines being administered safely and as prescribed. We found limited assurance of actions taken along with any learning. There was no documentation of what discussions had been held with staff at their meetings. We raised this with the provider as this shortfall had not been identified within the providers own governance arrangements.