Bush Rest Home

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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

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 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 the legal regulation in relation to governance systems at the service.

This service scored 61 (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 vision for the service which referenced developing and demonstrating best practice to provide the highest standards of care. However, whilst improvements had been made to some aspects of the service the provider had not fully embedded systems and practice which supported and realised this vision and there was a continued breach of regulations relating to the governance arrangements. We found a lack of review of some incidents for learning and risk management and inconsistent information in people’s summary care plans about key risks to people which meant people may be exposed to the risk of harm. The governance arrangements had not identified these concerns and therefore action had not been taken to address these issues.

Leaders did not always demonstrate they had the knowledge and skills to consistently ensure people’s care; treatment and support was effectively delivered. The manager had not consistently ensured systems in place to keep people safe were operated effectively. For example, there were inconsistencies in how reports were made to the safeguarding authority when people had experienced an unwitnessed incident resulting in an injury. The location had a manager in post at the time of the inspection, however they had not made an application to register with the Care Quality Commission which is a requirement of the provider’s registration. We saw this manager had made some progress, and some improvements were noted at this inspection. People, relatives and staff described being supported well by the current manager. A relative told us, “The manager has taken so much time to help us.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The provider had a policy in place to ensure staff were able to speak up if they were concerned about anything. Staff told us they understood how to safeguard people and felt confident in raising concerns to the manager. The provider’s policy set out how they would protect staff who disclosed information and gave alternative contacts to raise concerns should staff feel this was needed. This meant staff felt confident to raise concerns about people’s safety.

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 provider told us in the provider information return how staff shared information about equality and diversity as part of their pre-employment information to enable the provider to offer any support needed and to have information about staff preferences relating to their protected characteristics. Staff received training in equality, diversity and inclusion as part of the provider’s mandatory training. There was an equality policy in place which set out how staff were treated fairly and how the protected characteristics of staff would be considered. Staff confirmed they felt fully supported in their roles as individuals.

The provider’s systems did not consistently ensure they identified risk or enable effective action to be taken to mitigate risk. For example, some incidents were not being adequately reviewed, and systems were not in place to identify this issue. Medicines stock control systems had been put in place which required staff to count medicines stock daily; however, we found this had not been done for several days and the systems in place had not identified this gap. The system in place to review care plans and risk assessments for accuracy had not identified where there was inconsistency in information in people’s summary care plans. This meant we could not be sure the provider’s governance arrangements were fully embedded or effective in identifying areas for improvement. Other systems were in place and operating effectively. For example, where people had falls, individual falls were reviewed and actions taken to prevent reoccurrence, checks on medicine administration records and daily records were identifying any inaccuracies and actions were taken to address this.

The provider understood their duty to collaborate and work in partnership and collaborate with others to improve services. In the provider information return the provider told us they worked with the dementia support service to develop an action plan on improving the service. They also referenced working with community nurses to monitor people’s health needs and seek advice, and dieticians to support people to maintain their nutrition. Records we saw supported this. Partners told us the provider had worked with them to make improvements following the last inspection and had developed a new unit to support local commissioners to provide care for younger adults with dementia.

The provider’s systems did not always consider learning and contribute to improvements.Where systems were in place to look at and review incidents for learning, these had not always been used to review all incidents including where people had an accidental scalding incident and distressed behaviour incidents. This meant we could not be assured learning had been considered and used to reduce the risk of these incidents reoccurring. Since the inspection the manager told us they had put systems in place to ensure all incidents were considered, we will check this at our next inspection. Where falls had been experienced, individual reviews were completed and changes made to people’s risk assessments and care plans. However, where trends had been identified there was no clear action taken to consider these and any wider changes which may be needed to reduce falls. This meant there were missed opportunities for learning when things went wrong.