Hickling House

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 governance 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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The home manager told us they worked hard to ensure people were consistently provided with good quality care and shared that they “wanted to give people the best life you can give them here.” Not all staff could relay the values of the home but described how they are caring, deliver person centred care and how the residents are their main priority.

A staff member said “it’s a great place to work” whilst a relative said “It is people, carers and Management that matter. This Care home is a godsend. I would recommend it.”

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge and experience to lead effectively.

We identified shortfalls that had not been recognised by the service through their own oversight and governance processes, indicating that areas were not consistently identified for improvement. When these issues had been highlighted, the staff responded to address most of these concerns.

The management team were visible, approachable and staff told us overall they felt supported in their roles. A staff member explained “The manager is so understanding and kind” and another explained “The manager and deputy manager are so approachable, I can go to them for anything.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff told us they felt able to speak up if they had any worries about care or safety and knew who to approach.

They were confident their views would be listened to and acted on without fear of retribution. The registered manager described an open-door approach, and staff were encouraged to speak directly to management.

This approach supported early identification of concerns. The provider had a whistleblowing policy and guidance for this displayed in the home.

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 received training around equality, diversity and inclusion and most staff said that they felt supported to develop their skills and some staff expressed an interest to explore more end-of-life training.

The service utilises a small group of regular agency workers who are integrated into staff teams, they receive the same induction, mandatory training and competency assessments as permanently employed staff based at the home, this ensures they are fully included in the service and able to provide safe consistent and person-centred care.

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.

Audits and quality assurance processes had not identified environmental issues or shortfalls within care records. We were not assured that policies in place had been read and understood by staff and their documentation was not up to date. We identified gaps in staff files and areas of the staffing rota that could have a potential impact on the culture of the service. The provider had not recognised or assessed this and had not implemented measures to mitigate any associated risk.

The informative guidance available from the Local Authority with reference to falls, safeguarding and medication errors had not been updated or reviewed to reflect current practice. Keeping guidance current reflects best practice the latest legislation and local procedures for supporting continuous improvement. This meant that governance systems in place were not consistently effective in identifying risks monitoring the quality and safety of the service or driving improvements.

Whilst the provider responded promptly once concerns were highlighted; improvements were reactive rather than being identified through the services own oversight and governance arrangements. Staff were clear about the management structure of the home and said that the manager spent a lot of time with people and staff during the day.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. Peoples care and support plans demonstrated that people were referred to appropriate healthcare professionals when needed.

Healthcare professionals told us, “Referrals to healthcare professionals such as district nurses, dietitians are carried out in a timely manner.” Whilst another healthcare professional told us, “We have felt the level of communication has improved in the recent months.” This supported people to have positive outcomes.

The provider worked closely with the local community and planned events and engagement throughout the year. The registered managers of the 2 sister homes met regularly to discuss staffing, peoples changing needs, and operational issues, this supported effective workforce planning.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research. We found that opportunities to embed wider organisational learning was not consistently evident.

Although audits were completed regularly, they were not consistently meaningful, or outcome focused and we found some demonstrated a lack of detail and contained inconsistencies in recordings and findings. Lessons learnt were shared but not always recorded and this limited the effectiveness of the services quality assurance.

The provider had sought feedback from people using the service, relatives and staff. There was limited evidence that the feedback had been analysed or evaluated, this meant that the service was unable to demonstrate how people’s views had been used to identify priorities.

The service demonstrated a commitment to improving people's lives and had introduced new approaches to activities. They communicated well with people using the service and their relatives keeping them informed and encouraged to share feedback.

Throughout this inspection the provider had been responsive and proactive in rectifying concerns we had found. The home manager was committed to improving the service and demonstrated a willingness to introduce new ideas and strengthen existing governance processes.