Harrier Lodge

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 inadequate. 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.

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.

There were management structures in place to support the registered manager and help ensure care was delivered in line with organisational values.

Feedback from people and relatives was mostly positive about the service and the care provided. A person told us, “It is okay. I would be able to say they are not doing what they should be doing.” Relatives spoke positively about the environment and staff, with 1 relative describing the home as “good” and “lovely home.” Further comments included: “I really think this home is wonderful. The staff and the setup of the home is just amazing – It’s like home and it’s all good.” And “The level of care is much better now. They seem to be more equipped for residents like my relative who need more care.”

Staff spoke positively about working at the service and told us they felt able to deliver good care. Records confirmed staff received training to support them in their roles. Most staff told us they would be happy for a loved one to receive care at the home.

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.

Feedback about leadership at Harrier Lodge was mixed. Staff confirmed the registered manager was contactable and that there were clear lines of accountability, with concerns usually escalated through unit leaders. Staff felt supported by their immediate supervisors and said the registered manager understood expectations around delivering good care.

However, people, relatives and professionals reported inconsistent engagement from the registered manager. They told us the registered manager was not always visible or easily accessible, and some found it difficult to make contact. Professionals described limited responsiveness, which impacted communication and partnership working, particularly where timely follow-up was required.

Staff also told us the registered manager was often office-based and less involved in day-to-day care. While they set expectations, some staff felt they did not fully understand the pressures of frontline work. A staff member said, “It would be good for her to spend time on the floor so she understands what we deal with.” Staff felt this would provide greater opportunities to demonstrate compassionate, inclusive leadership, build confidence in leadership and motivate staff.

People did not always feel they could speak up and that their voice would be heard.

Staff told us they were not overworked and understood how to raise concerns, including through formal grievance processes and whistleblowing procedures.

There were multiple opportunities for staff to share feedback and raise concerns, including anonymous channels and forums such as “colleague voices” meetings, which aimed to improve communication and team relationships.

However, feedback indicated inconsistency in staff confidence to raise concerns at a local level. Some staff told us they preferred to escalate concerns to senior management within the organisation rather than the registered manager, as they were not confident issues would be addressed robustly. Despite this, the registered manager was able to describe actions and outcomes from concerns that had been raised.

While systems and processes were in place to support speaking up, staff confidence in local leadership to respond consistently and effectively to concerns was variable.

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.

Systems were in place to support equality and equity for staff, including access to training and development opportunities, equality and diversity training, and flexible working arrangements where possible.

Staff described a positive and improving culture within the service. A staff member told us, “The atmosphere has improved and it feels more relaxed and a much better place to work.” Another said, “It is good to have new faces, new energy in the home. The attitude of staff has improved… we are working as a team now. It is a pleasant place to work and it feels like family.” Staff feedback reflected a workforce that felt increasingly supported, included and able to work collaboratively, contributing to a more positive and inclusive working environment.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The provider undertook a range of audits across areas such as care delivery, environment and health and safety to monitor quality and safety.

Audit processes were structured, with outcomes from registered manager audits submitted internally and reviewed. Actions identified through audits were incorporated into the service improvement plan, which supported the delivery of change and improvement. Governance systems also included regular review through quality assurance and health and safety meetings, where audit findings and progress against improvement actions were discussed.

The service used organisational systems to monitor performance, identify patterns in incidents and events, and review clinical risks and compliance with expected standards, such as care records and assessments. Complaints were recorded, tracked and reviewed through governance processes, including oversight within quality assurance meetings, to support learning and identify themes.

The provider did not always understand their duty to collaborate and work in partnership, so care and support worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Feedback from professionals described mixed experiences of partnership working. While some staff worked well with external teams and followed clinical advice, this was not consistent across the service.

Professionals raised concerns about poor communication, delays in escalation and failure to follow agreed processes. Communication was described as variable, with conflicting or outdated information at times, increasing risk.

There were also concerns about ineffective information sharing, including a failure to act on emails and to use agreed urgent communication routes. The service did not always engage constructively with external partners to support improvement. In addition, there were gaps in understanding and clarity around processes and clinical expectations, which had not been effectively addressed.

We discussed these concerns with the registered manager, who acknowledged the issues and told us they would take action to improve communication and engagement with professionals.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The registered manager told us they were part of the wider Care UK managers’ network, which enabled them to share learning, seek support and learn from other services. Regular managers’ meetings were held to review service improvement plans, quality performance reports and lessons learned from incidents and where things had gone wrong. Systems were in place to capture learning from audits, incidents and feedback, with oversight and support provided by senior leaders.

However, evidence from professionals and other areas of the inspection indicated that learning was not always consistently embedded into practice. Ongoing concerns were raised about communication, engagement and delays in escalation, which suggested that improvements were not always sustained or fully effective in reducing risk.

In addition, the service did not always demonstrate openness to external learning and challenge. For example, professionals reported that support offered to help the service improve in areas where concerns had been identified had been declined. This limited opportunities to strengthen practice through external expertise and partnership working.

While systems to support learning and improvement were in place, the inconsistent application of learning and limited engagement with external partners meant the impact on outcomes for people was variable. This reduced the provider’s ability to demonstrate continuous improvement and innovation in practice.