St Mary's Care Home

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 leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At the last inspection we rated this key question good. At this inspection the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care. 

We found the provider was in breach of the legal regulation relating to the skills of the registered manager and good governance.

This service scored 36 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Despite the registered manager saying in the statement of purpose they had provided support for people with a learning disability and autism for many years they had not made sure staff received appropriate training, changed the environment so it became more appropriate to encouraging enablement, and made sure there were sufficient staff to allow a move to provision of a specialist service. The registered manager did not recognise when changing the service to one operated as a specialist service for people with learning disabilities or autism, they would need to ensure the ethos of the home changed.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty. Despite inspectors and our registration manager for the national learning disability team sharing all the relevant guidance the registered manager continued to demonstrate a lack of understanding of the principles of right care, right support, right culture. They demonstrated a very limited understanding of best practice initiatives for working with service users who have a learning disability or autism. They failed to understand the principles of best practice when working with working age adults. They did not understand the principles of enablement so had not considered people might want to form relationships, have places of their own and lead an ordinary life.

In general, the registered manager fostered a positive culture where people felt they could speak up and their voice would be heard. Most people, relatives and staff were confident to raise concerns with the management team and felt any issues would be addressed immediately. However, some people found the manager was not always responsive when they raised issues. For example, when concerns had been raised about the lack of staff, this had been dismissed because the position was the service had a full complement of staff. We found staffing levels were insufficient for the needs of people. The provider addressed our concerns immediately.

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. However they had not ensured action was taken to employ staff with the skills and knowledge needed to operate a specialist service for people with a learning disability or autism.This meant they had not taken review service and make sure the culture of the organisation developed in the context of equality, diversity, and inclusion needs of the people using the specialised service that was now being provided.

The provider governance arrangements failed to identify the service was not effectively meeting people’s needs. The provider had not recognised the building and staff practices were not meeting the principles of right care, right support, right culture and therefore no action had been taken to ensure the service met the needs of working age adults and people with a learning disability or autism. For example, the governance systems had failed to identify the operating model used in the service needed to change from that used in older people’s care homes to models used within services for younger adults and people with a learning disability and autism. That the statement of purpose had not been changed to show they were now operating a specialist service. They had not recognised care records did not cover how peoples’ health conditions impacted their lives. That there were no positive behavioural support plans in place and care records contained no communication plans. That the registered manager had not ensured they had the skills and competence to run a specialist service. That the staffing dependency tool was designed for determining how many staff were needed for people with physical health needs and primarily used in older person’s services. That activities were not individualised and did not support service users to develop skills needed to live more independently.

Staff 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. A professional said, “I find the team always contact us when needed and are always responsive to our requests.” However, the management team had not effectively worked with people, their representatives and staff to build a culture that focused on enabling people to enjoy their lives, develop skills, have new experiences and live the life they choose.

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. Staff did not actively contribute to safe, effective practice and research. The provider and registered manager were not aware of current guidance and best practice when supporting people with a learning disability or autism. Therefore, they had taken no action to ensure staff understood how to provide a specialised service for people with a learning disability or autism. Therefore, staff continued to work with people in the same way as they always had.We raised concerns about staff practices during the inspection and in response the provider employed an external consultant whose experience had mainly related to managing larger care homes.