St Mary's Nursing 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 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 remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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 always clearly share their vision, strategy and culture, to show this was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

There had been changes in the provider running the home since our last inspection. Most people and relatives were positive about the culture at the home, with relatives highlighting the positive approach from staff to their family members and the skills staff had to meet people’s care needs.

One person told us, “I’m happy with the home, no cause for complaints. There’s nothing I would change, the food’s okay and there are nice [staff].” A relative said, “We met [registered] manager, she is lovely, and the [provider], too.” Another relative said because of the approach taken by staff, “There’s no question, they’re 10 out of 10.”

One staff member told us there was an expectation to focus on people, so their needs would be met. The staff member said, “I think we are a good team. The nurses and seniors are all great. We help each other.” However, there were mixed views from staff about how included they were in the running of the home, their access to 1:1 meetings with their managers, and paid time allocated to undertake training. Some staff told us although staff meetings were regularly held, these were primarily to inform them about decisions taken, rather than to encourage staff to share their views on the running of the home. Another staff member said, “Communication with the [leadership] isn’t good. Things aren’t shared, there’s no talking about things. If there’s something new or different you often learn about if from another staff member. No one explains.”

The registered manager acknowledged improvements were required to promote an inclusive and sharing culture. They told us systems had been introduced to share key information with staff about people’s needs, including through emails, WhatsApp updates and staff handovers. The registered manager had also started planning additional 1:1 meetings with staff and had recently allocated resources to support training during shifts. These developments, whilst needing time to embed, were intended to strengthen communication and a shared sense of direction across the team.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders were continuing to develop the skills, knowledge, experience and systems to lead effectively.

There was a clear management structure in place. The registered manager was supported by senior staff who maintained day to day oversight of the service Most people knew which senior staff to approach when they needed support, and relatives told us they were able to communicate with the registered manager about their family member’s care needs, either directly or by email.

Staff explained although the registered manager did not work directly alongside them in providing care, they received regular guidance and oversight from their line managers. One staff member said, “The nurses are really helpful. If you are worried about something, they will talk to you and help you.” Another told us, “I have found the deputy to be very good. If you have any questions, they will answer them or find out and come back to you.” Staff also said the registered manager offered advice during open‑door surgeries.

Senior staff had opportunities to develop their professional skills and maintain their registration. The registered manager told us they felt supported by the provider to deliver good care. They also planned to attend local provider and commissioning groups to further develop their leadership skills and to strengthen communication with the staff team.

Most staff said the provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff gave examples of how senior leaders listened when they raised concerns about the running of the home, and they told us leadership acted where needed. For example, to support individual staff member’s performance, or to alter break patterns to the benefit of people and staff.

Most staff said they felt confident to speak to leaders about whistleblowing concerns or, if necessary, raise these with external organisations. A staff member told us they had used the registered manager’s open‑door surgery to speak up and felt heard. Other staff told us they were comfortable raising concerns with their line managers.

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.

People were cared for by a diverse staff team. Staff told us the leadership at the home recognised their individual needs and protected characteristics, and supported and respected them. Staff described some positive experiences, such as managers being considerate of individual circumstances. Some staff told us their medical conditions, and their own protected characteristics, had been accommodated through adjustments to their workload, work practices and hours. One staff member told us this made them confident to be open about adjustments they needed to support them in their role. Another staff member explained they had been welcomed by colleagues and said, “The best thing is that you can build a family over here with the team.”

The provider had clear responsibilities, roles, systems of accountability or good governance. They did not always act promptly on the best information about risk, performance and outcomes.

Although the provider’s governance systems had identified concerns with medicines management, the necessary improvements were not implemented in a timely or effective way. Similarly, while mattress‑setting checks had taken place, these systems did not ensure 1 person’s mattress was promptly adjusted to the correct level, leaving avoidable risk unmanaged. Systems for communicating people’s required food textures also needed strengthening to ensure safety information was consistently shared and acted upon.

More robust communication across staff teams was required to ensure governance processes were effective in driving improvement and to make sure the culture of the home consistently centred on the needs of people living at St Mary’s Nursing Home. The registered manager started to address these areas during the inspection.

However, other governance processes were operating effectively, with several checks supported by oversight from the provider. People and relatives told us the home was run well, and they recognised improvements since the provider took responsibility for the service, including a significant reduction in the use of agency staff. Health and social care professionals also reported improvements in the recording of people’s care.

Staff understood the standards expected of them. One staff member said, “You learn on induction that you must follow the care plans. By following them you know you are doing the right care for the resident. If you can’t do something or if a resident refuses, you report to the senior carer or the nurse so they can check.”

Staff told us the registered manager and senior team monitored how care was delivered and provided supportive feedback. One staff member said leadership took a positive approach to helping them improve their practice: “She tells us if we are not recording properly on the electronic care system. [Registered manager’s name] is nice about it.”

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

Relatives told us when they raised individual concerns or suggestions about their family member’s care, they felt listened to. People and relatives had previously completed surveys, and we saw evidence their feedback had led to improvements. The registered manager told us further surveys were planned to gather updated views.

Health and social care professionals told us communication with leadership and staff at the home was good, and described good levels of rapport with staff. A health and social care professional who regularly supported people living at the home told us, “The staff at St Mary’s work proactively with me to improve the care being provided with the aim of reducing unnecessary hospital admissions, improving dementia care and care at the end of life.” Another health and social care professional described how they had guided staff, so a person would receive access to the funding they wanted.

Staff gave examples showing how they had sensitively supported people where there were areas for potential conflict, and worked with other health and social care professionals to ensure people’s wishes were fully supported.

The registered manager and senior team had established structures to support people’s access to other health and social care providers. Further development to support people to access the local community was being considered.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Relatives who had previously raised concerns told us the service had listened carefully and taken learning from their feedback. One relative told us this had led to improved staffing levels. Health and social care professionals told us staff were committed to learning about people’s individual support requirements and how their health conditions might affect them. One health and social care professional said staff worked with them to increase the frequency of checks required, so they could be sure their understanding of people’s needs was current.

Systems were in place to support ongoing learning from complaints and accidents and incidents and to identify any emerging patterns. The registered manager and provider reviewed these occurrences, to identify areas for improvement. Learning was also shared across the provider’s other locations.

The leadership were responsive to feedback and demonstrated a clear commitment to continuous learning and improving the quality of care.