Romney 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 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 provider was in breach of legal regulation in relation to the governance of the service.

This service scored 54 (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.

Leaders told us they cared deeply about the service and were passionate about ensuring people were safe and well looked after. They said the home was a family affair which had been passed down over the years, and everyone had the same focus. Leaders said this was providing people with a good standard of care in a homely setting.

Staff told us they enjoyed working with those who lived at the home and wanted to do the best they could to meet their needs. One staff member told us if they were short staffed, there was never any impact to people. They said this was because staff worked extra hard to ensure people received the care they needed.

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, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders recognised keeping up with systems and documentation was a challenge. They said this was because they made sure people’s needs were met, whilst the management of the service was given less priority. Leaders told us, “Residents come first before any form”. They said they would look at improving this area moving forward.

Staff told us they did not receive regular one to one meetings with leaders to discuss their performance and staff meetings were infrequent. They said the meetings were generally to discuss a big change in practice, not for information sharing or suggestions to enhance practice. Staff told us leaders spent time in the service although their office was at the bottom of the garden. This impacted on their presence, and easy accessibility.

Leaders told us they were approachable, and there was a designated Health and Wellbeing representative. This gave focus to ensuring staff were supported and their wellbeing was promoted.

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

There was variable feedback about raising concerns. One staff member told us they were not always sure concerns would be dealt with effectively. They said this was particularly so if the concern was related to those staff who had worked at the service for many years.

Concerns were not always taken seriously or appropriately investigated. This was because leaders believed any negativity was gossip unless raised formally with them. They said they trusted staff, and believed poor practice such as people being in soiled bedding would never happen at the service. However, curiosity and verifying their beliefs was needed to ensure accuracy.

Concerns had not always been documented. This did not demonstrate the concerns were taken seriously and appropriately investigated or enable patterns and trends to be identified. Leaders told us they would address these shortfalls moving forward.

However, other staff told us they would speak up if needed. One staff member told us the office door was always open, and leaders often worked alongside them. This gave opportunities to raise concerns if needed.

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.

Leaders told us they had a diverse team of different ages, and life experiences. There were male and female staff, which enabled people to have a choice of who supported them. Leaders told us the team worked together well and were accepting of each other’s individuality.

Records demonstrated equality and diversity training formed part of the provider’s training plan for staff.

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.

Whilst some auditing was undertaken, shortfalls found during this inspection had not been identified. For example, information within care planning was not up to date or person centred and risks people faced had not been effectively identified, assessed or mitigated. This placed people at risk of harm.

Leaders had not identified aspects of the environment were not safe. This included exposed hot surfaces, hot water from hand wash basins, unrestricted windows and unsecured cleaning materials. They were not aware if the recommendations identified from an external contractor regarding the risk of legionella, had been actioned. These shortfalls increased the risk of accidents and incidents, which impacted on people’s safety.

Leaders told us they trusted staff to work effectively, but this was not tested through formal observations of practice or competency checks. Leaders did not routinely undertake nighttime checks or review call bell response times. This did not enable areas of development to be identified if needed.

Leaders did not always investigate concerns effectively or document their findings. For example, before the inspection, a concern about people being in soiled bedding was raised. Leaders told us this would not happen as staff would tell them, yet no written account to demonstrate their theory was documented. This did not evidence the concerns had been taken seriously or thoroughly investigated. Leaders told us they were aware their record keeping was an area they needed to develop.

There was a lack of management oversight of accidents and incidents. This was because they were documented individually on people’s care records, not listed to show an overview. This did not enable patterns or trends to be identified, which could be used to shape the service. Systems did not evidence there was clear learning from accidents and incidents.

Leaders told us they worked well with senior leaders, and each had their areas of responsibility. They said senior leaders were supportive and regularly visited the service. They did not however, undertake any formal audits or maintain a record of their visits.

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.

Leaders told us they had built established relationships with various health and social care providers. This included GPs, community nurses, podiatrists and specialist nurses. People were supported to attend hospital appointments and referrals could be made to professionals such as the dietician.

Leaders told us they were part of manager forums to share experiences and enhance learning. Different organisations were used to deliver training to the staff team.

A health and social care provider was complimentary about the service. They said “It’s a lovely home. I can’t fault them, they’re really lovely. They know the residents well and people always looked well cared for.” The health and social care professional told us staff made timely referrals when needed and any advice they gave was properly followed.

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. They did not actively contribute to safe, effective practice and research.

A lack of systems and processes did not enable learning, and ongoing development of the service. For example, documenting accidents, incidents and concerns on people’s individual care records did not enable clear management oversight. This did not ensure patterns or trends were identified or used to further develop the service.

Other systems such as monitoring call bell response times or assessing care delivery had not been undertaken. This did not ensure care provision met people’s needs, or any areas of development were identified and addressed.

Leaders had not ensured staff training had been consistently arranged in a timely manner. This included key subjects such as medicine administration and moving people safely. Staff’s competency in these areas had not been assessed, which did not ensure they were following safe practice.