Peter 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 inspection we rated this key question requires improvement. At this inspection the rating has remained 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 continued breach of legal regulations in relation to the governance of the service.
 

This service scored 46 (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 demonstrate a clear shared vision, strategy and culture which placed people’s experience of care at the centre of the service. People had not experienced consistently positive, person-centred care.

The provider’s policies for managing restraint and restrictive practices contained language which did not promote a positive, empathetic culture of understanding. For example, guidance referred to ‘problem behaviour’, ‘systems of rewards’ and ‘privileges’ which should be used to ‘encourage behaviour modification’.

People’s care plans described their needs in terms of their ‘behaviour’ rather than promoting a trauma-informed approach to understanding people’s unmet needs and communication. Care plans were not always written from the perspective of the person and their needs, but from the perspective of the staff. For example, people’s support needs were described as ‘emotionally demanding’ and ‘tiring’ for staff.

This did not demonstrate a positive, compassionate, listening culture that promoted trust and understanding between staff and people using the service.
 

The provider had not always ensured there were inclusive leaders at all levels who embodied the right values to lead the service appropriately.

At the time of the inspection, the service had been through a period of transition and there had been recent changes in the management structure. A new manager was in post and newly appointed supervisory roles had been created within the management team.

The new management team told us they were committed to driving improvements in the service. However, they were not always able to demonstrate how they planned to prioritise and address the improvements required.

Senior leaders were not able to clearly demonstrate how the new management team would be supported to develop the skills and knowledge to lead effectively or drive and embed improvements in the service.

Despite these concerns, people, their relatives and staff spoke positively about the new manager and told us improvements had been made in recent months.
 

Staff told us they could speak up and that their voice would be heard. Staff said they had access to information about whistleblowing and speaking up and felt able to raise concerns with the management team if required.

The provider had relevant policies and procedures in place to promote equity in their recruitment and development opportunities. Staff told us they had access to training and development opportunities and were able to request any additional support required. Comments included, “[Manager] has encouraged everyone that wants to progress within the company to sign up for their NVQs [National Vocational Qualifications] and their door is always open to all staff” and “All support and assistance have been offered to me whenever I needed it.”

The provider did not have clear responsibilities, systems of accountability and good governance. The provider had failed to robustly assess, monitor and improve the quality and safety of the service.

At the last inspection, we identified concerns with the provider’s governance processes. At this inspection, we found continued concerns with the provider’s oversight. Whilst the provider had implemented management audits and checks, these had failed to adequately prioritise and address areas of concern. We identified multiple issues with the oversight of key areas of people’s care and support including risk management, safeguarding, capacity and consent and dignified, person-centred care and support.

The provider’s model of care did not follow best practice guidance and leaders did not demonstrate a commitment to reducing restrictions and improving people’s quality of life.
 

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. The provider had not consistently acted upon feedback from health professionals to evidence how concerns were being addressed and risks mitigated.

The provider was not always able to demonstrate how they worked in partnership with people, those important to them and relevant health professionals to ensure people were supported to plan and achieve positive outcomes.
 

The provider did not demonstrate a commitment to continuous learning and improvement. The provider had failed to demonstrate how they were effectively evaluating and improving the quality and safety of the service.

At the last inspection this service was rated requires improvement and there were breaches of regulations. The provider completed an action plan to demonstrate how they would meet the breaches of regulation identified. However, at this inspection we identified continued breaches of regulation. This meant the improvement plans and governance processes implemented had failed to identify and address concerns and drive improvements in the service. This service has failed to achieve a good rating at any previous inspection.

The provider did not encourage creative ways of delivering good experiences and outcomes for people. Leaders were not able to evidence how they worked with people, relatives and staff to build a culture focused on enabling people to enjoy a full life.