Flowerdown 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 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 requires improvement. At this assessment the rating has changed to good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

At our last inspection we found the service was in breach of legal regulation in relation to the good governance. At this inspection we found the service was no longer in breachof this regulation.

This service scored 75 (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.

The registered manager instilled a culture of openness, kindness, empowerment and a drive to ‘get things right’. Where shortfalls in were identified, the registered manager was proactive, took action and learned from them. The manager spoke about people and staff as “a family” which was reflected by comments from staff, people and their relatives.

The registered manager was focussed on instilling a nurturing, inclusive and positive culture. Staff were committed to the service and upheld the values of the provider. Most staff told us they felt valued by the management, and they could speak to the registered manager at any time and would be listened to.

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 had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

There was a clearly defined, stable management structure who had distinct roles. This meant management tasks were effectively distributed and managed.

The registered manager knew people and their needs comprehensively and provided strong support and guidance to staff. Senior managers were known to people and provided robust and regular support to the registered manager and staff team.

The registered manager met with other managers to share learning to improve the service. They showed us examples of actions they had implemented to develop the service, for example, staff champions and a whole home approach to increasing quality interactions with people.

The registered manager demonstrated compassionate and inclusive values. For example, during a significant refurbishment, where people needed to move rooms, they considered the impact on people and involved staff ideas on how to minimise disruption. Staff were allocated specific tasks at specific times, and people’s new rooms were set up exactly as they were previously to reduce disturbance to people.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff were provided with different opportunities to speak up and feedback to management. There were regular staff meetings, staff surveys and the manager had an ‘open door’ policy, meaning they were always available for staff to speak to. There were ‘Speak Up’ champions, who were independent from management who could support staff to raise concerns. Guidance and information was available to staff on posters and in the speak up policy. Most staff told us they felt confident about speaking up and felt they were listened to.

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.

There was a diverse workforce which was welcomed and valued by the registered manager. They gave us examples of how they had supported staff to have flexible working arrangements and reasonable adjustments to meet staff needs, while balancing the needs of the service. We also saw examples of how the provider celebrated different values and diversity. For example, activities celebrating various cultural events throughout the year. Staff received equality training and were supported by policies which promoted equality, diversity and workforce wellbeing.

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 had clear and effective governance, management and accountability arrangements, meaning staff understood their role and responsibilities. Managers accounted for the actions, behaviours and performance of staff. For example, the registered manager identified shortfalls in staff recording. They investigated this and supported staff to understand the importance of timely recording and as a result recording improved.

The registered manager understood their legal responsibility to notify CQC of significant events affecting people and the service. Records showed notifications were submitted to CQC in a timely manner and were detailed. This demonstrated an open approach to their management.

There were robust arrangements for the availability, integrity and confidentiality of data, records and data management systems.

Systems and processes such as audits, action plans and spot checks, evidenced good quality assurance and management oversight. For example, out of hours visits were regularly completed by the registered manager to ensure the quality of care was maintained when they were not usually present.

Staff at different levels were empowered to be part of the quality assurance processes. For example, the medicines champion completed the medicines audits, and the head of unit staff completed quality checks. The registered manager had oversight of these, and senior managers carried out regular monitoring of safety and the standard of care, for example regarding falls, skin tears and hospital admissions. This reduced the risk of concerns not being identified effectively.

Although records showed regular, robust auditing systems identified successes and areas for improvement, we found a small number of audits which had not always been effective. For example, recruitment audits had not identified the concerns we found during inspection, although these were rectified after the inspection.

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.

The provider had positive and effective relationships with other professionals and people had access to health professionals who were involved with the service to meet their needs. Visiting professionals told us referrals were made quickly and appropriately, and they welcomed the professionals’ breakfast and benefitted from joined up working. The registered manager had collaborated with a local GP surgery to receive training on a computer program to improve efficiency and effectiveness around medication ordering.

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.

The provider ensured people and their relatives were involved in developing and improving the service. For example, their thoughts and ideas were gathered during meetings and surveys, which were then reviewed and responses were fed back to let them know what had been actioned.

There were systems and processes to ensure learning from good practice and when things went wrong took place. Leaders encouraged reflection and collective problem-solving with staff and relatives. For example, 1 relative told us the registered manager had worked with them to find a positive solution to a particular situation regarding their relative.

Staff were supported to prioritise time to develop their skills. The whole staff team completed various training and there was a ‘whole home’ approach, meaning staff across different roles supported each other and people as needed.

Staff told us they felt the provider actively involved them in understanding how to make improvements and collective problem solving, including when things went wrong. They told us this was managed through regular supervision, team meetings, training and learning and reflection sessions after incidents. Records seen during the inspection confirmed these took place.