Hamilton's Residential 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 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. The service was in breach of legal regulation in relation to governance of the service.

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. The provider had a mission statement, ‘To be recognised as a passionate and committed provider by providing the highest quality of care.’ Staff were not clear about the vision and mission of the provider. They told us the culture within the service had been poor under the previous manager. Staff felt unsupported and there had been a negative atmosphere. A staff member told us, “There has been a lack of leadership and direction.” Some staff felt they had been ‘cut off’ from the provider by the manager and had not been able to raise concerns with the provider. During the assessment, the provider acknowledged they had not recognised the poor culture within the service under the previous manager until shortly before they left. Staff told us they were optimistic about the new manager who they called ‘a breath of fresh air’.

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. The provider had not always ensured managers they employed had the skills and knowledge to lead the service and support staff.The provider had not completed relevant checks on the previous manager. This included checking their competence in previous management positions to ensure they could fulfil their role and responsibilities. The provider had not actively checked on the previous manager’s performance to ensure they were fulfilling their role. The previous manager had not been open and transparent with staff. They had not supported staff to develop their skills to provide safe care. The new manager had been in post for a month, had identified shortfalls and had started developing an action plan to rectify these.

People did not always feel they could speak up and that their voice would be heard. Staff told us under the previous manager they had not felt supported to speak up. They told us they had not been listened to. Some staff were treated differently, and they had been cut off from the provider. Staff meeting minutes showed staff had not been encouraged to voice their opinions and offer suggestions. Staff told us they had not received supervision to discuss any concerns or identify their training needs. The new manager had already met with staff and discussed how they would move the service forward and staff felt more confident.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff told us they did not feel all staff were treated equally. Staff told us they found their personal circumstances were not always taken into consideration when the shift rota was completed. The rota was often very late being given to staff and those who needed to arrange childcare did not always have time to do this. The manager was aware of the concerns around the shifts and was aiming to make improvements once staffing was settled.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. At our last inspection we identified shortfalls in the governance and oversight of the service. At this assessment we found there had been no improvement. The provider had completed monthly reports as part of their oversight of the quality of the service. These reports had not always identified shortfalls or reviewed areas such as care plans. When they had identified shortfalls, they had asked the previous manager to act, but this had not happened. There was a quality lead in post who was responsible for completing audits. However, these audits were not robust and had not identified the shortfalls found at this assessment. The large turnover of senior care staff in the past year had affected the quality of the service. Staff had been given responsibilities for areas such as maintaining care plans but had not been given the support and training to complete these roles. The provider had commissioned a mock inspection by an external consultant in January 2023 which identified shortfalls including medicines management and care plans. These shortfalls continued and were identified at this assessment.

The provider did not always understand their duty to collaborate and work in partnership so services worked seamlessly for people. The service worked with other health care professionals including district nurses. However, they had not fostered links with the community or had a system to take people out as part of activities.

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. The provider had not supported improvement within the service. The quality of the service provided had not improved since our last inspection. There was no effective system in place to drive improvement and there was a poor quality assurance process in place. The provider could not demonstrate learning or knowing how to make improvements within the service.