Harp Place

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• 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 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.
This is the first assessment for this service. This key question has been rated 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 Good Governance.
 

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 not fully embedded a clear shared vision, strategy and culture based on transparency, equity, human rights, inclusion and engagement. Leaders did not always evidence how they involved people, relatives, advocates, staff and partners to understand and respond to the challenges and needs of people using the service.
We found limited evidence that leaders had embedded a clear service strategy or used structured systems to check whether the service’s values were consistently delivered in practice. This was important because the service supported people with learning disabilities. Leaders had not demonstrated that the service’s shared direction consistently placed people at the centre of decisions about their lives, independence, relationships and community involvement.
The provider had not consistently evidenced how people, relatives, advocates, staff and partners contributed to shaping the service’s direction. Feedback also showed mixed views about leadership and oversight. One relative said the provider needed to improve communication about what a person did during the day and who oversaw the care package. This showed leaders had not always communicated the service’s direction and accountability clearly.
 

Not all leaders demonstrated that they fully understood the context in which the provider delivered care, treatment and support. Leaders did not always have the systems, knowledge and oversight needed to lead effectively with openness and accountability.
Leaders knew people using the service and were involved in day-to-day support. However, they had not consistently identified shortfalls found during the assessment. These included gaps in staff records, training oversight, care planning, mental capacity documentation and quality assurance. This demonstrated leaders did not always have effective oversight of the service or the risks affecting people’s safety, rights and quality of care.
Leaders showed compassion and commitment to people. People, relatives and advocates gave some positive feedback about leaders. Relatives said they knew how to contact managers, and an advocate said they felt the service was well managed. Leaders were approachable and responsive when people or representatives contacted them.
However, feedback about leadership was mixed. One relative said, “I am not sure,” when asked whether they felt the service was well managed.
Leaders were caring and accessible, but they did not always demonstrate the capability, regulatory understanding and oversight needed to lead the service effectively.
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.
People, relatives, advocates and staff described managers as approachable. A staff member told us, “I am able to speak up and managers would help me; they support me with work and personal challenges.” This evidenced that staff felt able to raise issues and seek support from leaders.
People and those important to them also felt able to raise concerns. One person told us that they felt confident and safe to tell their carer when they had concerns of any nature, they were also comfortable in escalating the concern beyond their carer. A relative said they would feel confident raising concerns with the provider and would let them know about issues. A representative we spoke to said they would feel confident raising a concern, stating, “Yes 100%.”
This feedback showed people and representatives could raise concerns informally and confidently felt that leaders would respond. The provider also described an open-door culture where staff could speak with managers about concerns. The staff we spoke to confirmed this.
However, the provider had not always supported this culture with robust formal systems. Feedback opportunities were not consistently offered, and records did not always show how concerns, feedback or learning were captured and used to improve the service.
 

The provider did not always evidence that they valued diversity in the workforce or worked towards an inclusive and fair culture by improving equality and equity for staff.
We found limited evidence that leaders had formal systems to monitor workforce equality, diversity and inclusion. Staff records did not always include complete recruitment information. This meant the provider could not demonstrate that recruitment and employment processes were consistently fair, transparent or robust.
The provider also did not maintain regular documented supervision or appraisal records. This reduced leaders’ ability to understand staff experiences, identify support needs, consider reasonable adjustments or address any workforce inequalities. Without structured supervision and workforce oversight, the provider could not show how staff had regular opportunities to discuss wellbeing, development, equality or workplace concerns.
However, staff confirmed that managers were supportive and helped when they had personal challenges, this suggested that leaders provided informal support to staff. We did not identify direct concerns about discrimination or unfair treatment, but the provider lacked records and systems to show they actively monitored equality and equity for staff.
 

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.
Governance systems were not always effective in identifying, monitoring and addressing shortfalls. The provider used a training matrix to track staff training. However, they had not taken timely action when some training had expired, including training linked to people’s assessed needs. Staff files did not always contain up-to-date employment histories or induction records. This meant the provider could not demonstrate effective systems to monitor staff suitability, training and competence.
Quality assurance systems had not identified or addressed all risks. Mental Capacity Act 2005 (MCA)assessments were not embedded into people’s care plans. Care plans and risk assessments were not consistently updated when people’s needs changed. Spot checks and unannounced observations had not been consistently recorded. Infection prevention and control (IPC) audits and personal protective equipment (PPE) stock records were not in place.
Medicines governance required improvement. A medication error had not been notified to Care Quality Commission (CQC) or the local authority when required, and it had not been included in lessons learned records. medicines administration record (MAR) audits had not been evidenced.
However, people described kind and reliable care from staff who knew them well. We did not identify direct impact on people at the time of assessment, but the governance shortfalls placed people at increased risk of avoidable harm.
 

The provider understood their duty to collaborate and work in partnership, so services worked more effectively for people. They shared information with partners and collaborated to support people’s care.
The provider worked with relatives, advocates, commissioners and healthcare professionals to support people’s needs. Feedback showed leaders contacted families and representatives when needed and worked with external professionals around care arrangements. A relative said the service had been involved in discussions with healthcare commissioners and regularly contacted the family. This showed the provider worked with others to support people’s care.
The provider also escalated concerns to external agencies where people’s needs changed or where risks were outside the service’s direct control. This included working with social workers, mental health professionals, healthcare professionals and other agencies to coordinate support.
The service supported people with learning disabilities, and partnership working was important to help people access community opportunities, healthcare and meaningful routines. Leaders recognised barriers in the local area and described trying to improve access to community facilities for people with learning disabilities and mental health needs.
However, partnership working was not always supported by strong internal recording systems. Relatives raised concerns about how daily information was recorded and shared. Formal review records and communication systems needed strengthening to show how information from partners and families was consistently used to update care.
 

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.
We found limited evidence that leaders used audits, incidents, complaints, feedback and outcome monitoring to drive continuous improvement. The provider had not always recorded incidents, lessons learned or improvement actions. Some concerns identified during the assessment had not been identified through the provider’s own governance systems. This included gaps in medicines reporting, care plan reviews, risk assessments, staff records, training oversight, IPC checks and feedback systems.
People experienced some positive outcomes, but leaders had not consistently measured these outcomes or used them to develop the service.
However, staff supported people to access activities and improve confidence, hygiene, independence and social wellbeing. The provider described trying to improve community access for people with learning disabilities and mental health needs, including exploring wider community resources, which was evidenced by ongoing communication with their local MP. This showed some willingness to innovate. However, relatives still raised concerns that community support was not always meaningful enough and that suitable local options remained limited.