Archived: Blakehill Healthcare Wiltshire

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 good. At this assessment the rating has changed to inadequate. 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 good governance.

This service scored 25 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Staff had experienced conflicting management approaches from several of the management team

Through discussions with the directors, we were not assured about their knowledge regarding the regulations which the service needs to adhere to. This meant the provider could not demonstrate they were able to deliver and develop the service in line with statutory requirements, thereby promoting an appropriate culture and direction for the service to follow.

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.

There had been several changes to managers and nominated individuals over the last year. This had led to different messages being sent to staff after each change of leader. Some staff were employed under the UK visa scheme. Despite this, managers had not ensured staff knew their rights under employment law in the UK nor under the UK visa scheme. We were informed a manager had recently shared with staff some information relating to their right to move to a different employer who was willing to continue with their UK visa. The manager stated they felt the sharing of this information had contributed to over 20 staff members finding alternative employment locally.

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

Staff told us when they spoke up their concerns were not addressed appropriately by managers, for example, a member of staff shared they had raised issues of staff competence with the provider but they saw no action from the provider in relation to their concerns. Some staff we spoke to told us they were confident to speak up, A relative shared with us staff on UK visa licenses were worried their licences could be withdrawn if they spoke out against the provider.

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. Some staff members told inspectors they felt they were being treated in a discriminatory manner by the provider. For example, at least 2 members of staff told us a colleague regularly spoke in a language they could not understand, which made them feel isolated and excluded. When this was raised with the provider, the issue was not resolved, leaving the staff member still feeling isolated.

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. The provider had experienced several changes in management and directors which had caused a period of instability within the leadership. Three people employed to manage the service had left within a few months of their employment commencing. The manager in post at the time of the inspection expressed concerns of being sidelined as a manager. They stated whist they were employed to manage the service, this had been made challenging by the provider controlling all management actions and preventing them from developing the service in a professional way.

At the time of the inspection, there was also a newly appointed director in post who had developed a new structure for managers, however this structure has changed again since the inspection visit with a new appointment to the nominate individual’s post.

The provider did not have adequate oversight of the service. Audits of systems and processes were ineffective or not in place. At the time of the inspection, there was only 1 audit available to review, which had been completed in relation to care notes. The provider could not demonstrate they had made changes because of the audit, despite the audit identifying changes were required to improve the completion of care notes. There were no other audits available to review at the time of our onsite visit. This meant there was not enough oversight of all aspects of the service including identifying and addressing incidents in a timely way, reviewing learning and development and making improvements to the service as required. Since the inspection the provider has shared some audits they stated they had completed before the inspection. These did not identify any failings in service delivery despite inspectors finding issues during the inspection.

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 always reported issues such as incidents appropriately to the Care Quality Commission. For example, relatives raised an issue of equipment being inappropriately used for a person which caused restrictions to them. This had not been reported to the CQC. Partner agencies we spoke to shared they were not placing support packages with the provider at the time of the inspection due to concerns that the service was not being run safely, specifically in relation to staff were being recruited and the number of changes to management over a short period of time.

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. Issues raised with the provider by families had not always been appropriately addressed nor could they demonstrate they completed any lessons learnt work with staff to ensure improvement in the delivery of service provision. The provider did not always ensure effective audits were being completed to enable them to identify good and poor practice and to ensure they were able to learn from actions of staff.