Elmhurst Intermediate Care Centre

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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

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

This is the first inspection for this service since its registration with CQC.

This key question has been rated as Good.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service 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.

Staff we spoke with understood the purpose of the service and demonstrated a commitment to helping people achieve their rehabilitation goals and maximise their independence and improve their quality of life.

We observed a positive culture across the service, with staff working collaboratively and respectfully across professional groups. Staff spoke positively about teamwork, leadership and the support they received from colleagues and senior staff. They described leaders as visible and approachable and told us they felt able to raise concerns, contribute ideas and participate in service improvement.

Leaders demonstrated a good understanding of the needs of the local population and the challenges facing local communities. This understanding informed service development and supported the delivery of care that was responsive to people’s needs. Staff and leaders shared a clear focus on supporting recovery, promoting independence and enabling people to return home wherever possible.

The service's approach reflected the wider vision of Mid Cheshire Hospitals NHS Foundation Trust to improve health outcomes, work in partnership and deliver more care closer to home.

The service 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.

Leaders demonstrated the skills, knowledge and experience required to lead the service effectively and promoted a culture that reflected the values of the organisation.

During the assessment, matrons were visible and approachable. Staff told us leaders were supportive, responsive to concerns and encouraged them to contribute ideas for service improvement. We observed positive and respectful interactions between leaders and staff throughout the assessment.

Leaders demonstrated a good understanding of the needs of the patient population and the challenges facing local communities. They worked collaboratively with partner organisations and multidisciplinary teams (MDT) to support the delivery of safe, effective and person-centred rehabilitation services. This helped ensure the service remained responsive to local needs and supported positive outcomes for people using the service.

Leaders demonstrated a commitment to workforce development through succession planning, leadership study days, specialist training pathways and educator-led development programmes. Several staff had worked within the service for several years and told us they valued the supportive team culture, opportunities for development and continuity within the workforce.

Staff had a clear understanding of their roles, responsibilities and reporting arrangements and told us they felt supported to develop their skills and deliver high-quality care.

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

The service encouraged staff to share feedback through a range of mechanisms, including staff surveys, team meetings and staff development workshops.

Staff had access to the Trust's Freedom to Speak Up Guardian and local Freedom to Speak Up champions, and most staff were aware of these roles and how to contact them. We observed information about Freedom to Speak Up displayed throughout the service.

Staff told us they understood how to raise and escalate concerns and felt their views were taken seriously. Leaders promoted an open and transparent culture and encouraged staff to report concerns, incidents and opportunities for improvement. We observed positive working relationships between staff and leaders throughout the assessment.

Staff described leaders as approachable and responsive, and felt confident concerns would be acted upon appropriately. The recently introduced improvement board provided a further opportunity for staff to share ideas and contribute to service development.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. Staff told us they were treated with respect and felt able to be themselves at work. Mandatory equality, diversity, inclusion and human rights training was in place, and staff demonstrated an understanding of the importance of supporting colleagues and people from different backgrounds.

Staff were able to access flexible working arrangements, including flexible hours and job-sharing opportunities, to support caring responsibilities and health needs. Managers implemented reasonable adjustments where required, including modified shift patterns and occupational health support. Return-to-work processes were used to review individual needs and ensure appropriate workplace adjustments were in place following periods of absence.

Policies and processes supported an inclusive, respectful and safe working environment. Staff told us they would feel confident reporting discrimination, bullying or harassment and understood the processes available to raise concerns. We observed positive and respectful interactions between staff of different roles, backgrounds and professional groups throughout the assessment.

Leaders promoted equality of opportunity through training, development and leadership programmes. Staff told us they had fair access to learning opportunities and felt supported to develop within the organisation. Leaders considered staff wellbeing and individual circumstances, helping to promote an inclusive culture and positive workforce experience.

The service had not always maintained clear responsibilities, roles, systems of accountability, or effective governance arrangements. As a result, it had not consistently acted on the best available information relating to risk, performance, and outcomes.

Staff understood their roles and responsibilities and were able to describe the reporting structures within the service. Governance meetings, audits, incidents and feedback from people using the service were used to monitor quality and safety.

Managers reviewed risk, performance and outcomes through established governance processes. However, these arrangements had not always been effective in identifying and addressing issues in a timely way. For example, compliance with some mandatory training requirements including safeguarding and manual handling training, had declined over time without sufficient oversight to maintain the expected standards.

Staff had access to relevant policies, procedures and clinical guidance and understood their responsibilities regarding confidentiality and information governance. Information was shared appropriately between teams to support continuity of care.

Leaders recognised the shortfalls in mandatory training compliance and had implemented an action plan to improve performance, including enhanced monitoring, protected time for training and strengthened oversight of completion rates. While improvement work was underway, the impact of these measures was not yet fully established at the time of the assessment.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service worked with community stakeholders, commissioners and partner organisations to improve care pathways and outcomes for people using the service.

We observed effective partnership working through multidisciplinary meetings and discharge planning processes. Staff communicated regularly with GPs, local authorities, social services, integrated neighbourhood teams and specialist services to support coordinated care and continuity of care.

Staff demonstrated a good understanding of the support available within the local health and care system. They worked closely with social workers and community teams to identify patients' ongoing health, therapy, personal care and social care needs and ensure appropriate support was in place prior to discharge.

Staff were able to track referrals and coordinate effectively with partner agencies, including social services and voluntary sector organisations. This supported timely discharge planning, helped people with complex social needs access appropriate support and promote independence following discharge.

The service 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 contribute to safe, effective practice and research.

Staff used information from audits, incidents, complaints, people’s feedback and governance processes to identify opportunities to improve care, people’s safety and rehabilitation outcomes. Learning was shared through team meetings, safety huddles and governance forums.

We saw evidence of quality improvement activity across the service. Staff reviewed incidents and trends, including falls, to identify opportunities to reduce risk and improve outcomes for people using the service. Leaders and staff also reviewed aspects of the environment and service delivery to ensure patients received safe, effective and person-centred care.

Staff were encouraged to contribute ideas for improvement and service development. The recently introduced improvement board provided an opportunity for staff and people to suggest changes and share feedback. Although in its early stages, this demonstrated a commitment to involving people in shaping and improving the service.

There was a strong focus on rehabilitation and promoting independence. Staff adapted care and therapy interventions to meet individual needs and worked collaboratively with partner organisations to improve people’s experiences and outcomes. Workforce development, training and education supported continuous learning and helped ensure staff had the skills and knowledge required to deliver safe and effective care.