Heeley Bank Care Home

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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

During our assessment of this key question, we found concerns around the leadership of the service. Vacancies existed within the management structure of the service which meant that appropriate clinical leadership and oversight was not in place over a sufficient number of days. Professionals who worked with the service reported that leadership was not effective, and the service did not always share important information about people’s health and care needs effectively. This resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities). You can find more details of our concerns in the evidence category findings below. The leadership at the service had not ensured that care was delivered safely and in line with peoples agreed plans, this placed people at risk of avoidable harm. However, it was noted that the service was aware of the issues and was working with partner local commissioners to make improvements.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Managers told us that they were planning to introduce the organisations values into team meetings as a regular agenda item, this is part of the service’s wider range of changes to improve the service. Managers told us that there were current issues with care not always being delivered in line with people agreed plans of care.

The service was in the process of implementing improvements to raise standards within the home, this included recruiting additional clinical leadership into the management structure to offer hands on support and guidance to staff. Although it is acknowledged improvement plans were in place, at the time of the inspection the service was not always delivering care that was in line with peoples agreed plans of support. This placed people at risk of avoidable harm.

Managers told us they had vacancies within their management structure at the service in relation to qualified clinical leadership. Plans were in place to fill these vacancies and how to utilise new clinical leadership within the service once this was in place. Some cover for clinical leadership was in place as an interim measure but this only covered 3 days per week. Managers told us that some staff did not fulfil all areas of their roles confidently and required support to take on greater levels of responsibility.

Current leadership had not ensured that care is delivered in line with peoples agreed plans of care. This placed people at risk of avoidable harm. Although managers were aware of the needs to improve and had plans in place to do so, at the time of the inspection these were not in place.

Managers told us that the service had implemented a freedom to speak up guardian to ensure that staff had a point of contact to raise concerns with. Appropriate polices were in place in relation to speaking up. Staff told us they would feel confident raising concerns if they had any and found managers approachable.

Staff told us they were happy working at the service and did not raise concerns in relation to discrimination, they felt managers were approachable and they could raise concerns if required. Managers told us that they had implemented process to ensure staff could raise concerns about their role if needed, to date none had been raised.

The service had policies and processes in place in relation to workforce well-being and anti-discriminatory practice. No concerns were noted in these areas.

Managers at the service told us that there were vacancies within the management structure at the service, particularly in relation to senior clinical leadership. Managers acknowledged issues in relation to safe care delivery and told us they did not know why errors continued to occur within the home but told us they had implemented a range of governance processes to attempt to rectify this and were recruiting into vacant senior clinical roles. Managers told us that some staff within the service did not complete all the responsibilities within their role effectively, for example completing clinical observations on time.

The service did not have effective leadership within the home. Vacancies existed within the service for clinical leadership and the service had not followed its own business continuity plan in relation to managing this. A regional manager was providing clinical oversight, but this only covered three days per week. Although governance processes were in place to monitor and manage risks, these had been ineffective at ensuring safe care delivery took place consistently that was in line with agreed plans.

People and their relatives told us they were happy with their care and support, they felt able to access professional health and social care support should this be needed.

Managers told us they were currently working in collaboration with local commissioners to improve the service, this included sending daily reports and working with visitors from commissioning. These improvement initiatives will take time to embed within the service.

Professionals who work with the service told us that at times the service felt chaotic to work with and that there was a lack of effective leadership. Professionals gave examples of information that had been shared with staff and managers that had not been shared more widely within the service to be actioned. Professionals told us that staff were kind and caring and that managers were keen to improve, however concerns persisted in relation to communication, leadership, auditing, management presence, medication administration, falls management, and clinical care. Some professionals felt that care plans were large and difficult to navigate, and that information was not always accurate. At the time of our assessment the local authority had stopped people being admitted to the home until improvements had been made.

Processes in place had not been sufficient in ensuring effective collaborative working. Improvements were being made in this area that will take time to embed.

Managers told us they had implemented several monitoring activities to learn from incidents and improve the service and were committed to ensuring improvements were made. Managers were unable to explain why unsafe care delivery continued within the service but told us there were plans in place for improvement and that recruiting into vacant clinical leadership posts within the service would support with this improvement.

The improvement initiatives and governance processes within the service had not resulted in sufficient improvements to show that they had been effective. Several examples of unsafe care delivery were observed during the inspection.