Spencefield Grange

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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 found that audits and processes were not always effective. During our assessment of this key question, we found concerns around provider audits, oversight and leadership of the service which resulted in a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The culture of the service did not consistently support staff to provide person centered care or achieve good outcomes for people. There was a lack of shared direction and vision within the service. You can find more details of our concerns in the evidence category findings below.

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.

Staff did not demonstrate a shared understanding of culture within the service. Staff were not fully clear in their roles and responsibilities which had created a poor culture of learning and a lack of reflective practice. A high staff turnover in recent times had impacted on cohesion and shared direction. Changes in leadership had resulted in a lack of continuity. The management team had identified this as a concern and was committed to making improvements. However, this was not yet embedded in practice.

There was a poor organisational culture within the service that did not support effective equality or diversity for people or staff. The provision of care was inconsistent for people and depending on the aptitude and skill base of staff providing this. For example, people told us they had repeatedly complained about meals and the need for activities and stimulation, but their concerns had not been actioned. Staff were task focused and did not consistently provide personalised care.

Staff did not feel there was an effective level of engagement or consultation in the service from managers. Staff told us, "We haven't had a manager for a while, The deputy has been trying hard to support and guide us." The management team acknowledged there had been a lack of engagement and was in the process of consulting with staff to clarity roles and responsibilities, though this was in the early stages of development.

The culture of the service did not consistently support staff to provide person centred care or achieve good outcomes for people. The manager was in the process of developing an improvement plan with the provider to address the failings we found at this assessment. We were assured the manager was clear on their role and responsibilities under the duty of candour. Appropriate notifications were submitted, and the management team were committed to improving information sharing and communication with relevant agencies.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us the leadership of the service was not supportive. We were told the management team did not have the oversight, training, or skills to support people who use the service, staff said, “To be honest I think we are just all doing what we think is right to help people, no-one knows what we are doing with them, we don’t have the training or the guidance to follow, particularly in relation to distressed behaviours."

We identified significant failings in the management and oversight of the service. Care records were not reflective of people's current needs. Audits and checks had failed to identify ineffective and inaccurate monitoring of people's care needs. Staff had completed training. However, the provider had not completed any skill analysis to ensure staff had the competency and skills to meet people's needs and ensure they were effective in their roles and systems had not supported effective review of staff deployment during peak times. The provider had been informed of some of the concerns through partner organisation reviews but had not taken sufficient action or implemented effective governance to improve the quality of care.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us they have received some training. However, they did not feel confident in managing peoples care and support needs. They felt learning was not effectively communicated following incidents of distressed behaviour. One staff member told us, “If a person falls and they got injured, I see seniors deal with it and call who they need to. Though other situations where people have an altercation and someone could become distressed, actions are not taken with that. They just leave people to argue, and no lessons learnt".

Processes and procedures were ineffective in ensuring continuous learning, innovation, and improvement within the service. We identified shortfalls in internal audits and analysis which failed to reduce the likelihood of accidents and incidents reoccurring. Where actions had been identified, there were no records to demonstrate these had been implemented.