Atholl House Nursing Home

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 requires improvement. At this assessment the rating has remained 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 service was in breach of the legal regulation in relation to governance at the service.

This service scored 50 (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 always have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. The culture of staff and the feedback we received from people meant we could not be assured the culture of the home was always positive. There were processes in place to ensure this information was considered, however it was unclear how this was implemented into practice to ensure people were able to raise their concerns. When concerns had been identified the registered manager was open and transparent and ensured these processes were followed. The registered manager spoke of a positive direction in the home. They told us how it was important to share and learn from concerns and challenges that had been identified, they also felt it was important to share this information with staff. Staff raised no concerns to us; they felt involved with the running of the home and felt information was shared with them through staff meetings and handovers.

Not all leaders understood the context in which the provider delivered care, treatment and support. A lack of understanding of the importance of effective governance systems from the leaders in the home meant the governance systems were not always in place or effective, this meant leaders did not fully understand their roles. This led to a lack of effective oversight of people’s care. However, people and relatives were happy with how the home was managed. One person told us, “I’m quite happy.” Other comments included, “Marvelous” and “I like it here, it’s my home”. A relative told us, “On the whole [my relation] has been happy and content here. Everyone is really kind to them.” Care staff were aware of their roles and responsibilities and when they needed to escalate concerns to senior staff or the nurses.

People did not always feel they could speak up and that their voice would be heard. As some people did not always ask for support due to the concerns they had with the care culture of the staff (as reported on under safeguarding) we could not be assured people would always speak up and raise concerns. However, when concerns or complaints had been raised to the registered manager action had been taken to address these. There was a whistleblowing policy in place and staff were aware of this and the procedures they needed to follow. The home had created an open-door policy where staff were able to speak up and share their concerns.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for the people who worked for them. Staff told us they were happy working in the home and felt they were treated fairly. There were procedures in place to consider staffs’ individual needs, this included considering staff’s diverse needs and ensuring all staff were treated equitably. The registered manager told us their workforce was important to them, and this was reflected in the low turnover of staff and the low usage of agency staff.

There were not always systems or effective systems in place to make changes and identify areas of improvement. Some audits were in place, however they were not consistently completed. For example, we saw a medicines audit had been completed for 1 of the units in December 2024. The other units had not had a medicines audit at this time. This had failed to identify the concerns we have reported upon in ‘medicines optimisation’ and therefore was not effective. Other audits, which again were not consistently completed, had identified concerns. The audit of care plans which was last completed in November 2024, for 1 unit, had identified where improvements were needed. However, not all actions identified had been recorded on the action plan and therefore action had not been taken to resolve this. Furthermore, these audits had identified people had not received fluids and pressure relief in line with their care plans, this information had been circled, not escalated, therefore no action had been taken to address this. We found the same concerns as part of our site visit, meaning the provider had not acted upon these concerns. There was no audit of call bells to ensure people received support when needed and there was no analysis of the incidents and accidents to ensure action had been taken and trends identified.

The provider had not always worked in partnership with other agencies to ensure concerns were addressed in a timely manner. We found some of the concerns identified by the local authority and the ICB had not been addressed, including concerns with medicines management and the safety of the environment. The home had introduced a ‘walk around’ following the advice of the ICB however had failed to ensure this was consistently completed. They had not always taken action to address the concerns these ‘walk arounds’ had identified. There were systems in place to ensure they worked in partnership with other agencies including the district nursing team and the community mental health team, to ensure people received the support they needed.

The provider did not always focus on continuous learning, innovation and improvement across the organisation. There was a lack of effective systems in place to identify concerns and drive improvements within the home, which meant learning opportunities were missed. For example, when incidents and accidents occurred, there was no evidence these had been reviewed so lessons could be learned. The registered and operations manager acknowledged this was an area needing improvement. After our site visit, they sent us an action plan identifying the changes they would be making.