Fethneys Living Options - Care Home Physical Disabilities

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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

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 the same. 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. Improvements have not been made since the last inspection and this is a continuing breach of the legal regulation relating to good governance.

This service scored 54 (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. According to the provider’s mission statement: Leonard Cheshire work in local communities to provide people with disabilities opportunities, choices, and support. Their mission is to encourage and move disabled individuals toward independent living, with the freedom to live life their way. Although some encouragement was given to promote people’s independence, poor management and oversight in the past had meant a decline in the provision of person-centred care and opportunities for people to pursue what mattered most to them. A relative said, “I am very worried about [family member]. A health professional said she has an extremely dull life. She is extremely bored; she just sits at the dining room table all the time.” People told us there had been improvements since the last inspection, but highlighted the lack of activities available to them, unless they pursued these without the need for staff support. We asked the management for their views and they said, “I would say it’s a very relaxed, inclusive culture. It helps there is a couple of staff that do both day and night shifts, so there is no blame game. We have a flexi-rota so everyone is moved around and they work with different people and different colleagues. Some work early, some late. It’s staff who develop the culture; they’re relaxed and smiling.”

Management of the home within the last year had been poor, and there had been a lack of oversight. The service had 3 managers within the last year and, as a result, management oversight and leadership had been neglected. At the time of the assessment, the manager registered with the Commission had resigned from their post, but had not informed us. An interim manager had been appointed on a consultancy basis and had taken up the post a few weeks before this assessment. The new interim manager had been brought in by the provider to oversee and manage the service until a new permanent manager could be recruited. They demonstrated a thorough understanding of regulatory requirements and had the experience, capacity and capability to make the changes required and to drive improvement. New processes had been introduced, such as medicines audits, but daily monitoring and charting of some people’s care needs were a concern since staff did not always complete these properly. The interim manager was aware of this and was taking steps to ensure staff did complete accurate records in this regard.

The management team were actively promoting staff empowerment to drive improvement. Staff were encouraged to raise any concerns with the team. The interim manager had only been in post for a few weeks, and staff were getting to know them. One staff member talked about the lack of support from the management in the past and said, “We have a staff rep for the company. I had some personal issues and they came here to talk to me and sorted everything out. I feel better now.” The interim manager told us, “Staff can come to me or the deputy manager. We also have a ‘Freedom to Speak Up’ poster with provides human resources details that Leonard Cheshire provide. We have a divisional director and chair of staff now, so staff can talk with them. They meet staff face to face and advocate for them. We also have a whistleblowing policy in place.” (We were provided with a copy of the whistleblowing policy during this assessment.)

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff were valued for their contribution, and an inclusive, equitable culture had been developed. Staff came from a variety of ethnic backgrounds with different cultural and religious beliefs. Adjustments were made to the rota to enable staff to take holidays at times that were significant for them. A staff survey had been completed and views gathered from staff were generally positive. Staff were aware of, and understood, the provider’s policies on whistleblowing and equality and diversity.

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. Systems were not sufficiently robust to provide effective oversight of the service to drive improvement. Issues found at this inspection had not been identified through the provider’s auditing processes or, if they had, actions had not been taken. For example, monitoring charts for people in food and fluid intake, and bowel monitoring had not been fully completed, putting people at risk. This was a concern identified at our last inspection. Incidents, whilst reported, did not always include what actions had been taken to prevent similar events from reoccurring. Care plans had not been completed for 2 people so staff did not have up-to-date information on people’s care and support needs. Representatives from the local authority had recently visited and told us they had found little or no improvements from a previous visit in September. This included the quality and consistency of daily record keeping, for example, repositioning charts. Representatives also told us there was poor recording of daily handover meetings as it was not always recorded who had attended or any actions required. We were told care plans were fully reviewed with people and their families once a year, then reviewed monthly with people. Keyworkers completed a monthly report and met with people to discuss their goals. The interim manager told us the plan was to update people’s goals to establish what activities they would like to participate in, and places they wished to visit. For one person, the goal had been to redecorate their bedroom in their favourite football team’s colours, and this had been completed.

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 home worked in partnership with the local authority, but guidance from the local authority on how improvements could be made had not been heeded. Local authority representatives had been collaborating with the home for several months and would continue to provide ongoing support until progress was made in daily recording and management oversight. The local authority was concerned about the lack of evidence of management oversight in the home, exacerbated by the fact the home has not had a consistent manager within the last few months. People appeared happy at the home and positive relationships had been developed between people and staff. When local authority representatives visited the home, they commented that people appeared happy and settled in the service. One person told us, “Staff do their best and I’m very happy with what they are doing for me.”

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. They did not always actively contribute to safe, effective practice and research. The lack of management oversight, and changes within the management team within recent months, had resulted in a lack of continuous learning, innovation and improvement at the home. A new interim manager had been in post for a short time and had identified some shortfalls that needed addressing. For example, medicines management had improved with a new system of audits being introduced. However, new monitoring charts for people had not been completed properly by staff, putting people at risk of unsafe care. In addition, we observed people’s dignity was not always respected. At lunchtime on the first day of our assessment, we saw 2 people eating their meal with tomato pasta around their mouths, cheeks and down their fronts. These people were struggling to eat their food independently and staff did not come to their aid until we requested they do so. Staff told us of the changes in management in the past and felt their confidence had been eroded because they were not listened to. One staff member explained, “Previous managers did not listen to staff, but things are changing, and now I feel listened to. It is a relief now because [manager] is very supportive.” Staff were encouraged to progress their training through national vocational training. The interim manager said, “We have various different optional training that staff can do online. Staff are encouraged to progress. Some staff have completed ‘Train the trainer’ for moving and handling and medication, so they can train and sign off staff for competency. There’s always opportunities for progression.”