Pilgrims Way Care Home with Nursing

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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

The oversight and management of the service continues to require improvement. The management of the service had not been stable since the previous registered manager left. The systems in place to monitor the quality of the service had mainly been effective to make sure people were safe. However, oversight of staff development, learning and improvement including gaining feedback from people had not been undertaken. A new management team had been employed shortly before our assessment but were not established within the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There had been no clear vision for the service since the last registered manager left in 2023. There had been frequent changes of management since then and there was no registered manager at the time of the assessment. A deputy manager had recently started in their post and a manager had been employed to start shortly after our assessment. The new management team were clear they wanted to improve the service and outcomes for people in their experiences. They shared their vision for the service and their strategy. They told us they had planned training for staff to develop their skills, knowledge and experience to be effective in their roles. They told us they were looking at having a clinical lead for the service.

There were no effective systems in place at the time of the assessment to meet with staff and people to share information about changes within the service. There had been no staff, relative or resident meetings to obtain feedback. The deputy manager had plans in place to introduce regular meetings. There were relevant policies and procedures for the operations and management of the home. Staff we spoke with understood their roles and responsibilities.

Staff told us they felt supported by their managers and colleagues and felt confident in raising concerns and asking for help and guidance, despite the number of changes that have taken place, and the lack of a clear management structure at the time of the assessment site visit. The new management team do not have a clinical background and we discussed how they would support and have clinical oversight of the nursing staff. The new manager told us they were considering employing a clinical lead to meet this need.

There were no effective system in place to make sure care staff received regular supervision to discuss their practice and training needs. Nursing staff had received some supervision but there were no records of these. There was limited oversight to identify training needs and make sure staff were competent. Staff induction had not been recorded to show staff had the skills to support people safely.

Staff told us they had the freedom to speak up and they knew how to do so if needed. They told us they would speak to any of the nurses or the person in charge. They also had access to the nominated individual who was approachable and available in the home. Staff knew to contact external agencies to raise their concerns if needed. The deputy manager told us they walked around the home daily to check with people, relatives and staff if they were happy or had concerns to share.

There was a 'Speaking Up' policy. We saw a poster in the reception area which provided details on how to raise concerns within and outside the organisation. Staff confirmed that team meetings did not take place and therefore the opportunity to voice ideas for improvements or any concerns was not done on a formal, documented basis. However, staff told us they felt confident to raise concerns at the time and would whistle-blow if necessary.

Staff told us they were treated fairly and equally and would feel supported if they had any personal issues. They told they would approach the manager if they needed to, on any concern, including their well-being. There was a diverse workforce at the service and people told us they thought the staff were treated well. Staff told us they enjoyed working at the service because the people and their colleagues were supportive.

Staff had undertaken equality and diversity training. There was an equality and diversity policy in place. Staff knew how to raise their grievances if they had any. Staff had break times allocated to them during their shifts, and they were encouraged to have their breaks. There were facilities for staff to rest during their breaks. The new manager had booked various training courses for staff.

Staff told us they liked working in the service. However, staff also commented on the frequent changes in management and how it had negatively affected the organisation and staff morale. Staff commented that they had relied on each other for support and endeavoured to ensure that any organisational changes did not affect the quality of care people received. Staff we spoke with were confident that they could discuss any concerns with the management team, and these would be acted on in a timely manner. Staff were aware of how to escalate concerns to senior management or outside of the organisation.

There had been regular audits to check the quality of the service, this included all areas including care plans and medicines. However, other shortfalls had not been identified such as lack of staff supervision and meetings for people and staff. Following our assessment visit, the manager had scheduled meetings and surveys had been sent out to people and staff to gather feedback.

People told us they received visits from various health care professionals such as the GP, the physiotherapist and the chiropodist. People also told us that they went out with their families to the café and staff told us that several people were going to spend Christmas day with their loved ones.

Nursing staff followed national good guidance practice. All staff worked closely with visiting health and social care professionals. The provider worked closely with the local authority commissioning team. The provider was working on the actions the commissioners had requested to improve the service. Staff told us visitors were made welcome, including local clergy, and a choir. The service had recently recruited 3 activities co-ordinators who were expanding the remit to include more opportunities for interaction with the local community. The new manager planned to join their local providers forum and subscribe to skills for care to learn good practice.

The local authority commissioning team told us they had been working closely with Pilgrim’s Way to make improvements at the service. A health care professional told us, “All referrals are picked very promptly. Also, when I ask the GP to complete referrals, the nursing staff have been very prompt to get it done.” Another health care professional told us, “I found the nursing staff supportive of the patient I was visiting and trying to meet his needs. He was wanting to go home to collect some items; they arranged a taxi for him. They subsequently kept our team updated whilst he was under their care.”

The provider was collaborating and working in partnership with health partners, social services and the local authority contracting teams. This enabled them to share information and learning with partners and collaborate for improvement. The local authority was actively working with the service on an action plan to improve areas of concern. The provider has also been visited by the fire service and made all the improvements required to fully meet fire regulations.

The new management team had identified there were shortfalls in how the service continued to learn and make improvements. They told us they were going to join local and national organisations to keep up to date with developments in social care and work with staff to improve the service.

There were limited formal processes to record and identify learning from incidents and new information. Changes and learning following incidents were given to staff during handovers, there had been no regular meetings or supervisions to promote learning. The regular change of management had not promoted the identification of shortfalls and learning as there had been no consistent oversight of the day to day running of the service.