Archived: Nutbush Cottage

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

Leaders and staff showed a lack of understanding regarding their responsibility to meet the principles of RSRCRC. There was a closed culture within the service with some staff feeling they were unable to speak out and report concerns. Quality assurance processes were not effective in highlighting shortfalls in the service and where concerns were identified these were not actioned in a timely manner. The provider failed to ensure processes were in place to assess the quality of people’s lives. During our assessment of this key question, we found concerns around the lack of robust oversight and lack of assurance processes. This was a breach of regulation. You can find more details of our concerns in the evidence category findings below.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders continued to demonstrate a lack of understanding regarding how to create and maintain a positive culture where people were supported to achieve good outcomes. We asked staff who had been present since our last inspection how they felt the service had changed and developed. One staff member told us, “Everything is good now, everyone is happy.” A second staff member told us, “We are doing everything better now. It is very person centred.” However, they were unable to give examples of how things had improved and were unable to consistently demonstrate this in their approach.

We continued to find a closed culture within the service where people’s individual needs were not always respected. Staff were unable to describe the values of the service and tasks and routine continued to be prioritised. Staff did not recognise and seek guidance on how to support people with their anxieties and the advice of external professionals was not always followed. There was no shared vision of how the service needed to develop to enable people to live their lives with freedom and autonomy.

The management of Nutbush Cottage was overseen by a compliance manager who was based at the service fulltime. The provider told us they had appointed a registered manager to cover three residential homes including Nutbush Cottage. The provider told us the registered manager was supporting the compliance manager in their role. However, the registered manager told us that since their appointment their time had been mainly spent at the other two homes. They told us the provider was aware they were only able to spend a few hours a week at Nutbush Cottage and the home was in the main run by the compliance manager. This meant since our last inspection there had been no significant increase in the time leaders spent at the service in order to drive improvement in the quality of life for those living at Nutbush Cottage. The provider did not show a supportive or compassionate approach regarding the management of the service during our discussions. Their responses indicated they felt others were responsible for the concerns identified at Nutbush Cottage despite limited additional support or oversight being provided to staff and the compliance manager since our last inspection. They failed to demonstrate an understanding of how to develop, support and embed effective management practices.

Despite the rating of Inadequate at our previous two inspections the provider had failed to ensure the compliance manager running the service received the training and mentoring they required to develop their skills. There was no evidence discussions had taken place to assess the skills of the senior team within the home and no plan as to how their learning and development would be approached. Supervisions with senior staff members did not reflect the previous Inadequate rating or improvements needed to the service. No measurable objectives had been set for the leadership team at Nutbush Cottage and skills development for leaders throughout the organisation was not highlighted on the providers action plans. The ongoing breaches of regulations identified during the inspection demonstrates a lack of skill within the leadership team to ensure people received safe, effective and responsive care.

Some staff told us they felt unable to speak up and raise concerns due to worries how this would be responded to by the management team. Concerns shared with us included how they would be spoken to, no longer being offered additional hours and being moved to a different service. The registered manager told us they felt there was a more positive atmosphere at the home following changes being made to staffing during our assessment. They stated staff appeared more relaxed and there was a better atmosphere. They added, “It feels like there’s a sense the relief, it wasn’t a ‘laughy’ house before, but it is now.” We asked the manager what action had been taken to improve the atmosphere prior to this. They told us,” I just assumed it was because of everything going on [with the CQC rating].” They were unable to demonstrate how this had been explored with staff or the steps which had been taken to improve morale. We asked the provider how they supported staff to speaking out about concerns. They told us they always reassured staff they could speak with anyone in the office including themselves. However, there was no evidence they had taken additional steps to implement more independent ways for staff to report concerns.

There were limited processes in place to support staff in speaking out and when this did happen, concerns were not robustly investigated. Two staff members had reported concerns to the provider in relation to how they were treated at work. Although one of the statements was later withdrawn, there was no evidence the second staff members concerns were addressed. No systems had been implemented to implement additional monitoring or training in relation to the issues raised. The registered manager told us they were not sure what the concerns were regarding as they had not followed this up. As the concerns were had not been shared with the registered manager, they were unable to have oversight of the issues raised. The failure to ensure staff felt they could speak freely and the lack of action taken were concerns were highlighted further demonstrated a closed culture within the service which put people at risk and meant lessons were not learnt.

The provider told us staff received training in equality diversity and inclusion. They said they were happy to work flexibly to meet the needs of staff and encouraged open communication regarding this. Despite this we saw evidence of no action taken when staff reported concerns and the provider not respecting staff diverse and cultural needs.

We saw staff had completed training and policies in relation to equality and diversity in the workforce were in place. However, the leadership team had not fully implemented and monitored these policies to ensure the diverse needs of staff were consistently met.

The provider told us they felt auditing systems were now more robust. Despite this assurance we found that the audit information shared did not reflect the shortfalls identified during the inspection and long running concerns had not been addressed. For example, the provider told us records were now more detailed and reflective. However, we identified people’s notes were frequently copied and pasted within the system when staff were describing how people had spent their time. In addition, we found incidents of people’s anxiety had not been accurately recorded. When we brought these examples to the providers attention they told us, “There are definitely still improvements needed. We can work and improve on these things.” These concerns had initially been identified during our April 2023 inspection and were still present. This showed processes to address shortfalls were not effective.

Provider audits were not comprehensive and did not assess the quality of people’s care or their quality of life. The interim audit system implemented following our last inspection in November 2023, was an audit/action plan in one document. Information regarding what was being audited, what evidence was available and what the service could do better was identical across the 4 months the plan was in place. Many of the target dates were moved to the next month following each monthly review. This meant the provider was unable to comprehensively evidence what improvements had been made during this time and the impact on people’s lives. The providers new auditing system had been implemented shortly before our assessment. A review of the audits showed that whilst checks were made that documents were in place, the quality had not been reviewed. There was no narrative regarding people’s views or experiences of their care within the audits. Records in relation to other processes such as staffing and residents’ meetings had not identified concerns regarding the quality of information, gaps in recruitment checks and the lack of staff supervisions.

People’s experience of being part of their community varied. One person told us they had begun to use public transport locally which they felt was a positive step. However, for other people we found few regular links had been made and the use of local facilities was limited.

The registered manager told us they felt positive relationships were being developed with other professionals. They felt reviews had gone well and they were able to demonstrate positive aspects of the support being offered. They acknowledged it could be difficult to keep up with the number of requests for information. The provider stated they were keen to work with other agencies to meet people’s needs.

Partners told us they did not feel advice and guidance was always taken on board. The said when suggestions about how to improve practice or meet the needs of residents were made this often met with a defensive reply from staff, team leaders and management. Other comments shared reflected that information was provided on request although the service rarely made contact to inform partners of changes in people’s care or within the service. Feedback reflected the quality of information shared could vary greatly which led to concerns regarding consistency of reporting. Partners spoken with all stated that in recent times they had received prompt responses to any requests made.

Whilst there was a willingness to share information and communication with partner organisations, there was limited evidence of how feedback and guidance was shared amongst the staff team to develop good practice. This meant that support provided from partner organisations did not always lead to improvements in the quality of people’s care. During the assessment we identified pockets of improvement in supporting people to develop community links such as regular swimming trips and use of the bus for one person. However, there was no overall strategy or action plan in relation to this.

Staff were not fully involved in the running of the service. Staff meeting minutes reflected issues that were shared with staff rather than being used as an opportunity to develop the service as a team. These discussions were extremely basic information and did not cover people’s support or care but were centred around task orientated issues. When speaking with the provider regarding this they told us they were pleased to find staff were now bringing their own ideas and being proactive regarding people’s support. When asked for examples of this they said staff had found ideas to support personalising people’s bedrooms. Despite giving a number of opportunities to feedback in relation to this they were unable to give any further examples.

The provider had failed to ensure systems of continuous learning and development. Previous inspections in April and November 2023 had highlighted many of the same concerns found at this inspection. Whilst pockets of improvement had been made, there was no systematic approach to ensuring processes were reviewed and people’s safe care and quality of life monitored. Examples of this included the continued lack of detail within care records and the arrangements for the recording of people’s personal finances. Despite previous concerns being raised no changes had been made to how these records were maintained, and no additional support provided to the compliance manager responsible for monitoring. This meant people continued to be at risk of their needs not being fully met and of their finances not being safeguarded.