Housing 21 - Anvil Court

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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

There had not been a stable management team at the service for many months. Despite the regional management team having oversight of the service, there were no robust quality governance in systems to ensure any shortfalls in the safety and quality of care were addressed in a timely manner. The local authority were working with the service to address this but this was not having an impact due to recommendations not being followed up by the regional management team. This left people at risk of receiving prolonged poor care. There was a lack of trust between staff working in the service and the regional management team as staff felt their concerns were not listened to or actioned. This led to staff feeling they were not supported and did not feel valued.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a negative culture within the service. Staff did not feel concerns had been taken seriously and felt they had been left to run the service without leadership. One staff member told us the management team had told them they were the worst service as no one they supported had commented in the annual survey regarding the care they received. They told us, “After all the work we’ve put in that really hurt.” Another staff member told us, “We have no one to turn to. We’re told not to contact on-call and there is no one here at weekends. Staff argue. Things never used to be like this. I don’t know what can happen to make it better.” The regional management team told us there was a divide in the service which created bad feeling and staff did not feel listened to. They told us they were trying to approach this by setting boundaries and putting systems in place but the lack of management cover meant this process had been slower than they had hoped.

Systems to mitigate the risk of a closed culture within the service had not been implemented. The lack of management oversight, support and supervision for staff and adherence to policies and procedures to keep people safe had led to a divide between the staff and the management team and provider. Both the regional management team and staff all told us they wanted people to receive good care, there was a lack of shared direction in how to achieve this. The negative atmosphere at the service was also reflected in how people spoke about the pressure they felt staff were put under and the lack of management support. Whilst this was acknowledged by the leadership team, swift and robust action had not been taken address the concerns. This was a breach of Regulation 17 (Good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff told us there had been a large number of managers in the service over the past couple of years. This had led to them feeling unsupported and without leadership. Staff told us they felt as though they were responsible for the service and did not always feel valued. One staff member told us, “They don’t say ‘Thanks for your hard work [when they have done extra work]. The girls pull together. The carers are running this place.” Another staff member said, “The staff who are here are nice and I can go to them but I think it’s not enough, they get overworked and tired. This slows thing down and mistakes happen.” The regional management team told us, “There is a lot to do here. We recognise morale is low and we are trying to rebuild trust with the staff. We need more management cover as support.” They went on to say they were aware of divides within the staff team which caused friction and bad feeling.

The management team spoke of bringing in additional management but this was for specific tasks or timescales. No assessment had been completed regarding what skills specific skills were needed to be able to address the shortfalls and staff morale. Staff did not feel supported by the on-call service. When staffing issues arose, they had been told to try to solve this by ringing for agency or staff cover themselves. However, staff did not have sufficient gaps in their schedules to be able to do this and felt the management team were being unsupportive. The lack of trust and support between the staff and management team had built up over time with to a point where staff were feeling let down and not cared for. Systems had not identified and acted upon these concerns at an early stage. The regional management team were relatively new in post and were looking to work together with staff. However, the provider had failed to ensure regular management support was in place to support this process. Following our inspection the provider informed us they had taken action to recruit a manager for the service on a temporary basis.

Staff told us that whilst they were able to speak up, they did not feel listened to and did not feel there was a management presence to enable them to speak openly. One staff member said, “We haven’t got any management [to speak up to]. They are not telling us the true story. We are not supported or managed. No one to call at weekends. If we do ring them they don’t pick up.” The regional management team told us the dynamics within the service had been difficult between managers and staff. They recognised this was due to the number of changes. They told us they were currently trying to assure staff things would change and they were listening whilst also trying to establish systems and boundaries. There was a clear will to work collectively with staff and leaders were trying to rebuild trust within the team.

Processes were in place to support staff and people speaking up about concerns or conduct. Complaints and whistleblowing information was clearly displayed on notice boards. The management structure was known to staff and the regional team visited the service weekly. Although staff meetings had lapsed these had recently been re-introduced to enable to staff to discuss issues. Despite these processes being in place, staff did not feel that their concerns were being fully acknowledged. Were these concerns related to people safe care they felt progress was too slow.

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.

The regional management team told us they were working to an action plan. However, due to the scale of the concerns and the changes in management cover this was proving difficult to achieve. The regional manager stated, “We’re just firefighting at the moment. With only one assistant care manager that’s all we can do.” The regional management team were able to describe what systems and processes should be in place and how the service should be monitored. However, these systems had not been implemented which meant the provider did not have good oversight of the service. They told us of plans to bring in additional management support although this was for short periods rather than looking to implement a sustained management presence which people and staff were asking for.

The provider had failed to ensure regular audits of systems and the care provided were undertaken. Medicine records were audited for two people each week. However, checks were not comprehensive and had failed to identify and act upon concerns regarding medicines not being available and records accurately recording what medicines people were prescribed. Daily records were checked for two people each week. However, no check was made against the duration of the call times people should receive and the length of the care call they did receive. This process was therefore not effective in monitoring if staff stayed for the full duration of the call. No other audits had been completed. This meant concerns identified such as the failure to report safeguarding concerns in line with requirements, outdated care records, poor monitoring of accidents and incidents, staff not receiving supervision and the dissatisfaction with staffing arrangements had not been reviewed in detail to ensure appropriate action was taken and concerns prioritised. Monthly management reports were not completed in line with the provider processes. We found monthly reports had not been completed for over a year. This meant the provider had not been able to fully review how the service was operating and any action any shortfalls. There was no evidence to show the lack of reporting had been identified or challenged.

People told us there were things to do although commented that trip and support to go out used to happen but was less frequent over the past couple of years. A relatives told us, “[Outings occur] only if I arrange it. I take her to coffee, church, another group in the middle of the week. They used to have regular outings, Christmas outings, but nothing in the last couple of years has happened in regard to that.” Another relative told us there was armchair yoga, they have games afternoons and music nights, the carers arranged a get together in the lounge on Christmas evening.

Partners who worked alongside the service echoed the difficulties we identified during our assessment. One external partner told us, “Lately there’s been difficulties with management, but the office staff are supportive. Theres been lots of changes and no stable management team for a while. I’ve been going in there since the day it opened, and it used to be so happy and its lost its soul. Theres no regular permanent manager who keeps tabs on the place. People aren’t happy.”

The service was meeting regularly with the local authority to monitor and improve the service. Whilst this was a positive step, there was little evidence of how this was impacting the service during the inspection. The service worked with the local GPs to arrange visits and prescriptions. The service worked with the local GP to arrange visits and prescriptions. In addition, links had been established with the community health team, local hospice and physiotherapy. However, a lack of knowledge of the local pharmacy procedures meant there were difficulties in people’s receiving their medicines on occasions. The care co-ordinator told us one pharmacy charged for delivery people had refused to pay. There had been no communication with the pharmacy and research regarding which pharmacy could better support people. The activities held at Anvil Court were supported by the day service provision which was linked to the service. With this exception, there were no other links to community partners in terms of people’s social wellbeing.

Staff felt the leadership team were not acting on their concerns which meant issues continued. They did not feel the management team understood the impact either on staff or the people living at Anvil Court. One staff member told us, “I feel things are stuck in a rut at the moment but we are hopeful. It’s such an enjoyable job but needs updating and they need to listen. We need a manager.” Another staff member said, “We have all of these managers coming to us and telling us it will get better. They don’t listen.” The regional management team told us of plans for the future which included bringing in electronic records which would time stamp when people received their support and provide staff with the information they required. They told us this was due to come into place within the next year. However, no interim plans were in place to ensure people received the care they needed prior to this being implemented.

There was a lack of process to identify areas of learning and improvement. Concerns we identified during the inspection from reviewing incident records, communication book, care records, speaking with staff and people and from resident and staff meetings had not been addressed in a timely manner. The management team had not invested time to speak with staff the majority of staff in a structured way to gain their views and offer reassurance. There was a lack of analysis regarding staffing concerns, accidents and incidents, medicines errors and complaints which meant themes and trends had not been identified and improvements embedded.