Alice House

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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

We assessed all the quality statements in this key question. We found a breach of regulations relating to good governance. The provider had some systems such as audits to monitor the quality and safety of the service, however these were not effective. They did not always identify or address the concerns we found during this assessment. For example, in relation to safeguarding, managing risks to people, safe staffing levels, recruitment, medicines management, environment and infection prevention and control practices. The level of provider oversight was poor at the service. We identified aspects of a closed culture within the service where incidents had not been escalated or responded to appropriately to keep people safe. A closed culture is where a service has a poor culture that can lead to harm, including human rights breaches such as abuse.

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.

Overall feedback from the staff was good about learning and improving. There comments included, "I really enjoy working for this company. They always appreciate me, gave me confidence, I progressed to senior. A positive place to work." Another staff member told us, “We record the incident online, we send to the manager, we try and keep people safe. The manager does the audits."

The service did not consistently promote a positive culture to enable staff to provide safe care to people. We were not assured of the providers understanding of their regulatory responsibilities. There was little evidence of management oversight in several areas to monitor the quality of service provided, record actions and identify opportunities for learning and improvement. This placed people at increased risk of harm.

The provider and the operations director told us they had a trusted relationship with the registered manager and were not aware of the extent of the shortfalls we found at the service. They gave us reassurances that they planned to make the necessary improvements.

During the assessment the registered manager left the service. We found the provider’s oversight of the service was not detailed or comprehensive and was not checking aspects of the service where we found concerns. The deputy managers, operations director and nominated individual were managing the service in the interim period. The provider told us they had contacted a consultancy service to supply them with an interim ‘turnaround’ manager. This was to support them in the short term to manage the service and implement the necessary changes. Insufficient oversight and governance meant we could not be confident about the care, treatment and support that was being delivered at Alice House and whether all the concerns and shortcoming were fully understood by the provider. There was a lack of documentation to evidence how staff, people, and relatives were involved in identifying areas for improvement and development.

We received mixed feedback from staff about the culture within the service. Most staff told us they felt supported and able to raise concerns. Some staff raised concerns and described a closed culture. They did not always feel able to speak up and appropriate actions had not always been taken in response to incidents. We identified several incidents where appropriate actions had not been taken or documented to address ongoing risks to people. Not all staff had a good understanding of the whistleblowing procedures. The registered manager was absent after the first day of the assessment and therefore we were not able to gather their feedback. The provider told us they were concerned about the culture within the service and during the assessment we were told some staff had raised concerns with the provider about a culture of staff bullying and harassment. The provider told us they had taken actions in response and were committed to improving this aspect of the service. We spoke to 10 staff during this assessment by phone or in person. The provider was also asked to forward an email to the staff from the CQC. This was to seek feedback. We did not receive any responses.

We identified a closed culture had been created within the service and concerns had not been escalated. Staff had reported some concerns, but they had not been dealt with appropriately. We identified several incidents where appropriate actions had not been taken or documented to address ongoing risks to people. We could not be assured relatives were always informed as appropriate following incidents within the service. Records of residents’ and staff meetings were maintained, but many entries were missing key details, discussions with staff about incidents and lessons learnt were not documented. We could not be sure resident’s meetings were conducted in a way which was accessible to people using the service. We were told relative’s surveys had been conducted; however, we did not receive records to support this. This meant we were not assured the systems at this service were effective to encourage and support a culture of speaking up, learning and improvement within the service.

We received mixed feedback from staff with regards to equality and inclusion. Most staff told us they were satisfied working at the service and well supported, whilst some staff raised concerns and described aspects of a closed culture. The provider told us they were concerned about the culture within the service and during the assessment we were told some staff had raised concerns with the provider in relation to staff bullying and harassment. The provider told us they had taken actions in response and were committed to improving this aspect of the service.

There was a diverse workforce within the service, and staff demonstrated an awareness of equality, diversity and inclusion. However, we found the provider’s processes used at the service to record, learn from people’s experiences and feedback had not been sufficiently adapted to the needs of people living within the service.

We received mixed feedback from staff about the management and oversight of the service. The provider told us they were not aware of the severity of the concerns before this assessment. They acknowledged our findings and gave us assurances, that they planned to improve the service and the provider oversight.

Service level and provider oversight of incidents and safeguarding was poor. This led to a significant number of incidents not being reported to the local authority safeguarding team and the Care Quality Commission. The registered manager was undertaking an audit of incidents. This was not effective in addressing issues. There was no provider oversight of incidents and safeguarding. We identified a lack of timely intervention and insufficient oversight. This led to multiple incidents involving the same people, resulting in harm to others. People’s care plans were reviewed by the registered manager and were checked as part of the provider’s audit; however, these processes did not identify and address the issues we found with care plans and risk assessments as documented in the safe section of the report. For example, the provider did not have an overview of people’s weight. We found some people had lost weight and it was not clear what actions had been taken and the reasons for the weight loss. We found admission assessments had not been fully completed for people and therefore the staff were not fully aware of people’s needs. The provider told us they felt some people had been inappropriately placed and their needs could not be met by the service The provider told us no audits were undertaken of recruitment procedures. We found incomplete recruitment processes for some staff which had not been identified or risk assessed. We could not be assured staff were recruited safely. We found the provider’s recruitment policy was in need of review. This did not provide clear guidance as to how safe and competent staff were to be recruited. The provider was completing quarterly audits. The last audit was undertaken in March 2024; however, it had not picked up on the areas where we found concerns such as care plans, infection control, environment, safeguarding, staffing and incidents and medicines. The provider audit mainly focused on the environment, IPC and medicines.

People were not able to tell us their views. We spoke to people’s relatives and no concerns were raised about how the service worked in partnership and supported people to be part of their local community.

The deputy manager and operations director told us they worked in partnership with other professionals. We were told where they had any concerns such as a person being unwell, they contacted the GP.

Health professionals told us they had faced some challenges working with staff at Alice House. Some professionals raised concerns about the conduct of a staff member when visiting the service. Other professionals told us at times they experienced resistance from staff when accessing the service to provide treatment to people. We shared this information with the provider.

The GP visited the service weekly, and a list was prepared of those who required people needing a GP visit. The GP carried out medicine’s reviews of people. Due to the shortfalls we have identified regarding people’s wellbeing and weight loss, we could not be assured staff reported all concerns to the GP.

We received mixed feedback from staff about learning and improving at the service. Some staff felt action had not always been taken to improve the experiences of people. Other staff felt supported and were happy within their role and with how the service was managed

Staff had not received clear guidance in relation to mitigating known risks. We were not assured the provider had adequate measures to assess, monitor and mitigate the risk to people’s health, safety and welfare. The provider had failed to respond sufficiently to previous incidents of harm to learn and mitigate risk within the service. This has been documented under the safe key question.