Nazareth House - Cheltenham

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

Systems and processes were in place to identify and monitor the safety of the home and the care people received. The registered manager and senior team had worked collaboratively to improve their governance and oversight of the home. Where required, they had sought specialist advice and implemented recommendations. However, we found the provider's auditing reports were inconsistent and did not always clearly outline the steps being implemented to address their findings during their auditing process. The registered manager was responsive to our feedback and made immediate changes to help them monitor staff practices. However, further time was needed to ensure systems were effective, and the actions taken would be sustained and embedded into daily practices. Staff, people and their relatives all spoke positively about the care they received and were confident the home was being run by capable leaders who were passionate about making improvements to the quality of care being provided, the home’s environment and staff support and development. Systems were in place to enable people and staff to speak up and influence the culture of the home.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were told there was a better culture across the home and improvements were being made to improve the care people received and communication within the staff team. They told us there was an emphasis on working as a team. One staff member said, "[name of manager] is approachable, dedicated. Making changes for the better. We need to follow procedures - staff now improving on medicines records and now being completed properly - staff did not understand previously."

The registered manager and staff were supported by representatives of the provider to help embed the provider’s vision and standards of care. Managers and staff were making improvements to work towards the provider’s vision and goals. The registered manager was available to support staff and knew people and their staff team well. They were developing effective systems and changes in the culture across the home which focused on providing good quality care and driving improvements.

Both people and staff praised the management of the service and felt confident the home was being run by capable leaders and were assured by the management of the service. They told us the managers had the right approach and they were seen to be passionate about improving the service and people's experience of care at Nazareth House.

The seniors and managers of the home were visible, inclusive and led by example. They addressed any issues with staff individually and recognised and praised good practices. The senior team members met daily to discuss any current events and issues within the home. The registered manager received support and advice from representatives from the provider and other registered managers within Nazareth Care Charitable Trust.

Staff felt they were able to speak up and openly share any concerns with the management team. They explained they were confident the managers and seniors would listen to and act on their concerns without any repercussions. Staff told us they worked well together as a team but also recognised the importance to raise any concerns if they witnessed poor practices or were concerned about people's needs or the welfare of their colleagues.

Processes were in place for staff and people to speak up and share any concerns with the management team. The registered manager was visible around the home and had an ‘open door’ policy and welcomed feedback from people, staff and visiting stakeholders to enable them to understand their experiences of the home.

The registered manager explained they were sensitive to the diversity and culture of their workforce. Most of the staff employed at Nazareth House originated from India and had been supported to adjust to British culture. Staff were also supported to celebrate and share their own culture both personally and within the care home. We were told people enjoyed this experience and learning about the backgrounds of staff.

Systems were in place to ensure staff were treated fairly and experienced equity within the care home. The registered manager recognised some staff needed more emotional and practical support to help them understand British culture and overcome any personal worries. The provider’s policies and procedures on equality and diversity created a fair and inclusive environment for employees to operate within, which promoted a culture of fairness and equality. The protected characteristics of staff and people were recognised, and reasonable adjustments were made to prevent discrimination.

The registered manager informed us they were making improvements to the provider’s quality assurance processes and were working with representatives of the provider to address identified shortfalls. A service improvement plan was in place and being regularly updated to outline the necessary actions needed to enhance people's experiences and the safety of the home within specific timeframes. Staff told us they believed improvements had been made at the service since the employment of the new manager and senior team.

Since being in post, the registered manager had been working with their staff team and the provider to improve the governance and running of the home. For example, we saw evidence of improved staff training and the assessment of staff skills and knowledge. They were making progress in ensuring staff training was being completed and improving their oversight of the health and safety of the home. However, whilst we saw improvements to the provider’s auditing systems, further time was needed to further develop some of the systems. For example, the provider’s medicines audits had not identified the inconsistencies of fridge temperature checks. Progress was being made in staff development; however further time was needed to ensure ongoing staff training would be sustained. Some of the audits would benefit from more detail of the checks being completed and any actions taken to address any identified shortfalls such as home’s health and safety checks and the monitoring of people's risks and medicines. This would ensure there was an effective audit trail of the checks being completed and the actions required to address any identified shortfalls.

People's relatives provided us with examples of when staff worked and communicated with them about people's changing needs and the actions they had taken such as contacting the GP or 111 to seek medical advice.

Staff told us they had developed a good working partnership with people's relatives and key health care professionals to help support continuity of care in the best interest of people. The registered manager told us they had built ties with a local businesswomen’s group who were supporting and organising a fund raising ‘marathon’ event in the grounds of Nazareth House.

Some healthcare partners raised concerns with the commission about their relationship with Nazareth House and felt staff had not always alerted them to changes in people’s needs in a timely manner. However, this feedback differed from the views of other professionals and our observations. The registered manager explained they recognised that improvements in their working arrangements with some healthcare partners were needed to ensure consistency of care and promote positive outcomes for people.

The home had a working arrangement with two local dedicated GP surgeries who oversaw people's medical needs and helped to prevent hospital admissions. This assisted the staff to manage and monitor people’s medical needs and their medicines and access specialty community and hospital services when needed.

The registered manager and staff were willing to take on advice to improve outcomes for people. For example, the registered manager told us how they had engaged with an external organisation and had implemented their recommendations such as introducing National Early Warning Score (NEWS) 2 training to enable staff to effectively recognise and monitor people's decline in health and to seek medical support in a timely manner.

Effective systems were in place to manage, investigate and take action when things went wrong. Staff had built a strong working relationship with people and their families. We were told by relatives the communication from the home was generally good. The registered manager had an open-door policy. They encouraged staff, people and their relatives to share their feedback and make suggestions so action could be taken to resolve their concerns and improve their experiences.