Allambie House

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service was in breach of legal regulation in relation to governance at the service.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision and culture, but improvement was required to ensure it was embedded throughout the service. The provider’s mission statement of kindness, respect and dignity was displayed in the entrance of the home. The new registered manager explained the vision of the home was, “To give best care for all of the residents and keep them safe.” They told us they checked staff were working in accordance with that vision through, “Observations, appraisals and discussions.” A senior member of staff told us they were encouraged to put people first and explained their aim was, “To give the best care we can and work as a team and make sure we are giving person centred care. We have hard working staff here and they give their hearts to the residents. As a senior, I remind staff to make sure their heart is in looking after people.” However, staff needed to have a better understanding of their role in promoting person centred care through reporting poor practice and encouraging high standards of care throughout the home. In addition, the provider had not ensured all staff had access to regular supervisions, so opportunities to maximise setting the culture of the service were not always fully taken.

The provider had inclusive leaders, but they required more time, knowledge and experience to ensure high standards of care were consistently maintained. There had been significant changes to the way the home was managed since our last inspection and there were 2 registered managers. The deputy manager had been promoted to registered manager and was responsible for day-to-day management of the service. The previous manager had maintained their registration and was providing guidance and support for 10 hours a week. Both registered managers acknowledged the reduction in managerial hours had impacted on their oversight of the service, particularly during the introduction of a new electronic care planning system. The longstanding registered manager told us, “When I stepped back and [new registered manager] took over, I think she was lacking the support I had from her. We want more delegation for our seniors and more responsibility from them.” Despite the demands on their time, staff were positive about the registered managers and felt guided and supported by them. Staff who had regular supervision meetings described them as being beneficial to their practice and wellbeing. One staff member told us, “They (supervision meetings) are quite useful because they find out if there is any help you need. They find out anything you are finding challenging and just generally about your wellbeing and if you have got any concerns.” Another staff member commented, "I think the management are very supportive and understanding." Although there was no formal on-call system, staff told us they were able to contact the registered managers or the provider at any time.

People generally knew who the registered managers were and said they would feel able to speak to them directly about any concerns. Staff told us they were confident to raise issues or concerns or make suggestions which could improve people’s outcomes. One staff member told us, “We have a meeting every 3 months and we can raise any issue. It is an open meeting, and we can raise any issues we have. If you want to go privately to the manager you can do so, the manager is very approachable.” However, we found some staff did not know the provider had a whistleblowing policy or what protections they should be afforded if they wished to raise any concerns externally.

The provider valued diversity in their workforce and had processes to protect and promote the rights of the whole staff team. Staff told us they were fairly treated and had never witnessed discrimination or inequality within the service. Staff described a diverse team who respected and supported each other to celebrate faith and cultural events important to them. However, reasonable adjustments, where needed, were not always considered. For example, the registered managers recognised insufficient consideration had been given to differences in staff learning styles when the new electronic care system had been introduced.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes. Systems to monitor people's health and wellbeing required more day-to-day scrutiny. Records did not always demonstrate people received the right levels of care and safe practices were followed. This included medicines administration records which were not always correctly understood or accurately completed to show people had received their medicines in accordance with their prescriptions. The new registered manager conducted a daily 'walk around' of the service which they explained was used to observe staff practice and check people were receiving the care outlined in their care plans. However, these checks were not formally recorded so it was not clear how they were used to identify poor practice and drive improvement in the service. The provider did not have a clear process to assess the quality and accuracy of audits and checks completed. Processes to quality assure the service needed to be improved so they fully reflected current best practice guidelines, for example, in relation to medicines management and learning disability guidance. This would enable the registered managers and the provider to identify areas for development and create an action plan to further drive improvement at the service. Staff needed more guidance to ensure they had the confidence, support and systems to check the quality of their own work and that of their peers.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. Some further links needed to be promptly developed with other organisations, to meet people’s needs and inform the development of the service. For example, to ensure people had access to the spiritual support they wanted and to ensure the service was developed in line with best practice guidance. This included in relation to medication administration and supporting people with learning disabilities. The registered manager told us they were working with the local authority to address their quality improvement plan. They explained they were liaising regularly with the commissioners to drive forward improvements. Staff told us they worked in partnership with other healthcare professionals but stresses within the local system sometimes impacted on accessibility. People told us they were happy with the standards of care and any issues they raised were responded to. Comments included: “They are good at answering any problems I raise; I haven’t raised anything recently” and “The staff always give me the care that I need.”

The provider's processes to ensure continuous learning, innovation and improvement across the service were ineffective because they were not robust enough to sustain and improve quality standards. Improvements were not always embedded and standards evidenced at our last inspection of the service had not been sustained. Further improvements were needed to evidence the provider was monitoring the service effectively and taking learning from external professionals, to ensure improvements made were based on best practice and embedded in the practice of the home. The provider and registered managers welcomed our feedback and took some immediate actions to address the concerns we identified during our inspection visits.