Little Oldway

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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 identified 3 breaches of legal regulations. People who were able to share their views with us and their relatives spoke positively about the service, the staff and the care and support they received. However, we found the service was not operating in accordance with the regulations. At the time of this assessment the service did not have in place a registered manager. Governance processes provided limited oversight, were not effective in keeping people safe, protecting people's rights, or driving improvements. Throughout the assessment, the care manager and nominated individual were open, transparent, acknowledged any areas for improvement and were keen to address any areas of concern. Staff felt able to speak up and raise concerns with the care manager and/ or nominated individual. We have asked the provider for an action plan in response to the concerns found at this assessment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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 care manager and nominated individual described the systems and processes to monitor the service and ensure compliance with the regulations. Each month the care manager carried out a range of spot checks and audits to monitor the quality and safety of the service and ensure compliance with the regulations. Audits included, care plans, medicines, safeguarding, accident and incidents, recruitment, health and safety etc. In addition to the auditing process, the nominated individual told us they held regular meetings with the care manager to discuss the service, staff, and people to identify any concerns and agree actions. The management and staff structure provided clear lines of accountability and responsibility, which helped ensure staff at the right level made decisions about the day-to-day running of the service. People's personal records were kept secured and confidential. Staff understood the need to respect people's privacy including information held about them in accordance with their human rights. The care manager told us that regular handover and staff meetings helped to ensure essential information about people's care needs were shared within the staff team and / or escalated if needed to other healthcare professionals.

At the time of this assessment, we found the registered manager was no longer in day-to-day charge of the service. The registered provider failed to notify the Care Quality Commission of this change in line with their legal responsibilities. This meant at the time of this assessment the service did not have a registered manager. The failure to notify the Care Quality Commission of specific changes in the running of the service was a breach of regulation 15 of the Care Quality Commission (Registration) Regulations 2009 (part 4). The care manager and nominated individual told us they understood their responsibilities in relation to duty of candour. Duty of candour requires that providers are open and transparent with people who use services and other people acting lawfully on their behalf in relation to care and treatment. However, we found systems had not been effectively operated to identify and report significant events. This had led to the provider not notifying the Care Quality Commission of 5 significant events in line with their legal responsibilities. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (part 4). Governance processes were not always effective in keeping people safe, protecting people's rights, and ensuring that staff had the necessary skills to meet people’s needs. This meant they did not drive improvement and did not identify the issues we found at this assessment. Issues included concerns with regards to leadership, safeguarding, management of risk, mental capacity, DoLS, and training. This was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Throughout the inspection, the care manager and nominated individual acknowledged any areas for improvement and were keen to put processes in place to address any areas of concern.

Most people were not able to share their views with us about how the service worked in partnership with them to achieve good outcomes. However, one person said, “The place is run well”. Most relatives we spoke with had confidence in the service; the care manager; staff team and welcomed the opportunity to tell us how pleased they were with the management of the service and the care of their loved ones. Comments included, “Management is excellent. [care managers name] knows us and knows all the residents. They go above and beyond to ensure everyone knows what is going on,” “It is well managed and well organised. Very professional. I have no concerns and am totally happy with the care,” “No concerns at all,” “Manager is extremely approachable,” “The manager phones every couple of weeks, talks about changes or anything going on at the home. [care managers name] has an assistant. It’s well led, if you mention something to [care manager name] it is cascaded down and put into action.”

The care manager told us they recognised the importance of joint working with partner agencies to improve people’s outcomes. They described how they worked in close partnership with the district nurses who supported people with skin conditions such as, pressure ulcers. The SALT team, [speech and language therapist] to support people who may be experiencing eating and drinking difficulties, and the older person’s mental health team [OPMHT] who provided support for some people living at the service who have advancing Dementia. Staff told us they felt appreciated and could contribute their ideas to the running of the service. Staff were aware of the value of working in partnership with people, their families and other healthcare professionals.

Systems and processes showed the provider worked in partnership with key stakeholders. Care plans demonstrated the service actively engaged with people, their families, and relevant professionals to seek support from a range of health care professionals. This meant advice and support could be accessed as required. Regular meetings and handovers helped to ensure information was shared. Systems were in place to gather people's, relatives, and staff’s feedback on the quality of the service.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.