Abbeyfield Residential Care Home - The Grove

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.

We found a breach of Regulations 17 (1), (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance.

The provider failed to ensure there were systems in place to monitor the quality of service provided and identify improvements. Whilst the provider carried out audits and checks; these had not identified the shortfalls we had found during this inspection. As required by their registration the provider had not submitted the necessary notifications to CQC following significant events at the home, such as safeguarding matters and serious injuries.

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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

Staff told us management did not demonstrate a positive, compassionate, listening culture that promoted trust and understanding between them. Comments included, “Management should supervise the staff more and they should listen to both sides of staff’s stories. If staff aren't happy, they won't give good care. Communication could be better from management” and “Whistleblowers are being ignored. I go home and worry about residents. I've been raising concerns, and they are being ignored.”

Whilst staff were committed to providing a good service which met people’s needs, they told us they did not work well together. Staff did not always have a good understanding of equality and diversity within the workforce and spoke about there being a bullying and sometimes racist culture within the service. Managers were aware of these inequalities and told us they had been working alongside an external human resources company to support and address this.

There had been changes to the way the home was managed since our last inspection. The registered manager had recently left, and the service was being managed by an interim manager. There currently was not a registered manager employed by the service. A new manager was in the process of being sourced by the provider. Staff told us they did not feel that management was always visible within the service. Comments included, “I don’t feel that management have an oversight of the service. I am not aware of on call arrangements when they are not here” and “Management is poor. The office door is often closed, and management is not visible. Management is not always available and there is no on call available to seek guidance from.” We spoke with the interim management about on call arrangements when they were not on site to support staff. They confirmed these were in place and made sure information on how the on call manager could be contacted was available to all staff. Management and senior management told us they were aware of issues within the service around poor culture and had taken actions to address this. These had included meetings with staff to discuss ongoing issues and more detailed assurance processes. Senior management explained that a 'People Strategy Group' had been established the previous year and the provider had introduced a comprehensive health and wellbeing package and more robust human resources support for staff, together with other changes. These were believed to have contributed to revealing long-standing cultural issues among the staff within this service. The management team had recognised the need for service improvements and were working to embed cultural changes and monitor the service for continued compliance.However, whilst the management team were working on improving the service, more work was required to embed changes and monitor these for continued compliance.

Staff we spoke with did not feel there was a culture of openness and honesty in the organisation. They did not feel listened to and that their concerns were being acted upon. One staff member told confidentiality is often broken by management. They explained about an incident involving staff and that all day staff had been informed of this incident when they felt they shouldn’t have been. The staff member told us, “I felt the confidence was broken.” Other comments included, “I've been raising concerns, and they are being ignored. Things are being reported but nothing is being done” and “I’ve reported these concerns to management and CEO, but nothing has been addressed.”

There were opportunities for people and their relatives to speak up and provide feedback about the service. People and their relatives said they knew how to make a complaint or raise their concerns. Comments included, “I have the opportunity to attend Resident’s meetings and also give feedback on how things are done” and “Yes, I would know how to complain. Initially I would go to the manager. An invite goes out for relatives’ meetings about once a quarter, but I haven't attended.”

The provider acknowledged they needed to work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff had spoken of a bullying culture with some staff seeing other staff as being racist. Management and senior management told us they were aware of issues within the service around poor culture and had taken actions to address this. However, whilst the management team were working on improving the service, more work was required to embed changes and monitor these for continued compliance.

The provider did not always have clear responsibilities and systems of accountability or good governance. They did not always act on information about risk, performance and outcomes, or share this securely with others when appropriate. The provider had systems in place to assess and monitor the quality of the service. Audits were carried out by the management team to assure themselves of the quality and safety of the service. Whilst audits had been completed, they had not identified the concerns raised during inspection. Whilst staff had reported accidents and incidents there was no evidence that an analysis of these had taken place to identify any themes or lessons learned. The audits had not identified the discrepancies noted with safe management of medicines. There was no evidence that care plans, safeguardings and complaints had been reviewed. We reviewed the complaints log, the last entry was 29 October 2021. Where people had told us they had raised concerns there was no evidence of complaints being recorded or how they were managed. A dependency tool scored people’s support as low, medium or high. How the provider had concluded what support people required was unclear. Therefore, we could not be assured that staffing levels had been correctly identified. On reviewing care plans we identified fluid charts were duplicated therefore not giving an accurate record of people’s daily fluid intake. This meant people were potentially at risk from dehydration. This was raised with the interim manager who agreed to investigate this. This discrepancy had not been identified in any audits. Staff's training was monitored by the provider. There was a training record in place, but it did not clearly identify when staff had received training. Most staff told us they received the correct training to assist them to carry out their roles. The provider had not submitted the necessary notifications to CQC following significant events, as required by their registration.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service worked in partnership with other health and social care professionals to meet people’s needs. Records we viewed evidenced appropriate healthcare referrals and appointments. The interim told us they worked closely with GPs and district nurses to ensure people’s health and wellbeing needs were met.

People we spoke with were able to maintain contact with their local community. People were able to attend local church groups they had attended prior to moving to the home. One person said they were able to enjoy trips out.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. The management team recognised that they had not had the time to improve all aspects of the service, and this was a continuous journey. People and their relatives were invited to share their views of the service. Residents and relatives’ meetings were held periodically throughout the year. These meetings gave people and their relatives the opportunity to express their views about the service, to discuss any concerns they may have and make suggestions for improving the service. Comments included, “I have the opportunity to attend Residents' meetings and also give feedback on how things are done” and “There are Residents' meetings, we do sometimes get surveys but not always.” Records we reviewed did not clearly evidence that staff had received up to date training relevant to their role. The service used a matrix to monitor staff training. It was unclear from the training matrix which staff were up to date with their training. Lessons were not always learned from accidents, incidents or complaints. Records we viewed did not evidence that accidents or incidents had been reviewed to ensure lessons were learned and changes to care made where necessary.