Elmcroft Care Home

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 inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in continued breach of legal regulation in relation to the governance of the service, as systems and processes to ensure effective oversight were not in place.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. There had been a high turnover of managers at the service over a number of years, which impacted on the consistency of agreed aims and ambitions for the service. The manager told us they were working with staff to re-build relationships of trust, to develop a shared vision for the service. A staff member said, “There have been 100% changes to working here. We have had many managers who seem to come and go, this manager is the best, very positive thinking about the home.” Whilst the provider had a mission, principles and values; leaders confirmed that a vision, strategy and culture had not been co-produced for Elmcroft Care Home with staff and people who use it, which would help develop engagement and trust.

The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty. There was a disconnect between the provider corporate team and day-to-day management practice and care delivery. Directors did not demonstrate a realistic understanding of the widespread nature and seriousness of concerns identified at the last inspection, or the length of time required to resolve this. The new manager was highly visible, approachable and led by example. A staff member told us, “Because [the new manager] has a clinical background you feel like you can lean on [them] for support. [Manager] is very valuable.” However, whilst we received positive feedback from people, staff and professionals, the new management team had not yet had the time to make the extensive improvements required at the service. The provider was also still recruiting to roles to support the manager, including a new deputy.

People did not feel they could speak up and that their voice would be heard. Whilst staff told us they could now report concerns more openly, we identified some incidents where this was not evident. For example, a person had sustained a minor scald from a hot cup of tea, but none of the staff on shift felt able to tell leaders who provided the drink to the person, suggesting a deeply rooted blame culture which had the potential to impact people. A staff member told us, “Previously we were scared to go to the management, even to report incidents because we thought they would sack us, but now with the new management we are open to go and talk to them, they make us feel comfortable and able to raise a concern, or anything.” More time was needed to fully embed this change in staff culture.

The service did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who work for them. Whilst staff reported improvements in this area, changes in staff culture needed to be fully embedded and sustained long term. For example, some supervision records referred to differential treatment by colleagues on the basis of protected characteristics, with no clear action recorded. Further work was required to ensure the service was continuously alert to identifying and acting on potential closed culture indicators. However, improvements had been made to introduce staff team meetings, supporting the inclusion of all staff members. A staff member told us, “We have regular meetings with the manager, so we are up to date on things going on.”

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Since the last inspection there was a new Nominated Individual, home manager and operations manager. All of the management team were very new in post. This meant it was not always clear who was responsible for certain actions, and how this fed into wider oversight of the service. The manager had limited oversight of the service quality priorities and risks as they were being managed and overseen by senior leaders, including the completion of audits which would be better placed in the manager’s day-to-day operational practice. The provider had employed an external consultant to develop care plans. However, it was not demonstrated how they fully understood people’s individual needs and recommendations made were not completed in a timely way.

The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. However, professionals told us whilst there were still areas for improvement, they were confident in the new management of the service to continue making changes given time to do so. Leaders were engaged in regular multi-disciplinary team meetings to support improvement work at the service. A professional told us, “During the time of the current appointment of [new home manager], I have seen vast change in a very short space of time, [home manager] has greatly improved the standard of care. When I attend the site, the staff are asking me what I am here to deliver. They want to learn; they want to improve.”

The service did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research. Due to the significant failings identified at the last inspection, leaders were still reactively responding to concerns raised by external stakeholders and were not yet able to focus on proactive development of the service. Whilst improvement work had started, leaders were not yet in a position to demonstrate the longer-term outcomes and benefits. Although managers had a good understanding of where improvement was needed, there was no documented evaluation and review of changes made to measure outcomes and impact. This meant leaders could not demonstrate improvements were working and learning embedded. The manager confirmed they intended to create a development plan for the service going forwards.