Barnet Grange 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 leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated 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 provider was in breach of legal regulation in relation to the governance of the service.

This service scored 54 (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 always have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, and engagement. They did not always understand the challenges and the needs of people and their communities.

There were divisions in the home between the assisted living part and Copperfield. Staff felt there was a division within the staff teams and amongst the people in the home. The provider had identified the ‘hidden’ door to Copperfield as a potential issue, but they had not explored this and taken any action. Previous managers had not explored and tried to address this issue. We heard and some staff told us about the comments some staff made, such as “Going to Narnia” and “You’ve come over here for a holiday.” There was a risk given this division and weak leadership; a closed culture could develop. No plans had been made to address people’s negative views of those who lived with dementia to try and bring people together. Consideration was not being given to why people living in Copperfield were unable to access the other aspects of the home independently and without a member of staff. The provider and manager were not spending time assessing the dementia care experience, identifying issues here such as access, limited equipment and decoration issues.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Some leaders did not always have the skills and knowledge to lead effectively.

There had been inconsistent leadership at the service in certain aspects of the care provided. This had impacted on the division amongst the staff team, dementia care, risk management, and quality monitoring. However, managers within the home had worked hard to manage the areas they were responsible for despite these challenges. Staff had spoken well of the new temporary leadership of the home, saying they now understood their roles and what they needed to do. People’s relatives recognised the work of these managers, who they felt were holding things together, despite long periods of inconsistent overall leadership of the service.

People did not always feel they could speak up and that their voice would be heard.

Some staff and people shared views with us they did not feel able to tell the managers and the provider. For example, in relation to how some staff spoke with them, the extent of the cultural divisions in the home, and staffing levels. Staff said they had not been asked their views on these matters by the provider, which did not give them confidence to speak up on controversial matters. But most staff were hopeful this would change soon with new leadership.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff said they worked well within their teams. Staff had taken opportunities to progress their careers and other staff were aware of the additional qualifications and training available to them, if they wished to access these. Staff spoke well of the support their direct managers had given them since working at the home.

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, or share this securely with others when appropriate.

The provider did not have effective auditing processes in place. There were shortfalls with oversight in key aspects of the care provided, risk management, incident management, people’s experience of care, repeat medicine errors, safety checks, availability of equipment, the application of the Mental Capacity Act (2005), errors in care planning, for example, misuse of people’s names and recording of textured diets which could impact on people’s safety. Effective and regular auditing was required to assess the quality of dementia care, as these people were not able to advocate for themselves.

The provider did not always collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider did work well with the GP practice and community health. However, they were aware there was a divide amongst people living in the supported living part of the home and Copperfield, but they had not taken any action or made a plan and involved people, staff, and relatives to try address this. The hidden door had been identified, but not explored. When we spoke with the senior management team about this, there was a willingness to do this, but no actions had been taken. Improvements were hampered due to issues with incident management, and staff and people, not always feeling confident to speak up.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider had not promoted innovation and improvements due to limitations in their own auditing and assessments of the quality of the care provided. The service had not had consistent effective leadership, which had hampered improvements. When there was effective leadership, staff were not given the time to make the improvements. For example, issues with nursing practice and their knowledge had been identified, but the managers responsible were not given the time to make the necessary improvements, likewise with the responses to the medicine’s issues. However, recent temporary leadership arrangements showed improvement and had given other managers and staff confidence they will have the opportunity to make improvements to the home. As one member of staff said, “I now feel confident we can take this home in the direction it needs.”