Broadland House Residential 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 focused inspection completed in April 2021 we rated this key question requires improvement. At this inspection the rating has remained requires improvement. This meant the management and leadership was inconsistent which had led to failures in the quality assurance systems to identify shortfalls. The service continued to be in breach of legal regulation in relation to governance.

This service scored 61 (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, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The provider had recently reviewed their aims and vision and was in the process of ensuring staff received training in this. Our observations confirmed that the service had a positive culture in place and that staff worked to the provider’s aims, values and objectives. The relatives we spoke with confirmed this with one telling us, “The staff are warm and friendly; they care about [family member].”

Whilst the registered manager lead by example, demonstrated integrity and modelled inclusive behaviours, they were not consistently visible in the home and this had resulted in a decline in the quality of the service. At the time of this inspection, the registered manager was covering 2 of the provider’s locations at the request of the provider. This meant the lack of consistent oversight by the registered manager had resulted in shortfalls which had either not been rectified in a timely manner or not identified. This had negatively impacted the people who used the service.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard; staff told us this and procedures were in place to support this. Staff told us they felt able to raise concerns and that these would be listened to. They described a culture that was open and supportive.

The provider valued diversity in their workforce and a diverse staff team had been employed. The provider worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff told us this with one explaining how the provider had supported their individual circumstances to enable them to work.

Whilst senior staff understood their roles and responsibilities, the provider did not always have good governance in place and they did not always act on the best information about risk, performance and outcomes. For example, quality assurance systems had failed to either promptly rectify and/or identify shortfalls found at this inspection. Some quality assurance audits had not been completed as required. This had resulted in some safety shortfalls and people not receiving a consistently person-centered service.

The provider understood their duty to collaborate and work in partnership with other professionals so services worked seamlessly for people, and their responsibility to share information for improvement. However, the service had little engagement with the local community to identify new and innovative ideas that could lead to better outcomes for people who used the service, for example participation in local events and leisure clubs.

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. For example, despite other stakeholders providing feedback on how to make improvements within the service, these had not been fully listened to and/or implemented. If acted upon, these recommendations could have improved the service, people’s experiences and safety. The service had not actively and formally sought the views of a wide range of people, including staff, people who used the service and health and social care professionals. However, relatives told us they were able to contribute ideas and give feedback. No recent meetings for these groups of people had taken place which would have given them an additional opportunity to provide feedback with the aim to improve the service.