Marlow

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.

The service 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, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Some staff, and managers spoke of concerns around the lack of leadership and guidance from previous senior leaders. We were told this was now recognised by the provider and new senior leaders were in place and an interim local manager was supporting the service.

The provider had not had effective systems that assessed or monitored the day-to-day culture of the service, and this meant they had not identified the warning signs of a declining culture, and the risks poor staff knowledge and support created for people living at the service.

Staff told us the culture had been improving, and they felt the interim manager was accessible and open with them. The improvements are recent and had not had time to develop into a consistent culture at the time of the assessment.

Not all leaders understood the context in which the service delivered care, treatment, and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience, and credibility to lead effectively, or they did not always do so with integrity, openness, and honesty.

The providers processes had not effectively measured the skills and competence of leaders and as a result had failed to ensure they received support to lead effectively this resulted in the staff team receiving limited guidance and support. At the time of our assessment visit the interim management support had begun to improve the support to the staff.

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 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.

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 breach of legal regulation in relation to the governance of the service.

The provider did not always have effective governance systems in place to identify and drive improvements at the service. Audits were completed but had not always identified gaps in people’s records. The provider had not ensured managers and staff had the knowledge to identify the scale of risks in order to prioritise action, particularly in relation to people with complex health needs.

For example, where people had specific needs in relation to hoisting, the need for a modified diet and other health related needs, support plans lacked the detail needed to guide staff to carry out the support safely. This had resulted in several safeguarding concerns raised with the local authority. In partnership with health professional support plans and risk assessments had been updated. However, people’s support plans and risk assessments had continued to lack details about how to support people with assessing and developing communication tools, understanding, and practicing positive behaviour support and reviewing support plans against the expectations of the quality-of-life guidance. Action had not always been taken to ensure all commissioned hours had been allocated to ensure people received staff support with their social activities and needs. We were told this had improved, however managers confirmed people were not always receiving their funded 1:1 support and some planed external activities were missed.

The provider 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.

We received feedback from relatives and health and social care professionals, which told us communication between themselves, and management had been poor in recent months, but had started to improve with the new interim manager. One relative said, “Communications still needs to be better - blood test happened, and I didn’t know about it.” In recent weeks, people were referred to health professionals in a timelier way and there has been progress to support some people to have new experiences.

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 fully embraced the current best practice guidance right support, right care, right culture. Leaders had not always been collaborating with people, their representatives, and staff to build a culture that focused on enabling people to enjoy a full life.

However, the provider had, following the safeguarding and practice concerns, changed some of its systems and practices as a result of the lessons learnt from working with the local authority and health professionals. These included. Additional or refresher training for staff in Dysphagia and Safer People Handling. Introducing face to face handovers and putting emergency grab packs in place for people covering their basic details and support needs in the event of an emergency.