Cressington Court Care Home

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• 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

We assessed 2 quality statements in the well led key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. Though the assessment of these areas indicated significant concern since the last inspection, our rating for the key question remains requires improvement. We identified a breach of the legal regulations. Inadequate governance systems exposed people to a potential risk of harm. The providers auditing processes were not effective in identifying and driving improvement to the quality and safety of the service. Lessons had not been learnt and the provider failed to take enough action against known risks resulting in continued breaches of the legal regulations. There has been repeated failure from the provider to ensure the delivery of safe, high quality care.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us previous management arrangements had instilled a poor culture within the home. Whilst management changes have since occurred, they told us the culture of often feeling afraid to speak up was still present. A staff member told us, "Most of us still feel we shouldn’t raise things." Staff told us leadership had been inconsistent. A staff member told us, "There has just been so many managers here, no one stays." The providers senior leadership team accepted they did not spend enough time at the home, but they felt they did listen to the staff and had tried to improve the management of the home. A staff member told us they did not think the home was well led because in addition to the documentation being of poor quality, they felt the leadership team was not responsive to concerns they raised. They told us, "The leadership team are nice people, but I feel like I raise things, they listen, yet nothing else gets done."

Management arrangements were inconsistent and the staff in charge of the day to day running of the home lacked the capability to do so safely and effectively as demonstrated by the number of significant shortfalls in quality and safety identified throughout the assessment. Although processes were in place to support the manager, it was clear that the provider did not maintain effective oversight and therefore failed to identify the significant concerns we found with the day to day leadership.

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 culture within the home did not always support effective governance arrangements as staff told us they were often too afraid to speak up and share concerns that could lead to improvements in quality and safety. Staff told us they did not feel that their feedback was used to improve the service and we found many staff were reluctant to share concerns for fear of reprisal. Comments included, "They are not listening, we are scared of raising things now" and "We try to manage with the staffing numbers and the care plans the way they are because we are scared to say anything. Most of us are sponsored.” Staff told us they either did not know the providers senior leadership team, did not see their presence enough in the home or they did not listen to concerns they raised about the safety of the service. Comments included, "They don’t really take action because they are always in the other homes" and "[Staff] is speaking to the senior leadership team, but they are not listening."

Inadequate governance and quality assurance measures meant that people were exposed to unnecessary risk and avoidable harm. The provider was not assessing, monitoring or mitigating risk relating to the health, safety and well-being of the people living at the home. This placed people at risk of receiving inappropriate and unsafe care. There had been repeated failure from the provider to ensure the delivery of safe, high quality care. Continued breaches of the legal regulations meant the provider was not clear about their role and regulatory responsibilities and was unable to demonstrate their compliance with the fundamental standards. A range of audits were completed by the provider. However, they had failed to identify all shortfalls found with risk management, care planning, infection control, medicines and safeguarding. This meant opportunities to drive improvements to quality and safety were missed.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.