Rastrick Hall and Grange

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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

At our last inspection we rated this key question good. At this assessment the rating has changed to requires improvement. We looked at all of the quality statements for this key question. We identified a breach of the legal regulation in relation to good governance. Systems for auditing safety and quality were in place, but the provider had failed to make sure that robust oversight of the service had been maintained. Staff gave consistently positive feedback about the new manager. Most staff told us they felt confident to raise concerns and were assured they would be dealt with appropriately. Systems were also in place to ensure there was equality and inclusion amongst the workforce.

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 manager told us they had identified several issues within the service and intended to provide long term stability of management to support the service in meeting its vision and values. They were making people aware of how they intended to do this through meetings, drop-in sessions and being open and honest with people about what was happening at the service. Staff told us they had been affected by the instability but said the new manager was positive about making improvements. A staff member said, “When [the manager] first came in they had a hard task, morale was low and there wasn’t enough staff but they’re trying really hard to get things back to where they need to be. I like [the manager], you can go to them with any issues, and they will deal with them.”

A vision and values statement for the service was available for people to read in the entrance of the home. However, it was clear that changes in management and lack of effective provider oversight had meant organisational visions and values had not always been upheld. Meetings for people and their relatives had been organised to let people know what was happening in the service and what plans were in place for improvement.

The manager assured us of their understanding of what needed to be done to provide the service with effective leadership and recognised that this would take time to be fully effective. The manager was making sure staff and people involved in the service were kept up to date with what was happening and any changes. Staff valued the new management team and felt they were taking the home in the right direction. Feedback included, “I like them, they seem to value their staff, and you need that so that staff can provide the best care.”

Systems had not been in place to provide effective leadership within the service during the changes in management. However, this was being addressed and the new manager was receiving support from members of the provider’s senior leadership and quality teams. This was being kept under review and changes were made as needed to make sure the right people were in place to offer support in the right areas. The new manager had many years of experience in the position of being a registered manager with CQC and had been supported through an induction period.

Most staff told us they felt confident to raise concerns and assured they would be dealt with appropriately. A staff member said, “Very comfortable (raising concerns), especially if it was concerns about a resident. Yes, I think it would be dealt with appropriately.” However, one staff member told us that concerns not dealt with by a previous manager meant some staff had lost faith in speaking up. They said, “I think it’s probably going to take some time, and a few examples of staff concerns and ideas being taken on board before people start to believe there’s a reason to say something.”

The manager and members of the provider’s management team made themselves available at various times, including night times and weekends, for staff to speak with them. Whilst this was a positive initiative, it had only been in place since the appointment of the new manager and had not been part of the provider’s previous processes. There was a whistleblowing policy in place and people were encouraged to raise and share concerns.

The new manager had introduced social events outside of the service to encourage staff bonding and, along with the deputy managers, had planned a staff appreciation day in the home. Staff were generally appreciative of management and felt the new manager valued the workforce. An example was given of mandatory training being translated and made into a workbook for a staff member who struggled with computers and did not have English as a first language. Another staff member told us flexible working was available, “They’ve been so good in working together with me to agree my hours and work around my needs. There are always overtime shifts being offered and ways to swap shifts if you need a particular time off, they’re good at realising that staff have lives outside work too.”

Systems were in place to ensure there was equality and inclusion amongst the workforce. For example, recruitment processes were fair and equitable for all staff, with no gender pay gap and the service also encouraged internal promotions or movement between departments. Flexible work patterns were also in place, such as staff working set days to support with their home lives.

The manager was aware of the issues within the service and was working with the local authority to address them. They told us about further initiatives they hoped to introduce to involve staff in auditing safety and quality within the service.

Systems for auditing safety and quality were in place, but the provider had failed to make sure that robust oversight of the service had been maintained in the absence of a registered manager. This meant that auditing of the service had not been effective in identifying and addressing issues. Such as, assessing and managing risk and safeguarding, care planning, infection prevention and control, management of DoLS and some issues with medicines management. This had resulted in the home being subject to a large-scale enquiry by the local authority safeguarding team. Since their appointment, the new manager had been pro-active in identifying and addressing issues and was being supported by the provider’s senior management team. An aide memoir was in place for managers for reporting and governance. Daily, weekly and monthly schedules for reporting incidents and audits were also in place, which the manager was maintaining.

People’s relatives felt communication about the involvement of health and social care professionals in their family member’s care could be improved. However, people and their relatives had been invited to a joint meeting with the local authority, where they could share their concerns and learn more about what was happening in the service and the involvement of the local authority.

The management team had identified issues in relation to communication from visiting health and social care professionals and were putting systems in place to address this. Staff told us they worked in partnership with other health professionals to provide the best care for people. An example was given of preparing hospital packs which included the person’s care plans, MAR charts and medicines so that hospital staff would know how to care for them.

The local authority acknowledged the involvement of the provider to promote collaborative working.

Where some issues had been identified in relation to collaborative working, the provider had been pro-active in liaising with the local authority to promote effective partnership working. For example, at the time of our assessment, the management team were working very closely with the local authority to address issues within the service. The manager was also working to improve systems for communication between visiting health care professionals and staff at the service.

Staff explained how feedback and actions in response to incidents or accidents were sometimes shared in handovers and team meetings. The deputy manager acknowledged that learning from events was not currently fully embedded at the service. Carer huddles had recently been started to discuss things that had happened and to encourage staff involvement in making changes and improvements to reduce recurrence.

The learning culture within the service was improving, as the management team were working together to make sure lessons were learned from issues that had led to the level of local authority involvement in place at the time of the assessment.