Homelands Nursing 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 assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in 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 overall governance at the service.

This service scored 29 (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 have a shared vision, strategy and culture 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. The registered manager did not uphold people’s human rights, they failed to ensure staff were working within the principles of the Mental Capacity Act 2005 which meant the culture of the service was not person-centred. Relatives of people in the Coach House told us they were not aware of resident’s and relatives meetings and told us they were not asked for ideas and suggestions. Meetings were held for people and their relatives of the Manor House, minutes showed people were asked for their opinions of the food, activities and general running of the service. Results of surveys completed by people and their relatives were mostly positive, areas which required further improvements were discussed at resident meetings and staff meetings.

The provider did not have inclusive leaders who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills and knowledge to lead effectively, and they did not always do so with integrity and transparency. Staff meetings were held periodically, we reviewed minutes which showed a lack of engagement by staff. Minutes of the meetings documented where the registered manager had directed institutional practices, for example, ‘Residents must be toileted after lunch as directed by your nurses.’ Minutes further documented the registered manager’s advice of, ‘Failure to give them (people) their (call) bell means they would be unable to call for help or assistance and this amounts to restraint and/or abuse.’ Despite this advice, the registered manager had failed to ensure working call bells were available to people. The registered manger did not always show compassion for the people in the service, during the assessment we fed back about our observations in the Coach House of some negative staff interactions with people. The registered manager shared they had concerns about staff practices in the Coach House, however, they had not acted on this or enhanced their oversight. Following our assessment, the provider gave assurances that the team of directors will be working closely with the service, a manager from another of the provider’s services was deployed to provide additional support to the registered manager.

People’s voices were not always heard when they spoke up. There was a lack of quality leadership in the Coach House, most relatives told us they had not met the registered manager. Comments included, “No, to be truthful I don’t know the manager. I’ve only spoken to the nurses.” And, “No, I don’t know the manager. I talk to the main nurse. They are very nice.” Although relatives did not know the registered manager, they told us they thought the service was running well. Staff did not receive regular supervision with their line manager to promote opportunities to speak up if needed. Staff told us they could approach their line managers; however, we identified incidents where staff had not spoken up about people’s injuries which indicated they did not recognise the injuries were a concern or they were not confident to speak up. The registered manager put the responsibility of supervisions onto staff, minutes of a staff meeting documented their advice of, ‘Supervisors have a list of who they are expected to supervise. It is also the responsibility of the staff to make sure they receive supervision. If this is proving difficult, please come and see me.’ We noted some staff had not received a supervision and one staff member had not been supervised for over 11 months.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Many staff at the service had worked for the provider for a number of years, some staff had been employed on a sponsorship licence from overseas. Minutes of the staff meeting documented that overseas staff were to have un-minuted meetings with the registered manager, therefore, we were unable to see what was discussed. During staff meetings, the registered manager spoke about staff not completing their timecards and gave the following advice, ‘Timecards need to be filled in by the staff and not left for to me to do. Perhaps I will start making mistakes?’ This did not evidence staff were valued. Staff told us they could voice their ideas and suggestions any time, however, were unable to recall examples of when they had done so. Staff comments included, “We can go to [registered manager] and [deputy manager] we have freedom to talk they listen to us.” And, “I feel supported by the manager I wouldn't have been here so long if I hadn't.”

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Management oversight was lacking in respect of staff training, supervision and competency assessments, checks were not made to ensure staff were working to a high standard and providing person-centred care. Audits of people’s care plans were not effective, we reviewed audit outcomes which concluded people’s care plans were person-centred, however, care plans lacked any person-centred details. The registered manager lacked an understanding of regulations in respect of staff recruitment requirements and did not ensure robust checks were made before staff were deployed to support people. The registered manager failed to undertake assessments of risk in regard to works being completed in the Coach House, this led to people being able to access unsafe areas of the building. Further checks of the premises and equipment were not routinely carried out which meant people were supported in wheelchairs that were broken. People were at risk of harm as maintenance issues had not been identified. The registered manager told us staff were required to document concerns in the maintenance book, however, they failed to provide evidence and assurances of their own oversight to proactively keep people safe. Following our feedback, the provider told us they were looking to employ a senior deputy manager to support the registered manager, they had also employed an additional maintenance worker to proactively address works needed to the environment.

The provider did not understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not share information and learning with partners or collaborate for improvement. The management and oversight of incidents and safeguarding concerns was not robust, incidents had not been reported to the local authority safeguarding team and CQC. The registered manager told us they audited incidents, however, was unaware when we showed them incidents of a bedrail entrapment and agreed with our concerns regarding the restrictive practices. The registered manager told us they did not routinely share information with the local authority safeguarding team as they believed incidents did not meet the local authority’s safeguarding threshold, they also told us the local authority took too long to respond to safeguarding matters. Visiting health and social care professionals provided mixed feedback about their experience with the service. Comments included, “I have found the management at this home extremely difficult [registered manager] is often reluctant to communicate… I still don’t have direct communication with manager, the nurses will often refer patients.” And, “We tend to communicate with the clinical/nursing team at Homelands, rather than the management team, but [registered manager] is responsive to any queries... When we have had concerns or suggestions, in general they have been willing to discuss and work together in a constructive manner.”

The provider did not focus on continuous learning, innovation and improvement across the organisation and local systems. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research. The registered manager failed to keep their knowledge up to date, we identified incidents where the registered manager was unaware of guidance and regulation. CCTV was installed in the Coach House, we asked the registered manager to see the data protection impact assessment for the CCTV, the registered manager did not know what this meant. We asked the registered manager how they gained consent from people to be monitored by CCTV, they told us visitors were made aware by the posters outside the building and people living in the Coach House would not understand what CCTV was. This demonstrated a lack of respect and regard for people. Audits and quality checks were completed but failed to drive improvements within the service. The registered manager had identified that daily care notes and reports were not completed fully and had discussed this with staff at meetings. There had been no improvements, records remained challenging to read and follow. A visiting healthcare professional told us, “In terms of paperwork the home still uses paper files, which are quite difficult to trawl through.” We found care records were kept in different areas of the service and were not always fully legible. Following our feedback, the provider told us they had purchased an electronic care planning system which will help with the legibility, oversight and auditing of records. The provider had commenced works on ensuring legislation was followed for the use of CCTV.