Down House

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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

The operations manager was acting on behalf of the registered manager at the time of the assessment. The service management had the active support of the provider. The management team led with integrity, and openness. The management team demonstrated their passion to improve the service and recognised there were areas that needed further improvement. The service had an organised approach to gaining feedback about the service but there were issues which had not yet been responded to.

Staff training was good, and new staff were receiving the training they needed as part of their induction. Staff were overseen by the management team. Staff were pressured by the intensity of the needs of the group of people that used the service, but the provider had oversight of the staffing level necessary to meet the needs of people at the service.

This service scored 68 (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.

Most staff were positive about the leadership of the service and all said they felt managers in the service were caring towards them and the people that used the service. Staff told us they felt listened to and all said they were supported in their roles by an approachable management team.

One staff member commented, “The management are good. They are good and if they (the managers) have an issue (with anything) the (Operations Manager) and (Deputy Manager) will deal with it.”

All the staff we spoke with said they would recommend the service as a good place to work. During the assessment the management team demonstrated their passion to improve the service and recognised there were areas that needed further improvement.

The provider had asked the operations manager, who was a former registered manager of the home, to temporarily manage the service while the Registered Manager was on leave. This meant the manager in charge had a good knowledge of the staff team at the home.

At our assessment, we found the management team led with integrity, and openness. The management team told us they were being supported by the provider. The service management said the provider was in the home frequently.

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.

Feedback from staff was positive about their leaders be those nurses, or non-clinical management. The onsite managers told us how they managed the service. The service had some change in managers prior to the assessment and the management and coordination had struggled to remain consistent. The clinical lead managed nurses in the service while the manager of the service managed the care staff. The nursing staff were responsible for all care planning for nursing patients and some improvement was needed in nursing care planning.

We found some repairs needed to be made to the service. The provider of the service told us they had plans for major maintenance and improvements to the building and the site, but that these would have to wait until 2025 when cost pressures had reduced.

The service used an IT based audit. Where faults were identified the IT system required an action plan to address the issue. However, the audit system had not identified issues around social interaction or oversight of clinical care.

External governance and oversight for the service had improved through the provider’s frequent presence in the home and their involvement in the service.

People and their relatives told us health and social care professionals were generally contacted appropriately when required.

Staff told us they would contact relevant external professionals to meet people’s needs and we saw these external contacts recorded in peoples care records.

The present manager told us they had some difficulties with commissioning professionals over recent months, but these issues had been resolved, and generally the health and social care systems worked well with the service.

No concerns were raised during the assessment by external health and social care professionals. However, the quality of care was described by one professional as only ‘satisfactory’ and others said that maintaining the quality of the environment was a challenge.

Systems to engage with people, their relatives, visitors, and health professionals were used to obtain feedback about the service and share learning.

The service’s management had areas of improvement to make and there was not yet a learning and organised approach to feedback about the service. However, during the assessment, the service and provider level management demonstrated a wish to learn and improve the service.

We spoke with staff about learning and improving care. Staff told us training was good but more practical courses would be helpful. Records showed mandatory training, as defined by the service, was being delivered to all staff.

The service was not effectively using systems and processes to learn, innovate and improve. The service had asked people that used the service, their relatives and staff for their feedback, but the service had not responded to this feedback. Social interaction and activity had reduced, but this had not been responded to by the management of the service.