East Dean Grange Care 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

The home was not well-led and we identified a breach of Regulation 17 (Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a negative culture within the service. This was in relation to staff not people using the service. Staff told us that although they would raise any concerns they had regarding people, they did not feel able to raise any other concerns due to risk of reprisal. We raised these concerns with the provider who took swift action to address the matter, however these new processes needed time to embed in practice and improve the culture. Quality assurance processes were not always effective in identifying or addressing issues. Some of the concerns we found during our site visit had either not been noticed, or action had not been swiftly taken to address them. Staff worked well with partner agencies to achieve good outcomes for people. The registered manager had a good understanding of regulatory processes and had reported any incidents appropriately to both CQC and the local authority.

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.

There was a negative culture at the service. Management and staff did not always work together as a team. Staff meetings and supervisions were not effective because staff told us they did not feel safe or comfortable to raise any issues regarding the running of the home in general. They did confirm that they would raise any concerns of safety regarding people.

Although there were processes in place to ensure good culture, these were not being followed. There was a negative culture within the staff team at all levels. The culture relating to people and relatives was positive. We met with the provider to discuss our concerns and they told us about changes they had implemented to improve the culture at the service. This included a new Whistleblowing Procedure which incorporates a QR code with a link to a form that can be completed by staff, this could be anonymously if staff wish. This form was monitored by the provider and allowed for protected disclosures to be made without any fear of reprisals. A new group manager had recently been employed and was developing direct conversation with the staff team. They had also introduced a “Stand Up To Bad Behaviour” Policy to help staff feel empowered to stand up and voice their concerns.

Whilst the management team had the knowledge and skills to lead the service, these skills were not always used compassionately and were not consistently inclusive. Some staff told how they had been subjected to bullying behaviour and felt excluded from the wider staff team. There is more detail on this in the Caring key question.

Processes were in place to promote an inclusive environment and compassionate leadership, but these were not being followed. We discussed our concerns with the provider, and they told us about changes they were implementing to address these concerns. The resolution of these issues needed time to be fully implemented and embed into practice.

Staff were not always confident or free to speak up. Staff told us they would raise concerns that were related to people and their care to ensure safety. However, they would not raise other concerns to the management team for fear of reprisals.

The registered manager told us they had an open-door policy where staff could talk to them at any time. There were staff meetings and supervision. However, due to the lack of support and trust reported by the staff team, these were not effective. Following the inspection the provider told us about new measures that had been implemented to support staff and regain their trust and confidence.

Some staff told us about their experience of discriminatory behaviour and how their cultural differences had not been considered when starting work at the home. Staff did not always feel comfortable in approaching the management team to discuss any individual needs they may have.

There was an Equality, Diversity and Inclusion Policy and an Equal Opportunities policy. Whilst the Equality, Diversity and Inclusion Policy was followed in relation to people, the Equal Opportunities policy was not always followed in relation to staff. We discussed these concerns with the provider. They told us they had a zero-tolerance policy and attitude towards bullying and discriminatory behaviour. They had started to implement changes to resolve these issues. However, it would take time for these to be fully embedded into everyday practice.

The registered manager demonstrated a good understanding of the regulatory requirements. They told us they had robust oversight over accidents and incidents, and they analysed and reviewed audits each month and action taken to address shortfalls. Not all the issues found during our site visits, such as fire risks, had been identified or addressed.

There was a quality assurance framework in place however, this had not identified the shortfalls and concerns we found. Where shortfalls had been identified action to resolve these had not always been taken in a timely way. There was a lack of oversight in certain areas, for example in regard to wound care and which staff were competent to complete this, along with poor documentation. Care plans did not always contain all the relevant information and daily notes did not fully reflect what people did each day. Staff well-being was not supported. Audits were not always effective in identifying gaps, for example, one staff member was working without a full Disclosure and Barring Service (DBS) check in place. The registered manager knew this staff member well however the measures taken to minimise risk were not documented or evidenced at our initial site visit. This had been rectified by the second visit.

People and their relatives told us appropriate health and social care professionals were contacted appropriately when required. People were supported to access partner agencies, for example, the GP if needed. They had good links with the local community and were able to access this.

Staff worked well with external agencies and partners. They spoke of confidence in contacting relevant external professionals when needed to ensure people’s needs were met.

Feedback from external health and social care professionals was positive. They told us people were referred to them appropriately and staff worked with them well to achieve good outcomes.

Systems and processes were in place to enable staff to work well with various external agencies including, GPs, community nursing teams, social workers and Local Authorities. Relevant information was shared appropriately however the documentation of this needed improvement. The provider was receptive to this feedback and staff completed additional training regarding tissue viability following the assessment.

Discussions with the management team and staff demonstrated they recognised the importance of learning lessons and continuous improvement to ensure people received care and support that was safe and effective. Oversight and documentation of this needed improvement to ensure robust lessons learnt.

Safeguarding concerns, complaints, accidents, incidents and near misses were reviewed and analysed. Emerging themes were mostly identified, and action taken to reduce the risk of reoccurrence. However, some trends regarding the time-of-day falls were occurring had not been identified. This was raised with the provider who completed a full review of these following our site visit.