Horton Cross 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

At our last 5 inspections we found the provider had failed to consistently maintain good governance at the service. At our inspection in November 2023, we issued a Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities). At the assessment in February 2024, we found improvements had been made and the provider was no longer in breach of this regulation. At this assessment we found these improvements had not been sustained and the provider was again in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities). Therefore, people were placed at risk due to poor quality monitoring and oversight of the service provided. We will request the provider complete an action plan telling us how they will make and maintain the required improvements. There had also been inconsistent management at the home which had caused instability. The interim manager in post at the last assessment had left their role. The provider had acted promptly to put a manager in place, who stayed for 2 weeks. The provider then contracted a consultant to step in as the manager at the home. At the time of our site visit the new manager had been at the home for 10 days. Following our visit they completed two action plans setting out what needed to be improved. Staff told us there had been a high turnover of staff. They felt this was due to the inconsistency of the management team and concerns about the stability of the service. Staff told us they had confidence in the new manager and were hopeful they would make the improvements needed.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with understood the vision of the organisation and were supportive of the provider. Staff were hopeful the new manager would make the changes needed and embed them. One staff member told us, “I absolutely think she has what it takes to sort this out. I have found her approachable and very good.”

Staff had not always had the opportunity to discuss their professional development through consistent supervisions. The new manager told us in their action plan they would review old supervisions and appraisals and introduce a programme of 3 monthly supervision for staff going forward.

Staff feedback was mainly positive but some expressed concern about the inconsistency in the management of the home. Staff said they wanted stability. Staff spoken with wanted the service to succeed and were happy to be working at the service. Staff said the provider and new manager were approachable and supportive and they would speak with them if needed. An agency staff member told us, “The new manager [name] is very approachable and supportive. We can contact [name] as we have her number if we need anything.” They had all met the new manager and told us they were hopeful they would make the changes needed.

There was no registered manager at the time of this assessment. It was a condition of the provider’s registration to have a registered manager in post. The new manager said they were in discussions with the provider about completing their application to register with the CQC. The new manager had a good understanding of their role and regulatory responsibilities. They were engaged with us and the local authority regarding making improvements at the service.

Staff said they were able to speak up, share views and make suggestions to the provider and felt they would be listened to. The new manager said they had worked with the provider before and could access support and advice from them when needed. Staff from the provider’s other service had also been coming to Horton Cross Nursing Home to offer support when needed.

The provider had a whistleblowing policy in place. This gave clear guidance for staff to follow and encouraged them to raise concerns where needed. The new manager had identified in their action plan that they required staff to read, and sign updated policies and for the policies to be kept in the staffroom as a reference tool for staff.

Prior to the assessment concerns had been raised with CQC about staff feeling intimidated at the service. Staff we spoke with said they had never seen staff being spoken to in an unprofessional manner by the provider or senior staff. One staff member told us, “I have never seen any shouting in front of residents or otherwise… nobody is treated badly here.”

Staff completed training in ‘Equality, Diversity and Inclusion.’ They also had access to the provider’s policies and procedures.

At the last assessment in February 2024 the provider and interim manager had been working to ensure better outcomes for people and improve the morale of staff. They had implemented roles, responsibilities, and lines of accountability for staff. Staff told us they had confidence in the interim manager. At this assessment, the previous interim manager had left their role. The provider had acted promptly to put a manager in place, who then only stayed for 2 weeks. The provider then contracted a consultant to act as the manager at the home. These changes had caused instability at the home, with 5 different managers being in post since November 2023. Staff told us they were concerned about the inconsistency of the management and sustainability of the home and were worried it might close. One staff member commented, “The reason for the high staff turnover is the changing management which causes uncertainty.” Another said, “Staff are leaving to get other jobs as they are worried, we (Horton Cross) might close.” A third staff member said, “Staff are leaving because of job insecurity, it is no secret, financially the home is struggling.” They went on to tell us, they had been working at the home for just over a year and had had 5 managers in that time. Concerns had been shared with CQC about the food at the home. Kitchen staff demonstrated they had enough supplies to ensure people had food of their choosing. The cook told us they would be putting a new summer menu in place. Staff spoken with said they had no concerns about the food which they also ate if they were working a long day. The new manager told us about plans to set up a beverage section so people and relative could help themselves to drinks.

At the time of our site visit the new manager had been at the home for 10 days . Following our visit, they completed an initial action plan which was not very detailed. They then completed a second more detailed action plan, requested by the local authority quality team, setting out what needed to be improved. The previous manager had last fully completed the provider’s quality monitoring audits in March 2024. Some audits had been completed in June 2024, but not all. This meant people might be at risk of poor care and treatment. The new manager’s action plan set out the need to complete, ‘resident checks, medication audits, service reviews…monthly.’ The provider had failed to ensure effective and/or consistent systems were in place to monitor and improve the quality and safety of the service. This is a breach of Regulation 17, Good Governance, of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The maintenance person continued to complete monitoring checks to ensure the health and safety within the home. They told us about the actions the provider had taken and had scheduled to complete.

People and relatives spoke positively about collaborative working with the service and external professionals. Relatives said they were kept informed of any changes.

The provider had been open and honest with the staff team. They had made them aware of the financial difficulties due to the reduced number of people in the service. One staff member told us, “All the staff are behind [owner] and understanding of her plight.”

The provider had been working with the local authority quality team who had raised concerns about the speed of improvements. They visited the home 3 weeks after our on-site assessment and shared their findings with us. There was positive feedback about the improvements to the gardens. They were told about a significant refurbishment program which was being implemented. However, they shared concerns about the atmosphere within the home, a poor mealtime experience for people and audits had not been completed since the interim manager had left. They requested an action plan from the provider which was also shared with us.

The manager completed 2 action plans. The first did not clearly detail how, when and by whom the actions would be completed. The second action plan contained more details regarding the actions required, time scales and current status of the actions. We will be working with the provider and the new manager to ensure they achieve the action plan.

Staff told us they felt confident to put forward their views and ideas around improvement and innovation to the provider and new manager. They said they felt informed and included in the changes being made. One staff member told us, “[The new manager] asked us for a wish list of what we would like.”

Staff attended a daily handover meeting and had access to a handover document which kept them informed. The new manager told us they wanted to keep everyone involved. They told us they were writing to relatives to invite them to a ‘meet and greet’ meeting and would be holding staff meetings. They also told us they had new training software for all staff to ensure they completed their mandatory training. The new manager told us in their action plan that they had been in discussions with people at the home about creating a monthly newsletter to keep everybody informed.