Weymouth Manor

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

We found a breach of the legal regulation in relation to the governance systems and processes. However, the interim manager was open and honest throughout our assessment of the home. Where concerns had been identified through our inspection, the interim manager responded by making improvements. Systems and processes were not always robust, and this had led to staff not identifying when people were at risk of harm. Systems to ensure CQC were notified of reportable incidents were not robust, and this meant the provider could not be assured they met their regulatory responsibilities to ensure external scrutiny of the home. This had placed people at risk of harm. A lack of robust learning, improvement and innovation processes meant the provider could not be assured lessons were learned when things went wrong. The provider was not always responsive to our requests for information. People, relatives and staff told us they did not always feel listen to by the provider and when they had raised concerns, they had not always received a response. Staff were not always clear on their roles and responsibilities within the home, and some staff had not received a job description or full induction into their role.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were not always clear on the providers vision, values and strategic goals. Changes had recently been made at the home and staff were unclear about its future and what was expected of them. For example, staff had started in new roles but had not received any guidance on what was expected of them within that, role. One staff member said, “I am not sure, everything appears to be up in the air with no real direction. I feel at this time the honest answer would be no, I do not know what the organisation values are or the shared direction. There is a lot of ill rest and staff are felling very unsure of what the future holds.” We asked the provider what the values of the home were who told us, “The values of the company are to be able to provide true care to residents.” Staff told us the culture of the home had left some staff not feeling empowered or able to progress in their role. One staff member said, “It's been cultured by previous team ‘we will do it all’, and by doing that, they took the autonomy away from other staff and now we are not clear who is responsible for doing what.”

We asked the provider to tell us how they were assured staff knew what the organisation values were, and knew how to meet them? The provider was unable to tell us on the day of our inspection and sent us a core values statement afterwards. The statement set out the organisation core values however did not set out how staff knew what these values were. This meant the provider could not be assured staff were meeting those values.

We received mixed feedback from staff about the management of the home. Staff told us the registered manager had just left and provided us with comments such as, “Up until this past week I would have said this place had amazing management, [registered manager] couldn't be more supportive”, “[registered manager] did have her favourites, and made it clear which caused other staff to feel bad” and, “I really felt the [registered manager] was supportive.” Staff did not always feel supported by the provider. Sudden changes had occurred within the home, staff had not received clear communication about those changes, and had not always received a response when they asked the provider. This had led to staff feeling unsettled. One staff member said, “It has been very tough for us all. Not much information has been given to staff about the reasons for all the sudden changes from the owners. Then we had staff made redundant and staff were upset by the way this happened. Now our [registered manager] has left and staff do not know why. This made many of the staff that didn't have all the information angry, which has resulted in staff calling in sick or deciding to leave. This has of course made it extremely difficult for the rest of us that are still turning up for work every day. I must say the carers do a fantastic job and we have been providing good care through all of this, however, there have been occasions when residents have had to wait longer than normal for someone to help them.” Staff told us they felt supported by the current clinical lead and manager. One staff member said, “The clinical lead nurse and the interim manager are both excellent.”

We asked the provider 4 times to send us their assurances relating to the stability of the home for the next 6 months and beyond in terms of staffing, leadership and how they intended to maintain standards however, the provider failed to supply this.

Staff told us they had tried to raise concerns with the provider, however, did not feel heard. One staff member said, “You do not get a straight answer from [provider]. We have not been told why all these changes are happening, and we’ve tried to tell [provider] that we need more staff, especially on the nursing floor, but they do not listen.”

During our onsite inspection we were unable to find information relating to the freedom to speak up process for staff and staff did not tell us what the process was. Following our inspection the interim manager informed us they had sent staff a feedback survey to enable staff to share their views. We were unable to access the effectiveness and sustainability of this process during this assessment. In addition to the staff surveys, providers are required to encourage a culture of openness and transparency. After our inspection, we requested the interim manager and provider send us the freedom to speak up process for staff 4 times, however, they did not submit these. We were therefore not assured there is a freedom to speak up process for staff.

Staff told us meetings were not always inclusive and held at suitable times to ensure everyone could attend. However, staff also told us they were treated equally and felt the home was inclusive. One member of staff told us, “I feel everybody is quite supportive and not judgemental about people. Like me, I am not from England. I feel the home does support each person whether they have different religion or different choices of life. People are encouraged to be comfortable, to be who they are."

Staff told us staff meetings had not always been held at suitable times to ensure they were able to attend. For example, the last staff meeting had been held during school holidays meaning some staff were unable to attend. Staff told us they requested to see the staff meeting minutes but were not provided with any. Staff felt they had not been enabled to engage or have a voice to ensure the consistent and safe quality care. We asked the provider and interim manager to share the staff meeting minutes 4 times, they did not submit any. This meant we were unable to assess whether leaders ensured there were effective and proactive ways to engage with or involve staff. Following our inspection the interim manager told us they had sent out feedback surveys to all staff to gather their views. We were unable to assess the effectiveness and sustainability of this during our inspection. Recruitment processes included an application form and medical questionnaire. These helped to identify staff who had protected characteristics and ensure reasonable adjustments were made to support them in carrying out their roles, and to work in a fair and diverse workplace.

At the time of our assessment an interim manager had just been appointed to the home. The home was going through a large amount of change, and people, relatives and staff were feeling unsettled. The interim manager told us they were aware of the concerns we had identified during our assessment. They provided us with an improvement plan they devised during our assessment. The plan addressed themes such as seeking feedback from people, their relatives and staff. Making improvements to care plans, and ensuring appropriate care and treatment was provided and people’s needs were met. Staff were feeling low in morale when we started our assessment of Weymouth Manor. Sudden and recent changes at the home had left staff feeling unsettled. Staff felt the provider had not properly communicated with them. We fed this back to the provider and requested assurances relating to the stability of the home for the next 6 months and beyond however, the provider failed to respond to us. We discussed our concerns with the interim manager of the home who told us they were confident the home would start to settle, and small improvements had already been made. They said, “We need to have a proper system in place and you need to be on the floor also, not only sit in the office.” We were unable to assess the effectiveness and sustainability of these changes at our inspection.

At the time of our inspection the provider had not established robust systems to ensure the home was meeting legal regulations. This meant they could not be assured people were safe and having their care needs met. There was a lack of robust systems to ensure accidents and incidents were reported appropriately to the local safeguarding team and to CQC, which the provider is legally required to do. This meant the provider could not be assured all reportable incidents had been notified to CQC to ensure external scrutiny of the service. This had placed people at risk of harm. During our assessment of the home, the provider recruited an operations manager to support with improvements in the home. We were unable to assess the effectiveness and sustainability of these changes at this inspection. The management auditing systems and processes were not always effective at identifying areas of the service that needed improving to ensure people received good quality safe care. This had led to shortfalls in provision, and people placed at risk of harm. Governance audits of health and safety and the environment had not been completed since February 2024 meaning the provider had failed to identify concerns in these areas. Staff used an encrypted messaging service to communicate with each other about the day to day running of the home. The provider did not have robust processes around sharing information through this service, and we found staff who no longer worked at the home still had access. The provider could not be assured confidential information was shared appropriately and was a breach of the General Data Protection Regulations (GDPR). We discussed this with the provider who said they would no longer use this messaging service and planned to introduce a new system to protect people’s confidentiality, in line with GDPR.

People’s experience: People and relatives told us healthcare professionals were contacted by the home and visited regularly. Local community groups visited the home, and people took part in community activities. We saw people taking part in an arts and crafts community group during our inspection. One person said, “I enjoy when people come into the home, it’s good to talk to different people.”

Feedback from staff and leaders: Staff understood when people needed input from healthcare professionals and had appropriately arranged for people to be seen when required. One staff member told us, “We have a good relationship with [visiting healthcare professional].We know our residents and accompany the [healthcare professional] to assist with their rounds.”

At the time of our inspection, some people were being cared for as part of a ‘Discharge to Assess’ scheme (D2A). This was a scheme that offered people who are medically fit enough to leave hospital to continue with therapy and recovery in a care home setting. Healthcare professionals told us people’s experience of care was different between the residential floor and the nursing floor where people were being cared for as part of the D2A scheme. This was in part, due to the high needs of people, and the D2A scheme not fulfilling their part of the contract with therapy which placing extra pressure on the staff team. Comments from healthcare professionals included, “We have previously raised concerns with the home about the [D2A] contract. The pressure on the nurses and the dependency level has subsequently meant that basic care needs are difficult to deliver”, “I have personally observed that residents have not been encouraged to mobilise and participate in the home activities, leading to a delay in recovery and possible isolation” and, “I feel that pain management is often overlooked, or is inadequate. For example, a resident with chronic leg wounds and pain needed a review for pain medications available but was not given either regularly or often enough.” However, another healthcare professional said, “Staff are very welcoming and are very helpful with me. They always lead you to the room and stay with you. They're always really caring and lovely.” Another said, “I believe the carers are responsive to the resident’s needs, and communication is good between them and ourselves for the majority of the time. I generally have the same carers for each round which enhances continuity of care.” We shared this feedback along with other shortfalls we had identified during our assessment of Weymouth Manor with the local authority safeguarding team who started working with the home to drive improvements.

At the time of our inspection there was not a process in place to engage with people, communities, and partners to share learning and enable continuous improvements. The interim manager told us they had just sent surveys to people, staff, relatives, and healthcare professionals, and had begin to receive responses. We were unable to assess the effectiveness and sustainability of this at our inspection. Following our inspection, the interim manager and clinical lead told us they had implemented systems to ensure people received the care and treatment they needed in a safe and timely manner. We received feedback from visiting healthcare professionals that improvements had been made following our inspection. We were not able to assess the sustainability of these changes at this inspection.

Staff were not always clear that learning, improvement and innovation could take place due to poor communication and a lack of process. One staff member said, “It has not always been as well-led as it could have been, staff do not always know what their roles and responsibilities are, the previous managers managed their sections of the home but didn’t always communicate and didn’t share out responsibilities to teach someone to step in if they were away from the home. We need to start from scratch, we have a supportive team, we need to make improvements and we can improve.”

Opportunities for staff to leaders to learn, improve and innovate had been missed due to a lack of robust systems and processes being in place to identify and share learning. The interim manager and provider acknowledged this and provided us with an improvement plan on the second day of our inspection. We were unable to assess the effectiveness and sustainability of the improvement plan. We requested the interim manager and provider send us an updated improvement plan 4 times after our onsite inspection and were not provided with one. This means we could not be assured the improvements had been made.