Minstead House

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 provider’s governance and quality assurance systems were not sufficiently effective to ensure the delivery of good quality care and support. Audits and checks completed had not enabled them to identify and address a number of significant concerns we found during this assessment. These included shortfalls in the assessment and management of risks to people. This was a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff and management were not always clear about their individual roles and responsibilities, including the need for staff to consistently report accidents and incidents. Some health professionals told us the provider did not always liaise effectively with partners for improvement. This included a lack of clear information and guidance for staff in people’s care plans and risk assessments following changes. Most staff told us they felt well-supported by management and now felt confident about speaking up at work.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most staff we spoke with understood the vision for the organisation and supported the management approach to drive improvements for people using the service. Others felt this was not a shared direction or positive culture. Some staff spoke about a bullying, intimidating culture in the service. When this was raised with the management team, they confirmed they had known about this but had not been able to get under the surface of such allegations. Staff and management told us they understood the importance of listening to the views of people and their relatives on the service. Staff and the management team understood people’s human rights and told us about some ways in which they supported people with their diverse needs.

Not all staff had a shared vision and values regarding the care and support delivered. There was a culture in the service where some staff and the management team were not working to the same outcomes and the provider was investigating such concerns. Relatives had been provided with clear information on how to raise suggestions and concerns about the service. The provider had not sought feedback for at least 18 months from people or their relatives, to give them an opportunity to contribute to improvements. The systems in place to gain feedback from people required more improvement to enable them to communicate more effectively. This process, in combination with reviews of people’s care plans, had not always ensured a fully inclusive and collaborative process of care plan development. The provider’s processes and training provision required a more robust, consistent approach. Risk assessment and care planning processes had not always resulted in care plans which reflected and acknowledged people’s diverse needs, including the need for private time. This meant staff, who did not know the person well, may not respect their privacy resulting in an impact on their emotional responses.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us they knew about the service’s whistleblowing policy and hotline and knew how to raise concerns if they had any. Some staff told us they had felt they were unable to speak up due to the potential implications/retaliation from other staff members. We were also told that when they had spoken up to senior support staff, this information had been shared and had resulted in the staff who raised concerns, feeling vulnerable/intimidated. Other staff members told us how the registered manager operated an open door policy and they felt able to raise concerns as they arose. We saw this was the case during the assessment. Formal feedback had not been sought since 2022. The provider told us they had now arranged to send out questionnaires following the assessment.

There was a whistle blowing policy in place. Staff were informed about this as part of their induction. Service user meetings had not been held since 2020. One relative told us how they used to find these a positive way of keeping up to date and meeting the manager and other relatives. Systems to encourage people using the service to be able to communicate and speak up could benefit from being improved. We were told by a health professional that their recommendations to train staff in Makaton had been slow to be actioned. Such training may have enabled one person, the ability to communicate concerns they had to staff more effectively.

Most staff felt the management team considered their equality, diversity and inclusion and treated them fairly. However, some staff spoke of a bullying culture from other staff members based on their ethnicity. Most staff we spoke with felt included in the making of decisions and helping to drive improvement within the service.

The processes in place to act when there were known divisions within staff cultures in the service were not robust. There was a significant delay in triggering actions to minimise the impact on other staff members and people using the service. This led to a culture of bullying and fostered a closed culture. The provider had identified a need for closed culture training 4 months prior to our assessment commencing but this had not been commenced at the time of the assessment. If this had taken place sooner, it may have prevented such staff divisions. Team meetings and supervisions did take place as frequent as per the providers guidance.

Staff and management we spoke with told us they were clear about their individual roles and responsibilities as these related to delivering good-quality care. However, we found practices and the information they gave us did not always reflect this. For example, the registered manager was unable to provide us with assurances in relation to their oversight and governance of the service. The management team were aware of when to notify incidents to the relevant external agencies.

The provider’s governance systems were not effective enough and had not enabled them to monitor and manage risks to the safety and quality of people’s care. The provider has been transparent and shared their findings from recent audits of the service which have identified shortfalls to be actioned. The time taken to carry out such actions, at times has taken several weeks which has impacted on people who use the service. This included repairs to the environment, new furnishing due to broken furniture and that which could not be effectively cleaned. Audits completed by staff and management had failed to identify significant issues we found, including ineffective assessment and management of risk, inconsistent reporting of accidents and incidents and insufficient provision of training and guidance for staff in some key areas. We identified concerns in relation to the safe medicines administration, overview of staff training, lack of supervisions, poor mitigation of known risks including storage of cleaning products and flammable products. Some support plans lacked robust risk assessments to reflect current needs including regarding people’s emotional responses.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.