David 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

We assessed all of the quality statements within this key question. Our rating for this question has improved to Good. A new management team was in place which provided greater oversight and leadership of the service. They were open and honest, and staff and relevant healthcare professionals told us there were good joint working arrangements. People, relatives and staff’s views were sought and this was used to inform service development. A governance committee had been introduced which strengthened the governance framework at the service and provided oversight of the quality and safety of care delivered. The management team were aware that further improvements were required to the service and there was a commitment to learning and continued improvement. However, we found that current practices did not adequately review the quality and safety of all areas of service delivery, and complete, detailed records were not always maintained about people’s needs and how they were to be supported.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff understood the values of the service and were focussed on providing high quality care and support to people that met their individual needs. A staff member told us, “I feel proud to support people here. To be able to support people and let them do the things they want and have a happy life. These are important to me and makes me happy.” The quality assurance lead said the culture of the service had been improved to ensure a person centered approach in the delivery of care and support. They told us, “We have changed the culture and it’s now open and honest and transparent. Staff now understand they are here to support people and central to everything we do.”

There was a clear strategy and direction at the service which was shared with the staff team. This included the provider’s vision and values for the service which focused on quality, compassion, choice, and integrity.

The service was led by a home manager who was knowledgeable, experienced and understood the needs of people using the service. Staff felt well supported by the home manager and comfortable approaching them for advice and support when this was needed. A staff member said, “You can go to him any time. He’s transparent and honest.” The home manager told us they stayed up to date with relevant training to support them in their role. They also attended local network meetings and care forums to share and learn good practice which they then disseminated to the staff team at the service.

There was a clear leadership and management structure in place, with clearly defined roles and responsibilities so staff were able to take accountability for their actions and knew who to escalate any concerns to. This has been strengthened since our last assessment with the introduction of more senior members of the staff team to provide clarity in oversight and management of the service.

The provider encouraged a culture of openness and honesty at the service and supported staff to act with integrity when supporting people using the service. Staff were comfortable raising any concerns they had and said the home manager would listen and act on these in an appropriate way. A staff member told us, “So far, he has always taken the right action to support people.”

There were systems in place to enable staff to have the opportunity to speak up and raise any concerns. The provider was also in the process of identifying a freedom to speak up champion within the staff team.

Staff were valued and supported to work in an environment that was inclusive and which respected their rights. Staff told us they were treated fairly and had the same opportunities and support as each other to achieve their work objectives. The home manager understood the need for an inclusive and respectful workplace and said, “We promote our value system and make sure supervision is used to understand how staff feel about their role and if they have any issues with other staff or working at the service. We promote team work and working together.”

Systems were in place to ensure staff had access to the same equality and diversity rights as the people using the service and ensure their individual needs were taking into account and supported.

Staff understood their role and responsibility to deliver high quality care to people. Management oversight of the service was now more effective. Managers undertook regular checks and audits to seek assurances about the safety and quality of the care provided by staff. The quality assurance lead told us, “I do quality checks and reviews and make sure staff are doing what they should be doing.” However, the management team had overlooked some of their responsibilities regarding their CQC registration. This was not a concern at the time of the assessment and the management team listened to and acted upon our feedback.

A new governance committee had been developed. This was a monthly review of key performance information and a review of quality and safety of service delivery. In addition, there was a regular programme of audits. However, we found some of these audits were lacking detail and did not review all elements of practice. For example, the infection prevention and control (IPC) audit mainly focused on the cleaning schedule and not all elements of good IPC. The medicines audit included a stock check of medicines, but did not review all elements of safe medicines management. The care records audit had not identified and addressed the concerns we found regarding the lack of detail in risk management plans, mental capacity assessments and communication support needs. We also identified that governance arrangements had not always been effective in ensuring the home consistently adhered to the conditions of their CQC registration.

People were asked for their feedback about how the service could be improved. The provider acted on people’s feedback and made improvements that people wanted. For example, changes had been made to mealtimes and to the provision of activities at the service which better reflected people’s preferences and individual needs.

Staff and managers worked proactively with partners to continually improve the experiences of people using the service. The quality assurance lead told us, “We have monthly meetings to discuss [people] with various healthcare professionals for example, district nurses, the GP practice and other clinical support teams for people’s health needs. We also have regular input with the mental health team at London Borough of Sutton.”

Healthcare professionals working with staff felt involved and informed in service development. They told us their views and advice was sought, and any feedback was acted upon in order to improve practice for people using the service.

There were systems in place to ensure staff, people and relatives were involved in service delivery. This included completion of satisfaction surveys and regular meetings to obtain people and staff’s feedback. Feedback received was acted upon to improve practice at the service.

Staff were encouraged to give their feedback and views about how the service could improve. A staff member told us, “We have staff meetings and everyone has their own time to speak and talk about our suggestions and ideas.” Managers were focussed on learning and improving the service for people. The quality assurance lead told us, “We use the quality assurance framework and we are working collaboratively together to improve the service.” And “We have changed the environment by updating furniture and rooms have been refreshed. The garden is in better shape. We are putting in a conservatory in so there will be more communal space. We feel we are doing the right things.”

There was a commitment to improving practices at the service and this was regularly reviewed at the newly formed governance committee. This included actions taken following internal and external reviews of the quality of service. Improvements had been made including the strengthening of the management team, recruitment practices and training and supervision available to staff. However, we found improvements continued to be required to improve practice, particularly regarding the quality of documentation. The provider was in the process of implementing a new electronic records system which would help them to address the improvements required. The management team told us, “We are still in the process of transitioning. We know we are not yet at the place we need to be but we are moving towards that. We are working hard to streamline our processes.”