Bush Rest 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

There continued to be shortfalls in how the quality of the service was managed. We identified a breach of the legal regulation for good governance. Quality systems were not effective in identifying areas of concern and driving improvement. The provider had a mission statement and vision for the service; however, staff were unable to describe this. There was limited evidence staff were engaged in learning and improvement or innovation within the service. There was no registered manager at the home. There was an equalities policy in place however there was no evidence there was a system in place to embed this into the service. However, staff felt able to speak up if there were any concerns about the service.

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 and leaders did not describe a shared vision for the service. When asked, staff said they felt people were happy and content but offered no description of the vision or values. Leaders told us the focus of the home was on developing the staff team and carrying out improvements to the home’s décor to improve the quality of the service.

A vision, mission and values statement was in place for the service. This set out how the service would work alongside staff teams to demonstrate best practice and create an open culture where ideas can be shared. However, the processes in place to engage staff in meetings did not show evidence of staff sharing ideas or making suggestions about how to improve the quality of the service.

Staff gave mixed feedback about the management of the home. Some staff felt the management were supportive, whilst others commented they felt the management team unapproachable. However, all staff felt people at the service were happy and content. Leaders told us they received support from an area manager and other registered managers in linked services.

There was no registered manager at the location at the time of the assessment. The provider told us they had a manager in post who would be registering but was currently not at work and another manager had been appointed on a temporary basis.

Staff told us they would report any concerns they had to the management team, and they felt these would be addressed. Leaders told us there was a whistleblowing policy in place and staff were able to raise any concerns and seek action.

There was a whistleblowing policy in place which set out how staff could make disclosures about concerns they had about the service and how the provider would protect staff. The policy set out how to manage disclosures and support staff effectively including advising on reporting concerns directly to the CQC if staff felt, no action had been taken.

Leaders spoke about equality and protected characteristics in the context of the people they supported but not about how staff were supported. Staff spoke about how people would be supported in relation to their protected characteristics but made no reference to support in place for the staff group.

The vision for the service references inclusivity and ensuring people can be heard. The Equality Policy provided set out how staff would be treated. However, there were no processes in place to ensure this vision and policy were being implemented.

Leaders told us they had a system in place to monitor the quality of the service people received. However, they confirmed there were no checks in place to ensure care plans were accurately completed with all relevant details. Staff told us there were systems in place to ensure safe management of medicines. However, they confirmed they had not completed medicines audits to identify the concerns we found with medicines as required.

The providers quality assurance policy indicated a systematic approach to monitoring and evaluating the service was in place. However, we found systems were either missing or not operated effectively to identify concerns and drive improvements. Systems to monitor risks to people were not ensuring action was taken where incidents had occurred, or risks had increased to ensure people were safe. Systems in place to have oversight of medicines were not effective in ensuring accurate stock levels of medicines were recorded and action was taken when people had missed medicines being administered.

People were generally happy with their care and felt able to direct how this was delivered. However, relatives mostly described not feeling engaged in care planning, with one relative telling us they had not had any involvement in the care planning process.

Staff told us they had good working relationships with health professionals who came to the home to support with people’s care. Leaders confirmed there were close relationships with local doctors, nurses and other partners including commissioning teams.

Partners did not share any concerns with us about the service and told us the provider was approachable when they engaged with them.

The providers vision set out how they would involve families and residents as care partners. However, care plans did not show how people, relatives or partners were engaged in people's care plans. We did not see references to people or their relatives’ views included in care plans and limited information on the role partners played in delivering people’s care.

Staff told us they felt happy working at the service, and they felt anything they asked the manager for was completed. However, staff did not reference how learning improvement and innovation were supported. The manager told us there was a systematic approach to sharing learning across other services when incidents happened.

The vision for the service referenced a need for the service to challenge themselves and others and seek innovation. However, there was no evidence of the provider seeking to innovate or learn from best practice sources within the service. The quality assurance policy spoke about developing a culture where staff could reflect on practice and critically evaluate their practice, however, we saw no examples of activity encouraging staff to do this.