Dale Care - Beechfield Court Extra Care

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 identified a breach of regulation 17: Good governance of The Health and Social Care Act 2014. due to some concerns and failures. The governance system needed to become more robust to identify where improvements were needed to care provision, as identified at inspection, to ensure the improvements were brought about in a more effective and timely way. The provider had previously had clear responsibilities, roles, systems of accountability and good governance. Since the last inspection the provider had made changes regarding the day to day running of the service. The registered manager of the service was no longer on site 5 days a week. A new management role had been introduced for the day to day running of the scheme, which required more oversight, training and support until the role was embedded. Improvements being made to the culture of the service needed to be continued and sustained to ensure people received safe and person-centred care from a motivated and positive staff team, where people and staff felt valued and listened to.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Improvements were being made so all staff and leaders shared the values and vision of the organisation. New staff received support and training which helped them to show those values in their daily work with people. The quality and vision of the service was discussed with staff during a range of meetings. There had not always been a positive culture and plans were underway to make improvements. Some staff reported they did not feel as if staff worked as a team. We received several comments from people using the service that all staff did not work effectively. Some staff also commented, “Some staff work better than others.”

There had been a change in management arrangements since the last inspection. The registered manager was no longer on site each day. The role of scheme manager had been developed and they were on site each day to oversee the running of the service. We discussed this new role with the management team improvements that were needed to ensure support was available and people were aware of their role and responsibilities in overseeing the daily running of the service.

The new management team were responsive to feedback and were realistic about their journey to make improvements. The area manager told us they also had concerns about medicines management and the lack of sustained improvement, despite the initiatives that had been introduced by the provider. Pockets of poor practice had not been reduced and removed. There were plans to increase and motivate staff with team building and more effective performance management. A manager commented, “There will be some team building at Beechfield Court.”

Systems currently and previous management approach did not all promote a positive, person-centred culture to benefit people living at the service. People's lived experience was not always the focus of care. People were not always listened to, engaged with and they did not all receive person-centred care.

Feedback from people and some staff was they did not always feel listened to. If they raised concerns, changes were not made, some people said it made no difference if they complained. One person commented, “I know how to complain, I don’t bother complaining as I don’t feel I would be listened to.” Another person told us, “I do not feel I am listened to, all I get told is we will investigate, I never hear the outcomes” and, “They, management seem to listen but nothing changes.” A staff member commented, “I don’t always feel supported, not all colleagues are helpful, no teamwork. Managers don’t listen to concerns.” Another staff member said, “The management are becoming more responsive, if you raise a concern.”

Processes were in place for staff and people to speak up. The provider had a clear whistle blowing policy. Staff could raise concerns and the information about how to do this was available in the service and within the staff handbook. There were engagement surveys sent to people using the service, and staff. Regular staff meetings took place. There was a complaints procedure. However, feedback from people and staff did not assure us the systems were always effective. Evidence was not available of communication of outcomes to people, relatives or staff as a result of their raising concerns, speaking up.

Not all staff told us they felt valued and respected in their roles. Most said improvements were being made so they felt well-supported by the management, some said they were well-supported personally and professionally. A staff member told us, “Work can be stressful. The new manager is good, and colleagues are generally helpful.”

Policies and practices were in place to promote and maintain a workforce in which equality, equity and exclusivity prevailed. However, feedback from management and staff showed improvements were needed to the culture to ensure person-centred care was provided and to foster for staff to work as a staff team, who helped to support one another. Processes also needed to be strengthened to ensure the whole staff team have the skills to manage their work in line with their job descriptions and support to work effectively.

Leaders were responsive to our feedback both on the day of the site visit and following our visit. A new manager was in place who had applied to become registered with the CQC, they would also be overseeing other schemes, so would only be on site 2-3 days of the week. The new area manager planned to have an increased initial presence at the service to help address the concerns and support on site management. Staff were positive about changes in management. A staff member told us, “There have been improvements with the new managers, more ‘open door’, easier to report issues/concerns and the response from management is better” and, “Management are more approachable.”

We identified a breach of regulation 17: Good governance of The Health and Social Care Act 2008 Regulated Activities 2014 due to some concerns and failures in the monitoring of service provision and improvements needed to some records regarding medicines management, detailed in the safe section. There was oversight from the provider to review the quality and safety of the service in line with regulatory requirements, with quality checks carried out by the compliance team, however these were not always effective. Where areas of improvement were identified, internal and external checks were not increased in frequency, to bring about more urgent improvement. For example, with regard to medicines management, infection control and staffing concerns. Other audits and checks were carried out such as around care records, health and safety, staff practice.

People told us the service worked with other agencies so people could access appropriate help and support when required. A person commented, “I have a social worker who attends regularly and joins in the care plan reviews which I have every 6 months”. Another person told us, “The carers are very good if I felt unwell they ring the doctor for me, I also have visits from the optician and podiatrist.”

We did not receive feedback from many partners. One partner agency said the service did not always work collaboratively with them to take up opportunities such as additional training to secure better outcomes for people. We were informed during the inspection the area manager was working with the local health trust medicines optimization team to secure additional medicines training for staff.

Staff and managers explained how they worked with healthcare, social care and community partners. They had good knowledge of the local services and support systems and how to access them. The manager told us they had a good working relationship with the local authority who visited and monitored and supported the service. Referrals were made in a timely manner to relevant people to ensure the needs of the people using the service were met. There was some evidence that the manager had a willingness to work with partner agencies.

Staff told us there were opportunities for training and development. A staff member commented, “We do face to face and online training.” Staff did not feedback that they were encouraged to speak up with ideas for improvement. A staff member told us, “I don’t feel valued or listened to, suggestions are not acted on.” When speaking with staff and leaders we were not assured that there was an effective process of reflection and lessons learnt following incidents. Individual incidents were reviewed but some kept recurring. A staff member commented, “Learning is identified and shared with the individual but not with the wider team.” Another staff member said, “We are encouraged to report incidents, but management response is not always supportive.”

The provider had systems in place to ensure learning and improvement was considered within audits, staff meetings and quality assurance activities. However, there was not evidence of improvements that had been made to the service as a result of the checks, audits and some people, relative and staff feedback. Processes to ensure that learning happened when things went wrong, and from examples of good practice were not well- established. There was not a clear strategy within the service of lessons learned and evidence of improvement with regard to for example, medicines management and other areas of concern raised by people who used the service or staff.