Gloucester House

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• 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 the management and oversight of the service had deteriorated. We identified a breach of legal regulations. The processes in place had not been effective to drive improvement. The provider had completed audits and identified significant shortfalls but had not ensured improvements were made. We identified the same significant shortfalls at this assessment, continuing to place people at risk. There was not always an open and transparent culture within the service. Staff told us, they did not always feel confident to raise concerns or that action would be taken.

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.

Feedback we have received from staff in different roles was conflicting. Staff who worked during the day, stated they were supported and working together. However, night staff felt they were not always supported and listened to, staff told us they had raised concerns but they were unaware of any action taken. Staff could not describe a common vision or values. A staff member told us, "The seniors do supervisions, my last one was about 4 months ago, I had been there about 6 months before it happened." The registered manager told us, they had been asking for additional support from the provider with the new electronic systems but this had not happened even when the provider had identified shortfalls in the service. They felt the provider did not support them with the vision of providing a high standard of care support.

There were no effective processes in place to communicate the culture and vision for the service. The management of the service had not consistently monitored the quality of the service and made sure shortfalls were rectified.

The deputy manager told us they were very supported by the registered manager and the provider. However, staff did not have the same experience. Staff told us, “The head office is the worst part of the job, them making decision about the job without knowing what nursing means, when they come here they don’t come and follow me, they get shut in the office, they know nothing about what nursing work is like.” Staff also told us when concerns have been raised about poor practice, the management team had not dealt with this. Some staff told us, they did not feel supported by the registered manager, especially the night staff, who told us they did not see the registered manager. Staff told us, they were asked to send an email if they wanted to speak to the registered manager and were not confident action would be taken. The deputy manager told us, they held regular staff meetings, especially after incidents within the service to check on staff welfare. However, the meeting minutes we reviewed showed the registered manager had not been present.

There were significant shortfalls in risk management and mitigation, medicines management, care planning, auditing and governance systems, therefore affecting people’s safety. Concerns we raised to the management team had not been considered or not known or identified through their processes and systems.

The Deputy manager told us they have a clear whistleblowing policy in place where they investigate concerns but try not to identify the staff member who raised them but only look at what has been raised. CQC received some information from whistle blowers which we raised with the management team and these were investigated. Staff told us they did not always feel confident to raise concerns. Staff told us, "We want to whistle blow in our company but other staff say it is not worth it because they know who it is."

The provider has policies and procedures in place to support staff to speak up about any concerns they have. The processes offer staff protection to whistle blow about any concerns without fear of discrimination. However, staff were not confident in the process and the management team and had not always raised concerns.

Staff told us, they thought the service supported diversity, "Yes it is diverse, there is no discrimination and I am a person of colour."

There was a clear policy of Equality, Diversity and Inclusion and this was evident from the staff base.

Staff were unclear about some of their responsibilities and the lack of feedback they received when they reported incidents. Staff told us, the management team did not consistently act on incidents and provide leadership to improve people's care and support. Staff told us they did not always feel supported as there were not enough senior care staff to have one on each shift to provide support when nurses were not available. Night staff told us, they were not consistently supported, there was little oversight by the management team and staff competency was not checked regularly or quality of care monitored. Staff told us they felt there may be ongoing problems with accuracy and safety if there are not more staff to assist with the governance in the service. The registered manager told us that the senior carers would be trained to complete people’s care plans and risk assessments. We were not confident this would improve care plans, as the training would be provided by staff already writing care plans and these were of a poor quality. Staff we spoke with were concerned that this will impact day to day care and support of people.

The processes in place were not effective in monitoring and making improvements in the quality of the service. The provider had completed audits in March and April 2024 and there were issues identified. The quality compliance team had rated the service ‘inadequate’, there were issues around the management team not completing monthly audits. There were issues with medicines management, care records not being individual or detailed enough and not regularly reviewed or updated, we found these issues continued. We reviewed a care plan which had been reviewed in the provider audit, and found multiple issues. There continued to be all the same issues, even though it has been reviewed by the management team. These included using the wrong name in one part, limited detail, and assessing the person as low need in some areas when there were significant needs. Despite the provider giving an inadequate rating in March and April, they had not undertaken a monitoring visit since, to check if improvements had been made.

People benefited from the service developing links with the local community. This had a positive impact on people’s well-being. People told us about a toddler group being held in the lounge on a weekly basis. We observed there was a lot of noise and chatter which stimulated people who were watching the children play. Spontaneous smiles were visible on people’s faces when children came up to them and gave them a toy to hold or waved or smiled at them. A relative told us that links had been developed at a local secondary school. They told us that pupils had taken part in a project which involved talking to people about their life. The relative told us how much their family member had enjoyed talking about their childhood and the different jobs they had had.

The deputy manager told us they had good relationships with healthcare professionals and funders. However, staff were not always given the detailed information to follow the healthcare professionals guidance.

Feedback from the local authority was they felt the service had run into some issues but appeared to be improving. Monitoring visits by the local authority would be increased until they felt the service were ‘in control of their management processes.'

The processes were not always effective in making sure feedback and guidance from health care professionals was given to staff. This meant the provider's systems put people at risk of not receiving the support health professionals had assessed people to have needed.

The deputy manager told us, on a recent audit and from concerns being raised they recognised that there have been issues with medications. They felt they acted accordingly and brought in a senior nurse to solely review medicines. They had not had oversight of the senior nurse to ensure improvements were made quickly. We identified there remained shortfalls, the deputy manager told us some improvements had already been made. The deputy manager did not acknowledge the lack of planning and goal setting to drive improvement quickly. The management team accepted the findings of this assessment and have told us they would act immediately to address the shortfalls. However, we do not have confidence, the management team understand the level of risk within the service and the speed in which improvements need to be made.

The management team did not have an understanding of the speed which improvements needed to be made to the service to keep people safe. The registered and deputy managers had not acted on the findings of the audits completed by the provider in March and April 2024, over 6 months before this assessment. The significant shortfalls continued and people remained at risk. An action plan had been formulated but the actions taken had not supported improvements, the registered manager had stated actions were completed when emails had been sent or audits started. There had been no checks to see if the action had been effective. The provider had placed people at continued risk by failing to follow up on the audits they had completed in March and April 2024, they had not acted to drive improvements.