Horton Cross Nursing Home

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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

Staff spoke highly of the management team and told us they felt there was better communication which was leading to improved care for people. The management team and staff were confident that the actions they had taken, and continued to take, was leading to better outcomes for people and this had improved staff morale. Staff had clearer roles, responsibilities, and lines of accountability. Where the management team had recognised the potential of some staff, they had ensured they had access to appropriate training to develop their skills and knowledge. Quality monitoring is an area which still needs further improvement. The management team were undertaking audits and identifying some areas for improvement. The management team were responsive to feedback from external agencies and took prompt action to address any concerns. However, their quality monitoring processes need to identify these areas for improvement and not depend on other agencies to identify areas for improvement.

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.

At the last inspection, we found the provider in breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued a warning notice. This was because the provider had failed to ensure systems and processes were established and operated effectively. Procedures for governance and oversight of quality and safety were not effective, and there was a failure to seek and act on feedback. Accurate, complete and contemporaneous records were not maintained. At this assessment we found that improvements had been made and the provider was no longer in breach of Regulation 17. The provider had put in place a schedule of quality monitoring processes. Staff completed audits and checks on the environment, medicines and fire safety. Actions were taken to address the concerns where issues were identified. However, this process was still relatively new and not fully robust at identifying all of the areas of concern. The provider was reactive to concerns identified by other agencies, but improvements were needed in identifying these areas through their own quality monitoring processes. Following the day of our first site visit, the provider sent us an action plan, setting out the actions they were putting in place following our initial feedback. The provider visits the home regularly and works alongside the manager and senior staff to implement improvements and assure themselves.

Staff spoke highly of the management team. Comments included, “Management support is so much better now” and, “The management is more structured now. A year ago, it didn’t gel, but now we do.” Staff felt there was good communication which was leading to improved care for people. One staff member said, “Communication between all team members has improved. We regularly catch up throughout the day to make sure everyone is aware of how people are. This means we can keep on top of things.” The management team recognised the potential of some staff and had ensured they had access to appropriate training to develop their skills and knowledge. The manager said, “I've promoted some of the care staff, I could see the potential in them. We [the management team] try and encourage and support the staff and give them feedback. It’s everything they didn’t have before.”

The new maintenance person had started to put new processes in place to manage health and safety within the home. This would enable risk to be better audited and managed. During our assessment there was a new manager in post. They had not started the process of registering with the Care Quality Commission.

The management team were confident that the actions they had taken, and continued to take, was leading to better outcomes for people. They also felt this had improved morale for staff. Staff told us there have been new roles created in the team and new staff recruited. All staff now had clear roles, responsibilities, and lines of accountability. Staff felt this had supported the improvements in each person’s care and in the service more generally. Staff comments included: “We have carers, senior carers, nurses and clinical leads; there is a lot more communication than there ever was before. We do have meetings where we discuss changes, any concerns that we have or any new things that have been brought in. It's definitely a lot better here” and “They [the management team] are very open. [As a senior carer] I did go to them with some suggestions for changing how carers work. This was taken on. The care is better. I haven't got any concerns at all now working here.”

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.