Honeybourne 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 identified 1 breach of legal regulations. Systems were either not embedded into practice or undertaken robustly enough to identify and monitor the quality of the service and effectively drive improvements. This meant systems operated by the provider had failed to identify concerns and shortfalls we found during this assessment and could not be relied upon as a source to measure quality and risk. Issues included concerns with regards to safeguarding, person centred care, staffing levels, management of risk, MCA, DoLS, and the environment. However, people who were able to share their views with us and their relatives spoke positively about the service, the staff and the care and support they received. We saw action taken by the new manager was having a positive impact on the care and support people received, as well as assurance checks and audits, but needed time to be embedded into practice. The manager had a clear vision for the service and described how they were developing good working relationships with other health and social care professionals which meant advice and support could be accessed as required. Throughout the assessment, the manager was open with us, acknowledged any areas for improvement and was keen to put processes in place to address any areas of concern. We have asked the provider for an action plan in response to the concerns found at this assessment.

This service scored 62 (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 providers values which was to maximise opportunities for people and to support a true sense of enjoyment and achievement. Managers and staff understood what was expected from them and had good understanding of their roles and responsibilities. Some staff told us they felt valued and supported by the management team. One staff member said, “Yes, I think it is an open culture here, staff can speak up. [manager’s name] and [deputy’s name] are very approachable and always have time to listen.” However not all the staff we spoke with were positive about the culture within the service. One staff member said, “I have been to a couple of staff meetings with the manager, and I do not think staff get heard, I have not fed this back as I do not feel comfortable to do so.” The manager told us they were aware that improvements were needed to develop a shared direction and positive culture within the service. They described how they had undertaken spot checks at night and at the weekend and some shifts on the floor to observe staff practices. Where concerns had been identified, these had been addressed through staff supervision and any lessons learnt had been shared with staff through team meetings. The manager said the provider had introduced values and attitudes training and ‘A staff pledge’ had been put in place. Staff had committed to support each other and communicate to make the positive changes within Honeybourne House. Changes in the management team meant staff now received regular supervision. We found the poor culture within the service at times impacted on people’s care and support. (see Learning culture section of this assessment).

All staff were required to complete an induction and attend regular training, which included equality, diversity, and inclusion training. In addition, the provider was working with the service’s management team to raise standards within the service and develop a shared direction and positive culture. All staff had recently undertaken values and attitudes training. The providers internal quality team had worked with staff on the development of a ‘staff pledge’. In which staff had committed to support each other, respect the skills and contribution of colleagues, embrace diversity, and treat others fairly. Records showed the new manager was now carrying out regular staff supervisions and appraisals. Staff meetings allowed opportunities for areas of improvement to be discussed and implemented.

While there had been a period where the leadership of the service had not been consistent. At the time of our assessment a new manager was in post, and was rebuilding communication with people, their relatives, and external professionals. We saw action they had taken was having a positive impact on people’s outcomes. For example, we saw that where concerns had been raised they had acted or made referrals to health and social care professionals. Staff told us they felt valued and supported by the new management team. One member of staff said, “[Managers name] is very approachable and really supportive.” Another said, “I can see [Managers name] is settling in now, getting the ball rolling and getting it to her standards so I am quite happy.” Throughout the inspection, the manager was open, honest, acknowledged any areas for improvement and was keen to tell us how they were going to address any areas of concern. They explained how they were working with their internal quality team and the local authority on a service improvement plan. The manager described how the providers internal quality team contributed to the oversight and governance of the service, while supporting them to settle into their role; develop action plans and improving reporting mechanisms. The manager was passionate about continually striving to improve people’s care and support but recognised, they needed time to improve the culture of the service and fully embed the providers values through staff training, staff induction, and staff supervision.

Leadership was sustained through safe and effective recruitment. Learning took place from accidents and incidents. Concerns and complaints were listened to and acted upon to help improve the quality of the care and support provided by the service. The registered manager described how they promoted continuous learning through meetings with staff to discuss work practices, training, and development needs.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The management and staff structure provided clear lines of accountability and responsibility, which helped ensure staff at the right level made decisions about the day-to-day running of the service. The manager was aware of their responsibilities in relation to duty of candour, that is, their duty to be honest and open about any accident or incident that had caused or placed a person at risk of harm. The manager told us they shared information with external agencies such as healthcare professionals when things had gone wrong as well as liaising with families where appropriate to do so. People's personal records were kept secure and confidential. Staff understood the need to respect people's privacy including information held about them in accordance with their human rights. The manager said that regular handover meetings between shifts helped to ensure essential information about people's care needs was shared within the staff team and / or escalated if needed. The provider had up to date policies, procedures and a governance system in place to help ensure their philosophy, objectives and values were embedded into staff practice. The manager carried out a regular programme of audits to assess all aspects of the safety and quality of the service. In addition, the providers internal quality team undertook independent audits of the service and produced action plans. However, we found these were not always effective in driving improvement in a timely manner.

Governance processes were not effective in keeping people safe, protecting people's rights, and providing good quality care and support. This meant they were not always effective, did not drive improvement and did not identify the issues we found at this inspection. Issues included concerns with regards to safeguarding, person centred care, staffing levels, management of risk, MCA, DoLS, and the environment. Although the provider had in place a set of policies and procedures, these were not always being followed. For example, staff failed to follow the providers safeguarding policy as detailed in the safe section of this report. The provider had not ensured that staff understood the principles of the MCA. This lack of knowledge and understanding risked compromising people's rights. Systems and processes had not been effective in addressing the poor culture within the service and driving sustained improvement. For example, staff knew their use of handing belts would be considered institutionalised practices. However, this knowledge did not determine practice and was not fully recognised as something that needed to be addressed and challenged. People and their relatives spoke positively about the service and told us staff were kind, caring and treated them with dignity and respect. However, we found people were not involved in a meaningful way in the development of their care and support and information was not provided in a way which met people's individual communication needs. Systems and processes to monitor the service were not effective in ensuring compliance with the regulations. This was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives told us the registered manager and staff team were approachable and kept them informed when things changed. One relative said, “A couple of occasions medicine has been missed, just one, they phoned me straight away and contacted the doctor for advice.” Relatives confirmed they had been asked to provide feedback via questionnaires and welcomed the opportunity to tell the management and the staff how pleased they were with the care and support provided. One relative said, “Both the manager and deputy are always available and make time to speak to me if I ask.” Another said, ““Yes, we do get questionnaires from time to time to fill in.”

The new management team had a strong commitment to improving the service and were open to suggestions for improvement, recognising the importance of joint working with partner agencies to improve people’s outcomes. The manager described how since taking over the service they had started to develop vital relationships with care managers, GPs, district nurse teams, families, advocates, and the local authority. Staff told us they felt appreciated and could contribute their ideas to the running of the service. Staff were aware of the value of working in partnership with people, their families and other healthcare professionals. However, we found at times staff had been slow to raise / escalate concerns or seek advice.

A representative from the local authority told us they had recently carried out a quality monitoring visit and developed an action plan in consultation with the new manager to support their ongoing improvement. They told us the manager was keen to develop the service as well as their relationships with partner agencies. They described the new manager as “Approachable, honest and capable.” Another healthcare professional commented, “When visiting I am always happy to see that clients’ needs are met and seem very happy. All staff are friendly and extremely devoted to the care and support of the clients.”

Systems and processes showed the provider worked in partnership with key stakeholders. Care plans demonstrated the service actively engaged with people, their families, and sought support from a range of health care professionals. This meant advice and support could be accessed as required. Regular meetings and handovers helped to ensure information was shared. Systems were in place to gather people's, relatives, and staff’s feedback on the quality of the service.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.