Smallbrook Care 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

We identified 1 breach of the legal regulations. Processes in place as well as the ethos, values, and behaviours of leaders did not always ensure staff felt supported and valued in their role. Quality governance systems were not always effective in ensuring the identified the shortfalls in care. Staff did not always feel confident in being able to speak up if necessary. Other staff did say they felt supported and listened to. There were some elements of the quality assurance that was robust. You can find more details of our concerns in the evidence category findings below.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff felt there was a lack of shared direction at the service. One told us, “There is not many changes for the better” whilst another said, “We get paid fairly but it’s the workload, staffing and not being heard” Staff told us they were directed to undertake task they did not agree with and this included waking people up to give them personal care in the mornings. However, staff did say they worked well as a team. The registered manager said, “We are one aim, duty of care, it’s a workforce, diversity and inclusion. I get the feedback from giving them quality assurance and how are they feeling in Smallbrook and that’s how I know they are happy here. If its negative, I try to mend it straight away. I feel we are all in one boat. I ask for constructive criticism.”

Meetings were taking place, but this was not always used as an opportunity to gain feedback from staff. There was a lack of record of discussions of how staff felt and whether they felt there needed to be improvements around the service.

There were staff who told us they did not always feel listened to or supported. Comments included, “We are not robots, we can feel tired, but we have to give 100% for our job and for the residents” and “Instead of being a leader [registered manager] is bossy for me. We don’t have much interaction." The registered manager was clear around their responsibilities of duty of candour and told us, “It’s about being open and transparent. If something needs to be reported, then report it. We can’t hide things under the carpet.”

We saw from the minutes of the most recent general staff meeting in January 2024 the majority of the discussion was regarding a complaint that had been raised through CQC. The registered manager was recorded to have said, “The care sector is a challenging place to work, those who are not committed please feel free to leave.” There was no record of discussion of how staff felt and whether they felt there needed to be improvements around the service.

Although senior leadership told us there were processes in place for staff to leave anonymous feedback or to raise concerns this was not sufficient as staff still felt uncomfortable speaking up. Despite CQC being contacted about concerns prior to the visit, we could not find sufficient evidence, of what work had taken place to improve the confidence with staff to raise issues directly with the management team.

Staff told us they did not feel confident raising concerns. Comments included, “If I speak up, they will mark me” and "I do not know if it is rude but she never listens to us. She [registered manager] will often say no, no. We have to stick to her plan for the care home.” The registered manager believed there were systems in place for staff to speak up freely. They said, “There are communication books, I allow [staff] to make a mistake, I get involved in handovers. If they see something, I made sure I do something. I will have an open discussion or on a one to one." They also acknowledged that more work needed to be done to improve staff confidence in speaking up. They said, “I am quite direct, my way, I do say come and talk to me one to one.”

The workforce team were diverse, and from observations worked well together. We observed staff speaking with each other frequently, checking in and overall working together well, We observed the deputy manager communicating with staff at reception in a positive way. There was an equality and diversity policy in place for staff to refer to.

Staff fed back that there were some staff that they believed were treated differently based on their backgrounds. They felt there were staff who were asked to undertake more shifts and they did not feel confident in saying no to this. One member of staff told us, “Some full-time staff are working overtime too much.” Another said, “There are certain staff are scared to speak up.” There were staff who fed back the staffing was diverse and this diversity was considered in their work. One member of staff said, “There is more female than male, there is only one male in the morning and two at night. There is a diversity in peoples backgrounds.” A senior member of staff told us, “We do have quite a few Muslim staff. I do my best to meet their needs. Some don’t work on Fridays. When they are celebrating Eid, some will have annual leave.”

Staff were not always clear on their roles and there was a lack of robust leadership. One told us, “There are small things, I think sometimes seniors needs to take their role more seriously" Another told us, “It is important to motivate us to work more and safely for the residents. In the morning when [registered manager] comes in they never say thank you for what you have done, they will look for the mistakes and say there is this and that.” The registered manager told us about the systems they had in place to monitor care. They said where areas of improvement had been found, "The action plan needs to reflect that things are happening or are things happening over and over."

Although audits were taking place, these were not always effective in identifying shortfalls. We found during the visit that people on modified or alternative diets were not given options of meals. Menus were left on the tables, but these were not accessible to all people living at the service. We found there was a practice of medicines being given whilst people were eating their meals in the dining room and staff confirmed most of these medicines did not need to be given with food. None of the concerns were identified through audits. We also identified concerns with the deployment of staff and where people lacked choices around how often and when they received a bath or shower. Although a call bell audit was undertaken, this was not auditing call bell times rather it was testing the call bells were working. There were missed opportunities to quality assure and audit whether there were sufficient staff deployed during the day and at night.