Caroline 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

At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The ethos of Caroline House was underpinned by a holistic approach to care. This included supporting peoples' psychological, physical, and social needs with respect and dignity. Staff spoke of the ethos and of the vision for the home, comments included, "We want to provide a home, I think we do," "We receive training and support in all areas" and "We treat everyone the same -equal."

The registered manager and staff understood and supported people’s differing social, cultural and spiritual needs, which was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding individual peoples' life style challenges. However, we have received feedback throughout the assessment process from visitors and health and social care professionals, that at times staff were not always empathetic to peoples' individual needs and need further training and support in person centred care. We were given examples where staff had not fully understood how to support people to make individual choices that may differ from other people. The registered manager was responsive to our feedback and immediately took action to review staff practice and ensure staff observations were included in staff supervisions, regarding enabling people to make everyday choices. The provider had a clear position around developing services which were person-centred and tailored to each person's needs. Staff training was provided and supported by organisational policies and procedures, which focused on upholding the diverse needs of people. There was a range of policies and procedures to guide staff on what was expected of them in their roles.

There was mixed feedback from staff regarding leadership at Caroline House. Some staff spoke of how the management of the home had changed over recent months, and they were missing the daily presence and support of the registered manager who was supporting another of the organisation's services. Comments included. "The manager is good when she is here, but not here very much lately, not sure really who is taking the lead," and "Very good leadership, positive, and supportive."

Despite mixed feedback regarding the leadership in Caroline House. Staff overall, felt the provider and management team promoted openness and honesty. We saw staff throughout the site visit approaching and interacting with the management team in a way that showed mutual respect. Staff told us they were supportive of each other and worked well together as a team. Health professionals however told us they were unclear of who was managing the service as staff when asked, were unclear of who was in day to day charge . Visitors told us, "I haven't met the new manager yet, but I'm sure I will soon." This showed that the management structure of the home had not been clear to staff and visitors and could impact on who they shared concerns with. We discussed this feedback with the registered manager said that she would address this by meetings and emails to reassure people of the management structure and they were now back to being in Caroline House full time. The registered manager told us they were well supported by the provider and senior management team. There were opportunities for staff which included career promotions and additional training to support extension to their role, such as medicine giver and senior care lead. The management team accessed appropriate support and development for their role, which had included external training. Supervision systems were in place to check staff practices embodied the organisation’s culture and values. Throughout the site visits, we saw positive engagement between staff and the people they support. The provider maintained regular oversight of the home with regular visits from senior managers, they could also access records and reports remotely via an electronic system. A newly recruited activity lead had just commenced work and was completing their induction and said it was very thorough and they were reading care plans to get to know people, but at present can only work in communal areas until all checks completed.

Staff told us that felt able to raise concerns. One staff said, “If I had any concerns, I would raise it with a senior and our manager, if it was about them I would go higher or straight to the local authority, we can do it anonymously if want to," and "I would go to the senior and then report it, we have all the details of how to do it."

The provider and registered manager understood their responsibilities under the duty of candour. The Duty of Candour is to be open and honest when untoward events occur. We have received notifications as required. During our assessment we found that the management team were open and transparent. They admitted when things had gone wrong and demonstrated how they had used these to make improvements. This included lessons learnt from safeguarding investigations and complaints. Staff were supported and enabled to voice their views and concerns, they told us that they had meetings daily, supervisions and so felt that they had ample opportunity to share any concerns. They were aware of the whistle blowing policy but felt that they could raise issues and be listened to and so had not had to whistleblow. The provider had up-to-date whistleblowing policies and procedures which were in line with current guidance. People and their relatives confirmed they knew how to complain, and a copy of the complaints policy was available in the home and on the service website . Relatives told us; they would make a complaint if they needed to, but would talk to staff first. A record of complaints was held in the service. These included the information on the complaint and how this was responded to. We saw complaints had been responded to and actions taken as necessary. People and relatives confirmed that the provider kept their website up to date.

Staff understood their role and responsibilities and knew where to find guidance and seek support. The registered manager demonstrated a good understanding of effective oversight in the home and told us of systems they had introduced as a result of feedback from investigations, and complaints. Staff told us of various ways they were involved in promoting good practice and safe care delivery. comments included, “There are different audits we get involved in, like infection control, and medicines, some are weekly, daily and monthly," and “It keeps the service safe, because it picks up things we need to do better.”

Quality assurance systems were in place and were used to improve the service. The management team had implemented relevant quality frameworks based on recognised standards, best practices or equivalents to improve equity in experience and outcomes for people using services and tackle known inequalities. There were computerised systems and processes to assess, monitor and improve the quality and safety of the service provided. This included health and safety, accidents, incidents, complaints, infection control, medication records and staff documentation. There were however areas that need to improve to ensure outcomes and actions were clearly documented. Incidents were not always followed up with an action plan to prevent a re-occurrence and linked to behavioural risk assessments or care plans. Care plans and risk assessments were not clear regarding peoples' mental capacity, fluctuations to their mental capacity, their mobility and changes to their health. Areas of people's documentation lacked reflection of staff management of certain behaviours that may distress, there were people on 1-1 support but little documented as to the reasons why, possible triggers and how were staff to manage this. On discussion with the registered manager we were told that they had identified that the care documentation system used at present needed to be changed and this would be happening in the near future. Staff were clear about their roles and responsibilities and had regular individual meetings with the management team which they felt were supportive. Management told us how they monitored and managed staff performance and acted on early indicators to improve skills or conduct. Staff were encouraged to improve their practice through additional training and development of their skills. One example of this was recent medicine training and competencies. There was a business continuity plan in place that covered all emergency situations.