Haldane House Nursing Home

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 one breach of the legal regulations. We found the registered manager did not always ensure all of the issues we found during this assessment that are described throughout the report, were identified through their own quality monitoring systems. Governance systems and audits had to be reviewed and improved to ensure it was more effective and consistent in identifying or addressing areas for improvement. However, we also received positive feedback professionals, staff and relatives about the registered manager and the work they have been doing which had a positive effect on the service. The registered manager worked together with the staff team and proactively sought support and advice from external partners to ensure any improvements needed were identified and implemented swiftly. People's and relatives', and staff’s feedback were sought and used to make improvements to the service. Relatives said they could approach the registered manager and staff with any concerns. The registered manager appreciated staff contributions and efforts to ensure people received the care and support.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager and the staff team demonstrated a shared responsibility for promoting people's wellbeing, safety, and security. The registered manager established a 'whole team approach' and culture in the service and worked with staff to ensure it continued to develop and grow. The provider and the registered manager supported each other to have a shared vision, strategy and culture to ensure provision of services needed. The registered manager said they aimed to provide the best possible care for people and staff were aware of this through training and caring for people. If the registered manager wanted to make a change, they would discuss it together with staff and/or other relevant parties to make those changes. The registered manager added, “Everyday, whichever staff are on, I thank them for their work. There is a lovely workforce here and everyone is covering each other”. The registered manager worked with staff and listened to them to ensure equality and diversity were actively promoted, and the causes of any workforce inequality were identified, and action was taken to address these. Staff were very positive of the changes being made since the new registered manger joined the service last year which supported the learning and a number of improvements. They said, “Since the new manager started, things have improved. [The registered manager] involve staff, they speak with people and relatives. If staff suggest something for example food change, the registered manager always listens”, “Huge improvements. With [the registered manager] in place, things are getting done…and much more professional and organised” and “Much better now under new manager. Staff are clearer on what they must do and when to do it. The new manager is very positive and encourages residents, relatives and staff to give their views”.

The staff used shift handovers and communication book to share and discuss any tasks to complete or what was going on in the service. The registered manager worked alongside the staff in the service. This way they were able to monitor practice regularly during the day and ensure appropriate action was taken to address any issues.

The registered manager understood the context and requirements how to deliver care, treatment and support and embody the culture and values of their workforce and organisation. The registered manager told us how they have been working on their own professional development to ensure they had the skills, knowledge, experience and credibility to lead effectively. The registered manager told us they encouraged integrity, openness and honesty in the service to ensure any issues or concerns were addressed quickly. The provider and the registered manager were visible to the staff team, people and relatives, and professionals. The registered manager was knowledgeable about issues and priorities for the quality of services and told us the changes they have been making since the start of their role. The registered manager added she felt supported by the provider and senior management to make changes to ensure people continued receiving care and support they needed. Staff felt listened to, supported and the registered manager was approachable. Staff said they all worked together well and the registered manager was visible to people, their relatives and staff. Staff added, “Yes. Better teamwork than before. All staff working hard to get the home rating better”, “Since the new manager, we all work as a team better. The manager is on the floor, knows the residents and they know her” and “Yes, we work as a big team. All staff have shift handover, and nurses and manager visible within the service”.

The registered manager and staff worked together to promote people's wellbeing, safety, and security and we observed a supportive staff culture. It was clear people who use the service were important to the whole staff team. People and the staff team had good relationships with each other. We also observed staff and the registered manager were respectful and kind towards people and each other. The registered manager promoted a positive, caring, transparent and inclusive culture within the service. The staff team were motivated to provide care and support to people as their needs and health were changing. The registered manager and staff worked positively with people to improve their skills, maintain their health or wellbeing so people could feel they could lead their life as they wished. The registered manager shared some stories that showed people experienced positive outcomes they achieved together that had positive impact on people’s life. One professional said , “Yes, the home has a good feel about it and staff are confident and interactive with residents. Staff can see the difference the dedicated dining room and activities have made to the residents and are willing to support change”.

The registered manager fostered a positive culture where people, their relatives and staff felt that they can speak up and that their voice will be heard. Relatives said if they had any problems or issues, they were able to contact the registered manager and/or other staff easily. Some noted they did not have to raise any issues as they were happy the way their family member was looked after. Staff’s feedback was taken into account to support any improvements. The registered manager encouraged staff to raise any concerns and promoted the value of doing so. All staff were confident that their voices would be heard, and they were happy to approach the registered manager for support. There was a culture of speaking up where staff could raise concerns and would be supported, without fear of detriment. Staff said, “Staff are happy, most have worked here a long time. The atmosphere has improved greatly since the new manager started”, “The new manager is clear about the improvements needed. They guide all staff in the right direction… They listened to what I said was needed in relation to the care plans and allowed me to make changes” and “All staff are made aware if anything that goes wrong, must be reported. Staff are assured it is not a blame culture but to deal with the situation so it can be assessed so it is preventable in future”.

When concerns were raised, the registered manager and provider have investigated those, and lessons were shared and acted on. Staff told us the registered manager was open and transparent with people and relatives if something went wrong, offered an apology and informed of actions taken.

The registered manager valued and respected diversity in the workforce. They took action to improve where there were any disparities in the experience of staff with protected equality characteristics. The registered manager continuously communicated with staff and shared any ideas or suggestion to ensure staff were included and were able to contribute to the service. The registered manager praised their staff team and the work they did. They said, “The staff are wonderful, very supportive of each other. The staff are hard workers and very caring. They cover each other for shifts. I cannot really fault them, and they are great”. Staff felt positive about the changes in the service and were confident that their concerns and ideas would result in positive change to shape services and create a more equitable and inclusive organisation. They felt supported and treated fairly. Staff said, “Staff all have equality training, and all staff respect each other and their differences. I do think all staff are treated fairly. They are made to feel important” and “Our staff team is multi -cultural. The manager ensures all staff and residents are treated equally and any differences are acknowledged. Since the new manager came in, the atmosphere of the home is much better and the culture is inclusive and positive”.

The registered manager valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked at the service. The registered manager used effective and proactive ways to engage with and involve staff, with a focus on hearing the voices of staff. This ensured the service had a positive culture which supported better outcomes for people.

The registered manager told us how they had established clearer responsibilities and roles for the staff team. They also had been working on reviewing the service and changes needed to support care and treatment to people. The registered manager communicated with staff to share information and act on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. The registered manager told us how they oversaw and managed behaviours and performance of staff as and when needed. The registered manager said, “Staff know the people so well and they have patience and understanding. They are aware how to support people, support them physically and even get little things for people that matter. They welcome families and support them during visits”. Staff understood their role and responsibilities. Staff were very positive of the changes and improvements made since the new registered manager came into the service. Staff said, “Since the new manager started, the management of the service has improved. More organised, open and transparent. It is very good now”, “The new manager and team are very hard working and positive. They audit and make sure everything going as it should” and “Things are much better since the new manager came. More organised and staff doing what they should”. Staff agreed they felt comfortable going to the registered manager or other management team with any concerns and they would be listened to.

Whilst the governance systems had improved since the last inspection, there were still further improvements needed to ensure all areas of concerns could be identified and mitigated using provider's quality assurance system. We found a number of concerns that the provider’s quality checks has failed to identify. For example, missing recruitment information for staff suitability and policy did not reflect the requirements of the regulation; discrepancies with medicine management and record keeping, and ensuring staff had consistent training with supporting evidence and records. The registered manager submitted data and/or notifications to external organisations as required. We noted 3 notifications were needed to be sent to CQC, and the registered manager acted promptly to rectify this. The provider had to improve their oversight and monitoring of overall service provided and records kept for it to ensure they were able to identify areas needing improvements promptly. For other areas of the service, the registered manager had an oversight of the service provided and ensured people received the care and support they needed. They used tools such as audits, spot checks, observations and feedback from people, relatives and staff to monitor, assess and improve the quality of the service.

People benefited from the service that worked in partnership with different professionals to ensure people were looked after well. Where necessary, external health and social care professionals had been consulted or kept up to date with developments. The relatives agreed the service worked with external professionals to support people’s health and wellbeing.

The registered manager understood their duty to collaborate and work in partnership, so the service worked seamlessly for people. The registered manager shared information and learning with partners and collaborated for improvements. The registered manager told us how they worked with people, their families, professionals to ensure people received the care and treatment they needed. Staff agreed things were going well and they were more open and transparent. Staff agreed they collaborate with all relevant external stakeholders and agencies. Staff said, “Yes more so with new manager. Everything is open, there is no blame culture. Referrals are made or sharing of information with local authority when needed” and “External stakeholders, the council and others have all confirmed how improved the service is”.

Professionals were positive about the service and the registered manager’s work to make improvements and ensure people were receiving the care and support they needed. They said, “I think [the registered manager] as a new manager has done a good job, [the registered manager] has reached out for support and training. [The registered manager] listens to the staff and works with them to achieve a positive feeling of support within the home. Training is paramount and the home is now using Skills for Care effectively” and “Yes, since [the registered manager], there is much better communication and management”.

Staff and the registered manager were open and transparent, and they collaborated with all relevant external stakeholders and agencies to ensure they achieved positive outcomes for people. Staff and the registered manager worked in partnership with key organisations to support care provision, service development and joined-up care.

The registered manager told us how they monitored the service and focused on continuous learning and improvement across the service. As the registered manager and staff had a good understanding of people’s needs, health and wellbeing, and they were able to identify where improvement were needed. For example, the registered manager changed the dining room to a bigger room as people were not sitting right in the chairs. Now people were using a bigger and brighter room, chatting and laughing. The registered manager felt this change had positive effect on the meals experience and food intake. The registered manager told us they had and used processes to ensure that learning happened when things went wrong, and from examples of good practice. The registered manager and provider sought feedback from people and those important to them, staff and used the feedback to improve and develop the service. They also kept in touch with external stakeholders to ensure information sharing was effective and useful to make any changes. Staff had staff team meetings to ensure any items arising from day to day running of the service and others’ feedback were shared with the staff team to ensure smooth running of the service. The registered manager had an open-door policy and would welcome any feedback of how to maintain a good service. The staff team also used handovers and communication book daily to share any matters, changes and updates ongoing in the service.

Staff and the registered manager demonstrated a positive, compassionate, listening culture that promoted continuous learning and supported improvements. The registered manager had established partnership working with outside organisations. Where necessary, external health and social care professionals had been consulted or kept up to date with developments. The registered manager proactively worked with the staff team, families and professionals to ensure people were able to achieve their goals and outcomes that had positive effects on people. The service had good links with the local community and the provider worked in partnership with other agencies to improve people's wellbeing. Professionals said, “Whenever I visit Haldane, it appears clean, the atmosphere is calm. I have never witnessed distressed residents or residents shouting. Residents…are free to safely wonder the home. I have visited a few residents who stay in their rooms in the past, again they seem calm and content. [The registered manager] got the home re-decorated soon after she arrived. The residents now have a lovely dining area which they lacked before. Activities are usually taking place in the afternoons when I visit with a good number of residents participating” and “I never need to make an appointment to visit and am always made very welcome whatever time or day I visit”.