Braywood Gardens

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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 assessed all quality statements in the well-led key question and found poor governance and oversight at the service. This is a breach of regulation related to good governance. The management team completed audits, however these auditing arrangements were not always effective at improving care. Staff understood their role and responsibilities, but found it difficult to complete all expectations due to the lack of staff.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff gave varied feedback on the management team. Some staff explained that the managers were supportive and approachable. Other staff felt that the management team did not have good lines of communication. One staff member explained they did not go to management with concerns as they did not feel comfortable speaking up. Another staff member said, “they (managers) can nit-pick that we haven’t done something. But they were right there and could have helped the person themselves instead of calling me back.”

Leaders did not create a shared culture of effective care, meaning there was a poor-quality culture at the service. This is because low staffing levels meant that people’s preferences, and dignity was not always supported. We found that safeguarding referrals had not been made as expected. This meant that while staff had received training and there were policies in place; this was not effective at creating a good culture.

Leaders did not recognise poor care and behaviours of staff were not effectively challenged. The registered manager explained the care home employed a diverse staff group. They explained that staff from different backgrounds are employed and supported to improve their skills. They explained that multiple staff are being encouraged to engage in enhanced training.

Leaders did not act to deliver care which mirrored a positive culture of care and value the workforce. We observed that staff had opportunities to speak to the management team, for example in team meetings and one to one supervision meetings. While this was in place, we found concerns with the quality of care provided.

The registered manager explained that staff were given different opportunities to speak up in team meetings, supervisions and anonymously. The registered manager also completed regular walk arounds of the service to allow staff to speak up. Some staff felt the management team would listen to concerns whereas other staff felt that speaking up would be ineffective.

When we spoke to people and relatives, they were unaware who the registered manager was, or explained that they do not regularly see them around the service. They also explained that there were some meetings for relatives and people to attend, however they felt these were not very regular. They also felt they did not always receive feedback about actions taken after the meeting. We were therefore not assured that there were effective processes in place to allow people to speak up.

The registered manager described how they work to employ a diverse workforce. Some staff felt that they were treated equally, other staff felt that the management team had favourites within the staff team. They explained this could cause tensions between staff.

We saw clear policies, which encouraged the equality and diversity in the service. However, whilst policies were in place, leaders did not use effective ways to evaluate how staff felt, or were aware of the poor quality of care provision.

The registered manager described multiple audits that were in place. However, we found these audits did not ensure the service was of a good standard.

Audits that were in place, were not effective. For example, we observed there were regular audits into the management of medicines. However, we saw that medicine concerns raised by the local NHS team remained at the service. We also observed there were monthly reviews of care plans and a senior member of staff would also spot check these care plans. We found both these monthly reviews, and senior management checks had been ineffective at improving the quality of care planning documents. Staff were safely recruited. However, the provider kept a log of all the recruitment checks that a staff member had received. This log had not been kept up to date. This can impact the management team’s oversight of safe recruitment.

People explained that relatives were encouraged to visit the home. However, unless relatives took them out of the care home; there was not a culture of regular activities outside of the care home.

There was a specific staff team allocated to activities in the care home. They were not available on the assessment day to speak to. When we spoke to other staff members, it was apparent that they were not aware these activity staff were unavailable. It is concerning that staff were not aware of this, as it could allow them to provide activities in the absence of this specific staff team. Some care staff felt that people were provided with enough activities, other care staff did not. One staff member said, “There are not enough activities, as some people don’t get visitors and I think they are bored.”

External professionals advised that they visited the care home, however they found their advice was not always acted on. This can impact the partnership’s within the home. The registered manager was working hard to improve partnerships and spoke of how they were engaging with external stakeholders.

Poor documentation by staff meant it was not always clear what advice had been given by external stakeholders. Regular reviews occurred of this documentation but did not recognise that improvements were needed.

The registered manager described that they were taking part in a pilot for the prevention of falls in the care home. They explained that they were keen to learn and innovate.

During the assessment, we raised multiple concerns with the senior management team. They responded promptly and provided evidence that improvements were being actioned. While this is reassuring, it is concerning that audits in place had not already identified and improved the concerns seen during the assessment.