Champion House - Care Home with Nursing Physical Disabilities

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 assessment the rating has changed to inadequate. We identified a breach of the legal regulation in relation to good governance. Systems and processes were not established or operated effectively, to assess and monitor the service, and to ensure continuous learning and improvement. The provider did not have a shared vision, values or strategy and there was a lack of shared direction and culture. There was a lack of effective and consistent management, which had impacted on the quality of people’s care. Staff did not have confidence in the provider’s systems for speaking up. The provider did not have effective processes in place to ensure leaders reacted promptly to concerns about workforce inequalities. Processes were in place to promote partnership working and joined up care, however these were not always implemented effectively. Leaders recognised that standards in the service needed to improve and had implemented processes to help drive and monitor this. Staff spoke positively of the support they received from the interim manager.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A staff survey was carried out by the provider prior to our assessment and showed workforce inequalities and allegations of bullying and harassment had been raised by staff, but there was no evidence to show action had been taken to address these. An interim manager had been brought in by the provider just prior to our assessment and, alongside a regional manager, had started to make improvements to the culture.

The provider's vision, values and strategy had not been developed with managers, staff and people who used the service. This had led to a lack of shared direction and culture. Ineffective and inconsistent management of the service had also impacted on the quality of people's care and had a detrimental impact on staff.

We found there had been a lack of inclusive leadership at all levels. Staff shared concerns with us about the previous management of the service. Staff said they had raised concerns repeatedly with senior leaders but had not been listened to, as nothing had changed. These concerns had been ongoing since January 2024, but action had not been taken by the provider. The interim manager acknowledged there was a poor culture and recognised changes were needed to improve the quality of the service. Staff spoke positively of the support from the interim manager. Comments included, “Since [Interim manager] came things are slowly getting better, he's given staff reassurances and support" and “[Interim manager] is superb, he uses really positive language to feed back to us on what we’re doing, what’s going well, what we could do to improve things even more.”

There was no registered manager in place at the time of our assessment and there had been a lack of effective and consistent management of the service. The provider had failed to respond swiftly to the concerns raised by staff about the management of the service. This had impacted on the quality of people's care and had a detrimental impact on staff. An interim manager had been recently brought in by the provider, to work alongside the deputy manager and staff team providing them with support and guidance. They had started to make improvements to communication systems, including daily manager walk rounds and meetings with service users, staff and relatives. Although it was early days staff, people and relatives spoke positively about the interim manager and the changes they were making.

There was a system in place for staff to speak up and raise concerns with the provider. However, staff were either unaware of, or did not have confidence in, those systems. Staff felt the changes in management had also impacted upon their ability to speak up.

Staff did not feel confident in the processes the provider in place to enable them to speak up. One staff member told us they had accessed the service to raise concerns but had not received a response. Another member of staff told us they were unaware of the process.

We received mixed feedback from staff about how leaders ensured workforce equality, diversity and inclusion. For example, 1 staff member spoke positively about the reasonable adjustments that had been put into place to enable them to carry out their role. However, concerns were raised about the treatment of overseas staff and the support that was available to them from the provider. The interim manager recognised improvements were needed in this area.

The provider did not have effective processes in place to ensure leaders reacted promptly to prevent and address inequalities and allegations of bullying and harassment raised by staff. 23 staff members had completed a survey sent out by the provider prior to our visit. The results identified disparities in the way staff were treated and highlighted incidents of bullying and harassment. However, we found there was no evidence to show allegations of bullying and harassment had been investigated or resolved. The provider acknowledged staff morale was low and told us they were working towards improving this.

Feedback from staff and leaders raised concerns about the effectiveness of existing governance and management arrangements at the service and the negative impact this had on the staff team, as well as the people using the service. However, staff spoke positively about the new interim manager and were hopeful the changes they were implementing would make a difference.

Systems and processes were not established or operated effectively, to assess and monitor the service, and to ensure continuous learning. Systems of audit were in place; however, they were not effective in improving the quality of care. For example, audits contained basic information and the shortfalls we found over the course of the assessment had not been identified. The provider had a service improvement plan, which had been updated by the interim manager and new regional manager. However, many of the issues which had been identified were found through our assessment, rather than through the provider's own quality systems and frameworks.

People told us there were limited opportunities for them to access activities or go out in the community on their own. Collaboration with stakeholders and agencies also needed to improve to ensure better outcomes for people.

The interim manager understood significant improvements were needed to strengthen partnership working and collaboration with other agencies. For example, they told us they had started working with Speech and Language Therapy to arrange specialist training for staff. There was evidence some improvements were also being made to ensure people had better access to activities and the community. For example, steps were being taken to reintroduce volunteers in the service, which had previously helped achieve good outcomes for people.

Processes were in place to support partnership working with stakeholders, but they had not always been effective. The local authority told us they felt the interim manager was working hard to make improvements, but found progress was slow in some areas.

Processes were in place to promote partnership working and joined up care, however these were not always implemented effectively. For example, 1 person had been in the service for over 2 months and had continually raised concerns about their placement and stated they wanted to move. However, there was no evidence to show contact had been made with the relevant agencies to discuss these concerns. When the interim manager joined the service, they contacted other professionals to review this person's care.

There had been a lack of trust between leadership and staff. Staff told us pressures had led to compromises in care, with a high turnover of staff and a lack of support from management. Staff said, before the interim manager came into post, they did not have confidence in the management of the service and had not felt able to raise concerns. Leaders recognised that standards in the service needed to improve and had implemented processes to help drive and monitor this.

The provider's systems and processes were not established or operated effectively, to ensure continuous learning and the improvement of the quality of care. People experienced care which did not always meet their individual needs. The interim manager was committed to learning and improvement. They were receptive to feedback and told us they were taking action to improve the quality of the service.