London Care (Bristol Court)

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

There were systems for monitoring and improving the quality of the service. However, these were not always implemented effectively because people using the service, their representatives and staff were not empowered and their views were not always considered. We identified breaches in relation to good governance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff gave mixed feedback about the leadership at the service. Some staff told us they felt supported and listened to. However, others explained they did not feel they could approach managers or that they would not be listened to. Most staff felt communication with the leadership team needed to be improved.

There were processes for leaders to listen and respond to feedback from stakeholders about the service. However, these had not always been operated effectively. People using the service, relatives, staff, and external professionals had some concerns about communication, speaking up and how the service was managed. They did not always feel leaders were compassionate or inclusive. The registered manager had left the service at the time of our inspection. They continued to work for the organisation in another role and were offering support if needed whilst the provider recruited a new manager. There were a team of senior staff supporting each other to manage the service during the interim period. There was a well-established area management team who visited the service and provided support and guidance.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Some of the records about people using the service were not completed well. Some of the language staff used to describe people and what they had done was not appropriate. We discussed this with the management team who told us they were aware of this and were addressing the issue with staff. Some records did not give enough detail, and this meant they may not be effectively used for monitoring and improving the service. The provider was moving from a paper-based system of records to electronic care plans and medicines administration records. Whilst these changes were being made, there were occasions when not all records were updated or did not always have the same information. This was something the provider hoped to overcome when the transfer to digital record keeping was complete.

The provider worked in partnership with the local authority and other organisations to run the service and provide a range of activities and facilities. External professionals gave mixed feedback on their experiences. Healthcare professionals and providers of social activities told us some staff were helpful and worked well with them, but others lacked the skills for good partnership working. Their comments included, , ''The service is very institutionalised and they will not be flexible to provide support for people to increase their independence'' and ''The staff are caring but the organisation is defensive and does not listen, they do not want to hear negative feedback, complaints get quashed and therefore people and their families do not feel heard.'' Other comments from external professionals were positive and included, ''The staff took the activity seriously and explained our expectations to residents'', ''Staff in the dementia unit are really caring'', ''We have a great relationship with Bristol Court'' and ''I have nothing but praise for Bristol Court and the employees.''

People using the service, relatives, staff, and external professionals told us they did not always feel improvements were made because of their feedback. One member of staff told us, ''They are very good with procedures but in terms of people feeling valued and safe, that culture is not there.'' The management team explained they had systems for auditing the service and that they were able to pick up and identify when things went wrong. This included checking records for missed care, accidents and when someone was unwell.

The provider's systems for monitoring and improving quality had not always been operated effectively. Whilst there were audits and systems for planning improvements, the feedback we received during this assessment showed that people using the service and others felt they were not always listened to. They told us concerns had not been acted on, allegations had not always been taken seriously and some people had experienced unkind or inappropriate care. Feedback highlighted that some people using the service and others felt communication was poor and they did not always feel their views were recognised or valued. Some relatives, people using the service and external professionals told us this meant they did not want to raise their concerns because they felt they would not be heard or there would be negative consequences. The local authority had identified some areas for improvement during a recent audit. The management team had developed an action plan in response to this. Failure to effectively monitor and improve the quality of the service and to seek and learn from the views of stakeholders was a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.