Implementing Governance and Leadership Support in a 23-Bed Dementia Care Home
Stabilising internal dynamics, mentoring new leadership, and embedding regulatory compliance.
Background
A 23-bed care home in the UK, providing accommodation and personal care for older adults, including those living with dementia, was experiencing growing internal challenges that threatened both service delivery and regulatory confidence.
At the centre of the issue was a strained relationship between the provider and the nominated individual (NI)—a family member—creating blurred boundaries, undermined trust, and inconsistent leadership. This dynamic had a direct impact on staff morale and team cohesion. Compounding these difficulties, the local authority raised concerns about poor documentation and a lack of demonstrable compliance with regulatory requirements.
Recognising the need for impartial expertise and structured support, the provider engaged Fulcrum Care to implement governance systems, mentor the newly appointed manager, and help re-establish trust with stakeholders.
Our Approach
Fulcrum Care began with a comprehensive assessment of leadership dynamics, regulatory risks, and operational systems. Several key issues emerged:
- Leadership tensions affecting decision-making and team direction
- A newly appointed manager with limited experience
- Inconsistent or absent governance and audit processes
- Increased regulatory scrutiny from the local authority
In response, Fulcrum designed a bespoke support plan to address both operational and interpersonal challenges within the service.
A suite of governance tools was introduced to provide structure and accountability across key areas, including care planning, infection control, health and safety, staff supervision, and training compliance. These tools helped build a culture of transparency and quality assurance.
Alongside this, Fulcrum provided fortnightly on-site mentoring to the new home manager, guiding them in leadership development, staff oversight, inspection readiness, and regulatory understanding. This support was supplemented with remote guidance to maintain momentum and consistency.
Fulcrum also worked closely with the local authority, sharing progress updates and audit outcomes to provide assurance of improvement and reduce external pressure.
As part of a wider modernisation effort, Fulcrum supported the home's transition from paper-based systems to the Person Centred Software (PCS) platform. This included training coordination, onboarding oversight, and implementation troubleshooting to ensure a smooth digital transformation.
The Outcome
Fulcrum Care’s involvement led to a range of clear, positive outcomes:
- Operational stability improved significantly, with governance structures restoring consistency across the service.
- Regulatory compliance was strengthened, with local authority concerns addressed and resolved through documented progress.
- Leadership confidence grew as the manager became more autonomous and capable in their role.
- Staff morale improved with the resolution of internal tensions and the establishment of defined leadership.
- Stakeholder confidence was restored through open communication and demonstrable improvements.
Client Impact
This case highlights Fulcrum Care’s ability to manage complex care home dynamics where operational and relational challenges intersect. Through governance implementation, leadership mentoring, and stakeholder engagement, Fulcrum delivered meaningful, measurable change—supporting both compliance and culture within the service.
Need tailored governance and leadership support for your care service? Get in touch with Fulcrum Care for expert consultancy.
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