Assisted Care Solutions LImited

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.This is the first assessment for this newly registered service. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in breach of legal regulations in relation to governance and oversight, keeping accurate and complete records, and reporting incidents to CQC.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities. People and some relatives told us they have not met the registered manager before. We received mixed feedback from people regarding the culture of the service. One person told us, “I can’t actually see the company; it just seems to be a group of carers coming out”.The provider did not ensure staff had regular meetings or that minutes were taken of any staff communication to evidence engagement and strategic discussions. Staff told us meetings had not taken place “for a while”, and there was no formal process for supervisions. Some staff noted it was completed over the phone annually however there was no further evidence provided for it.This did not evidence the registered manager engaged effectively with staff to ensure the service was working strategically and in line with a shared vision. The registered manager did worked with the staff team so they could demonstrate a shared responsibility for promoting people's wellbeing, safety, and security. The registered manager did not maintain regular communication with the whole team to ensure they were able to share and discuss any matters or what was going on in the service. This did not always ensure there would be a positive and compassionate culture that supported people, their relatives and staff.

The provider did not understand the context and oversight of delivered care, treatment and support. They did not embody the culture and values of their workforce and organisation. The provider did not demonstrate they had the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. Although the staff team were motivated to provide care and support to people as their needs and health were changing. However, there was a lack of oversight and support from the registered manager to ensure they promoted a positive, caring, transparent and inclusive culture within the service. The registered manager did not provide evidence how they ensured they were visible at every level and led by example, modelling inclusive behaviour.Staff told us they felt the service was a “nice place to work” and were positive about being able to approach their senior staff with their queries. However, staff also told us they did not have much communication with the registered manager. The service did not have staff surveys with the option of anonymity, and we suggested this as an option to encourage inclusivity of workforce. People and relatives we spoke to told us they had not met the registered manager.The registered manager did not demonstrate they were knowledgeable about issues and priorities for the quality of services or accessed appropriate support and development in their role.

The registered manager did not always foster a positive culture where people, their relatives and staff felt that they can speak up and that their voice will be heard. Staff told us, “I don’t get involved with [the] registered manager”, and “I do feel comfortable talking to [the registered manager] but I don’t always feel listened to”. Staff told us about the positive relationship with their colleagues and their team leader, “Communication [is] good across the team which is really nice. Anybody got any questions we can share and help each other”. People did not always feel they could share their experiences and that this feedback would be heard. We spoke to people and relatives about freedom to speak up, they told us they did not always think people and families received a sincere and timely apology and were told about any actions being taken to prevent something happening again when something went wrong. They told us, “I was supposed to have a meeting with [staff] so we could talk about [the incident] but some of them felt intimidated so it never happened” and “If there is a real complaint, I will go to [the registered manager] and he will say I’ll sort it and that is the end of the conversation. Like when [the person had an incident], no one apologised.” People felt staff were happy and positive working at the service and worked well with people using the service. However, people also said, “[Staff] often seem very tired at the end of the day” and “I think [staff] struggle with hours sometimes”. We asked about freedom to speak up and the registered manager told us, “Staff know they can contact CQC, ACAS, and other contacts.” There was no further evidence provided how the registered manager supported staff to raise any issues and to promote staff empowerment to drive improvement.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.The registered manager did not always communicate with staff about the service or any other matters to ensure staff were included and valued. The registered manager did not review their policies and procedures to ensure these supported and reflected staff needs and their responsibilities. Staff were not always able to share ideas or able to contribute to the service and its development and improvements. Staff supported each other however they also noted support from the registered manager had to improve. The registered manager did not work alongside staff delivering care to help them understand any issues or disparities staff encountered. We were not assured the working environment was inclusive, and staff’s wellbeing was considered consistently. This did not ensure the service had a positive culture which did not always support better outcomes for people.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The provider did not evidence they had established robust systems and processes so they could assess, monitor and mitigate any risks relating to the health, safety and welfare of people using the service, staff and the operation of the service. The provider’s quality assurance systems did not identify concerns we found during this assessment which are described throughout this report. The provider did not have oversight of the quality of care being provided, risk management and mitigation, staff practices, knowledge and competency to support people. The registered manager did not monitor recruitment checks were carried out to ensure all required information was gathered to ensure there were suitable staff to work with people.The people were not safeguarded from the risk of harm, and staff were not adequately trained and competent prior to providing care and treatment.There was no evidence the provider proactively looked at trends or themes in the incidents, accidents and complaints that occurred so that were able to identify areas of concern and take action to prevent reoccurrence and safeguard people.The provider did not provide any audits they used to identify and monitor the risks to people for different aspects of their care such as medicine, moving and handling and wellbeing. The provider did not ensure management of medicine was safe and proper including checks for medicine competencies. This meant they were not able to demonstrate how they identified and worked on the areas where improvements were needed. The provider did not gather feedback from people and relatives about the quality of care provided to show how they used the feedback to develop the service and drive improvements. All people and relatives we spoke to confirmed they did not have any spot checks completed during their care calls. The provider did not ensure that accurate, complete and legible records were maintained or updated when necessary including records for people’s care, risk management, daily records, management of medicine and staffing. The provider did not demonstrate they were aware of people’s individual needs to ensure safety from the risk of harm. There was no effective oversight to identify if risk assessments and care plans were followed and reflected in people’s daily notes. Systems did not always ensure incidents were reported to the local authority and/or CQC which was not in line with provider’s regulatory responsibilities.The provider did not evidence there were policies in place to mitigate the risk of harm to people or staff including safeguarding, whistleblowing, risk management, duty of candour, management of medicine, business continuity plans and recruitment.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement. People and relatives told us they were not sure if the provider had shared information with other services they used.The registered manager told us they communicated well with district nurses, social workers and occupational therapists. However, evidence we collected did not demonstrate the provider understood their duty to collaborate and work in partnership with other services to ensure continuity in people’s care and to achieve the best outcome for people using the service. For example, for one person who was under care of district nurses, we found staff noted they had developed a skin wound and applied dressings to this without evidencing they had contacted district nurses. This did not ensure the service worked collaboratively and shared information with partnership services to ensure people’s risk of harm was mitigated.

The provider did not have a clear process to focus on continuous learning and improvement from incidents, reportable events, audits and information across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. Where we identified shortfalls during this assessment, the registered manager was not always responsive to our findings to act on areas of improvement. Staff confirmed they did not have regular staff team meetings to discuss any items or feedback arising from running of the service. There was no policy provided to support the process of learning, measuring outcomes and impact or the services provided.The registered manager told us had an open-door policy and would welcome any feedback to support the service. However, this was not visible in practice and from the feedback we received. The registered manager told us they worked with people, families and professionals to ensure people were able to achieve their goals and outcomes that had positive effects on people. However, people’s and relatives’ feedback indicated this was not always the case.