Almond Tree Care Ltd

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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care

The service was in breach of two legal regulations in relation to governance and the display of a CQC rating.

This service scored 39 (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 had aims, objectives and principles in place which were based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. However, the provider did not demonstrate a consistently positive, compassionate and listening culture that promoted trust and understanding. Staff told us this and our evidence confirmed this. Whilst the people who used the service told us the staff that provided their care consistently demonstrated positive principles of care, staff told us the provider did not show compassion or understanding towards them. During this inspection, we found the registered manager did not fully engage with the process or submit full evidence as requested.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills and knowledge to lead effectively, and they did not do so with integrity, openness and honesty.

Staff talked positively about the care manager, however we received poor feedback in relation to the registered manager. They did not demonstrate they fully embodied a positive, compassionate and kind culture based on transparency. One staff member said, “[Care manager] is very approachable. However, I don’t think I can approach [registered manager] about anything.” The registered manager failed to demonstrate they had the knowledge expected particularly in relation to the expectations and requirements of the regulator. Furthermore, despite being requested to do so, the registered manager had not sought consent from some people for CQC to contact them as part of this inspection. We also found the provider was not displaying their previous CQC rating as required by the regulations.

Whilst the people who used the service felt able to speak up, staff did not; they told us this. Staff told us this was because they were fearful of repercussions and that in the event they did speak up, they would not be heard. They told us the poor culture within the service did not allow them to comfortably speak up. One staff member told us that when they previously raised concerns, they were told to ‘turn a blind eye’ by the provider. This did not demonstrate an open culture where staff felt able or encouraged to speak up.

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 provider employed a diverse workforce however one staff member told us they did not feel they were treated equally due to not being British. They told us they were sometimes frightened to say things in case they failed to word it correctly and that it would be ‘held against them’.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. However, the system has failed to identify and rectify the poor culture within the service.

The provider’s governance system had ensured people received a consistently kind and reliable service that they valued and which met their needs. It had been effective in ensuring people’s records were accurate and up to date and that people received safe care. Despite staff working within a poor culture, they had not allowed this to impact on the care they delivered. However, without rectification, this poses a continued risk to the care delivery.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Professionals who provided us with feedback told us the service communicated well with them to ensure people received the care they needed. The people who used the service, and their relatives, told us the service liaised with other stakeholders on their behalf as required.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. Whilst the provider had some systems in place to analyse information to help improve the service, such as in relation to accidents and incidents, we found some shortfalls. For example, complaints had not been thoroughly recorded and analysed as per the provider’s policy and some shortfalls identified at the last inspection completed in 2022 remained at this inspection.