Home Healthcare Delivery - South Tyneside

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• 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 legal regulation in relation to good governance at the service.

This service scored 61 (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 established a generally positive and supportive culture, supported by stable leadership and positive staff feedback. Leaders remained committed to continuous improvement.

The registered manager and Deputy Manager provided stable leadership and had worked over several years to strengthen the service culture. Regular team meetings, staff recognition, an open-door approach and action to address conduct and performance supported this. However, the positive culture was not reflected in every area of practice because some concerns were not communicated to managers promptly, which affected information sharing and the delivery of care. Leaders continued to reinforce expectations and improve communication across staff teams.

An anonymous staff survey completed through HR also reflected a positive culture. Most staff said they liked their job and colleagues, felt confident and supported by the team, and were happy with their pay.

Leaders had the skills, knowledge, experience and credibility to lead effectively. They understood person-centred practice and had relevant training and systems in place. However, some care-planning, risk-management and oversight shortfalls had not been identified or addressed promptly.

The registered manager and management team had significant experience and knowledge of adult social care and were passionate about their roles and the service. They were committed to improvement. People were supported in ways that promoted choice, independence and inclusion and reflected their individual needs. Staff completed relevant training, including equality and diversity and Oliver McGowan training. The provider continued to strengthen its checks and monitoring so that areas needing attention could be identified and addressed more consistently.

The registered manager was responsible for people’s care plans and risk assessments. Some contained errors, which were addressed following the assessment. In addition, some self-neglect concerns had not been identified or reported quickly enough. Leaders took action to address these issues.

People and relatives we spoke with were complimentary about the registered manager and management team stating they had met them on various occasions and felt they cared about their progress.

Staff provided positive responses regarding the leadership of the service. Staff felt very well supported within their roles.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider gathered staff feedback through annual surveys, which were reviewed and used to inform action plans. Staff could also share concerns and views through supervisions and team meetings, where records showed issues were discussed and acted on when needed.

Complaints and investigations were recorded and managed in line with policy. Policies gave staff clear guidance on raising concerns and helped them feel confident to do so.

Staff can use Safecall, which protects whistleblowers, maintains confidentiality, and provides support. Staff said they felt protected and knew concerns would be escalated and support offered. This approach embedded by the registered manager, helping staff feel part of the team. Staff felt comfortable visiting, bringing their children into the office, and having a chat or coffee.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for staff who worked for them.

Staff told us they felt valued and were treated well. Reasonable adjustments were made for autistic staff, including reduced duties where requested. Investigations were adapted to meet individual needs, such as adjusting communication style and avoiding information overload. The service also made adjustments for staff with injuries, including wheelchair access.

Staff took part in a wellbeing action plan, which gave them a safe space to raise issues or concerns. This also helped the provider understand and respond to staff needs, supporting a happier and more productive workforce.

The provider had clear responsibilities, roles and systems of accountability in place. However, general oversight needed to improve to ensure governance systems were effective in practice.

The provider carried out six-monthly audits of care plans. However, these had not identified several of the issues found during this inspection and were not frequent enough, given the number of people using the service, to provide assurance that needs were being met or that changes to care plans were recorded promptly.

The provider had medicines audit systems in place, which identified repeated recording and scheduling issues. Although the audits identified gaps, the action taken had not yet resulted in sustained improvement or a consistent reduction in repeated issues. The provider had introduced further audit activity as part of its ongoing governance arrangements.

Leaders acknowledged the shortfalls and were taking steps to strengthen governance systems. They had recently updated risk alerts to better identify people at risk of self-neglect, enabling prompt action where concerns were identified. However, these changes needed time to become fully embedded and demonstrate sustained improvement.

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

Previously where some required notifications and referrals had not been completed or submitted promptly, the provider had taken steps to strengthen learning, including reminding staff and leaders about when notifications and referrals were required. This related to specific reporting requirements and did not reflect the provider’s wider partnership working and information-sharing arrangements.

Staff supported people to integrate within their local communities on occasions, and people and relatives told us they could speak to the provider when they needed to.

For people receiving care from multiple providers, the providers’ roles and responsibilities were clearly recorded, and there was evidence of structured information sharing and learning across organisations. This gave assurance that the provider supported safe, joined-up care for people in the community.

The registered manager told us, “I think the service has strong relationships with partner organisations. Every day is different, we feel comfortable asking other services for support.” They also emphasised the importance of building relationships and maintaining open communication.

The provider did not always actively contribute to safe, effective practice. A lack of oversight and governance had impacted on their ability to do this. However, the provider had taken opportunities to innovate and improve the service.

The provider engaged an external company to improve the planning of routes so staff could attend calls on time. This would take account of travel time and scheduling and help mitigate risks when calls overran due to emergencies. This had not been fully implemented at the time of our assessment.

The service recognised staff through Cera Stars and recommendations from colleagues, clients, and families. Recognition included a certificate, pin badge, and nomination for the national monthly ‘Create, Commit, Care’ award, which included a cash prize. During the registered manager’s time in post, two staff members had received this award. Other recognition schemes included Carer of the Month, presents, cash prizes, bonuses, and end-of-year awards, often celebrated through ceremonies. Cera Care placed a strong emphasis on thanking and recognising staff.

We saw multiple examples of the provider recognising the need to improve and bringing in new ways of working. This included an innovative use of technology, such as AI-assisted assessments and route-planning systems, to better understand people’s needs, strengthen care planning and support more reliable, person-centred care.