Supportive Care Services 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 inspection we rated this key question inadequate. At this inspection the rating has remained 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 regulation in relation to good governance of the service.

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 clear strategy for developing their direction of business. They did not always understand the challenges ahead and how they could develop the service to support the needs of the wider local community.

The registered manager explained their outlook into developing the service. While the registered manager understood the requirement to prioritise safe, high quality compassionate care, the strategy to support with this development had failed to address the issues found at this inspection which were the same as the last inspection.

The registered manager did demonstrate a commitment to developing and promoting diversity within the staff team and the packages of care provided. However, some staff demonstrated a reluctance to engage with the inspection which did not reflect confidence in their practice.

The provider did not have leaders at all levels who understood the context in which they delivered care, treatment and support. Leaders did not have the skills, knowledge, experience to lead effectively.

Discussions with leaders, while on site and during the inspection, demonstrated there was a lack of understanding and knowledge to make the necessary improvements needed to meet the minimum fundamental standards of care provision for people. The provider did not have a thorough, safe and effective recruitment process that met regulatory and legislative requirements. This put people at risk of receiving care and support from unsuitable staff. This meant there was not a thorough, safe and effective recruitment process which put people at risk of receiving care and support from unsuitable staff.

Training had not been monitored effectively to make sure staff had updated their mandatory training. Staff whose first language was not English had difficulty completing on-line training without external support from household members. This meant staff were not always effectively supported by leaders with their learning and development and accessing training materials in a format that suited their learning style.

Leaders were not aware of regulatory requirement to have their rating clearly displayed on their website. However, this was immediately addressed at the time of our inspection. The provider had notified CQC of notifiable incidents and events such as death notifications.

Leaders were visible within the service to their staff team. There was a stable management and staff team. Relatives spoke highly of the staff and management team.

Staff spoke positively about the service and the provider. They told us they were always accessible to them and on the end of the phone. All staff we spoke with felt they could speak to the management team regarding any concerns or questions they may have, and they would be answered and acted on promptly.

People and their relatives told us they were happy with how the company was run.

The provider had processes in place where people felt they could speak up and they would be listened to.

People told us they would speak up and felt their voice would be heard. Staff had access to the relevant policies and procedures detailing what was expected of staff working for the service. Staff told us they felt able to raise any issues or concerns, including poor practice.

There was a whistleblowing policy in place for staff to access however not all staff were able to explain what action they would take if they had any concerns about the service.

The provider told us they worked towards an inclusive and fair culture by improving equality and equity for the people who worked for them. However, the provider did not put into place measures to support those staff with their training where English was not their first language.

The staff we spoke with told us they felt listened to by the provider. However we found staff difficult to contact to provide feedback or share any concerns about their experiences working with the provider.

The provider ensured they were regularly available to staff and held staff meetings.

The provider’s systems had failed to operate effectively to enable them to assess, monitor and improve the quality and safety of the service. Policies and procedures were in place but were not consistently followed. For example, the provider had failed to follow their own recruitment process, to ensure they were safe and robust.

Where audits and checks had been completed, these were ineffective and did not provide oversight of the service. For example, leaders had failed to identify through those checks and audits that staff had been providing support to people with their medication and application of topical creams. Because of this oversight, there had been no audits completed on medication administration records or topical cream administration records. According to the provider’s electronic system, spot checks of staff practice had been completed. However, the spot checks had not been effective in ensuring staff were supporting people in line with their care plans.

Audits and checks had not identified risk assessments were not always in place and some care plans lacked person-centred information related to specific health and medical conditions, to ensure staff had clear guidance on supporting people safely. Reviews of people’s care had been completed but it was unclear from the information how often and when these had been completed and who was included in the reviews. The reviews had not identified the issues we found.

Audits and checks made on staff learning and support had failed to identify some staff had not completed mandatory training and training for specific health and medical conditions. Audits had failed to identify staff had not completed their data security awareness training level 1, when the provider’s own data protection regulation policy stated they would ensure staff were trained to understand the principals of cyber security and their responsibilities in relation to this. Staff were using the app on their own phones, and it was not clear how the provider made sure the appropriate security checks were in place.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

Staff felt there was an open approach between the service and the people they supported.

The provider had systems and processes in place to record contact with health and social care professionals and would make referrals where appropriate.

The provider’s systems and processes for monitoring the safety and quality of people’s care were not robust or effective. Leaders did not understand how to make improvements through a consistent approach, measuring outcomes and monitoring impact.

Staff meetings were held regularly, and minutes were kept of the meetings. These were used to discuss care practice such as medication practice. The meetings gave the provider the opportunity to remind staff about their training and the importance of working together to make sure the service provided good quality care for people. However, these meetings had not been effective. The registered manager told us they had discussed with staff in these meetings about medication administration and told us they had emphasised to staff they should not be supporting people with their medication. As previously identified in this report, we found that was not the case. On reviewing minutes of the staff meetings, we found any references to medication was for staff to complete care plans and MARs accurately.

The staff meetings were also used to discuss training and deadlines when training should be completed. However, we found from the records shared with us, staff had not always completed the required training to support them in their role.

The provider had conditions placed on their registration from their last inspection. The conditions were put in place to support the provider to make the necessary improvements to meet the fundamental standards of safe care and delivery. The conditions had not been effective in supporting the provider to make those improvements.

The provider had processes to gather formal feedback from people and maintained contact with people through home visits or phone calls. People told us the provider was responsive to any concerns and dealt with matters in a timely way.