Pro Healthcare Services

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 changed to 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 governance at 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 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.

The findings from our assessment indicated the culture of the service that was not safe and person-centred. The provider had not created a culture where the team worked well together and learnt from incidents which meant people did not receive good care.

The provider had developed an action plan following our last assessment where a breach in regulation had been identified. However, at this assessment we continued to find concerns previously identified and we found new issues.

We were not assured that the culture of the service and the vision and values promoted high quality, person-centred care with a focus on continuous learning and improvement.

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, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

The registered manager and nominated individual did not have an effective oversight of the management of the service. The registered manager did not have a good oversight of the day-to-day delivery of the service. We found several examples of risks not being well managed and poor management oversight for example around risk management, knowledge around catheter care and medicines management.

People and relatives shared mixed feedback about communicating with the office or management. Their comments included, “If I needed to ring the office, they would not answer;”

“You leave a message and they do not get back to you. Whoever is responsible, they do not get back to you anyway” and “The office is helpful if you need them.”

The registered provider was not working in line with regulations, best practice guidance or its own policies and procedures. This impacted on their ability to meet the fundamental standards and placed people at risk of harm.

People did not always feel they could speak up and that their voice would be heard.

We saw there was a lack of regular engagement with people and their representatives. Although we saw some questionnaires had been filled in with some people and relatives’ feedback, some people and relatives told us they had not been asked for feedback about the service. Their comments included, “There are no questionnaires or anything to ask for feedback.”

Some staff told us they felt they were able to speak up and were aware of the service’s whistleblowing procedures, and how to raise concerns outside the service.

We reviewed the provider’s service improvement plan and there was no indication that concerns raised by people and relatives in complaints or surveys had been used to improve the service. For example, relatives had raised concerns about late care visits, but there was no indication of this issue being considered and reviewed by management.

The provider recognised the importance of equality and inclusion, and management team described fair recruitment processes and how they supported international staff. However, systems did not consistently ensure equitable and safe working conditions. For example, rotas were not always effectively managed, and travel time was not consistently incorporated into staff schedules. There was also limited evidence that leaders regularly evaluated the impact of these arrangements on staff’s wellbeing or monitored equality of experience across the workforce. This reduced assurance that equality, inclusion, and staff welfare were fully embedded within the service.

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.

We found the management and oversight of essential areas of delivery of care was not always robust or effective. Governance systems in place had either not identified or addressed concerns found during this assessment. For example, concerns identified with medication management or provision of catheter care.

Quality assurance processes had not always been effective in driving the necessary improvements. We found examples where the issues found during our assessment were not previously known by the provider, even though quality checks were being completed in these areas such as medicine audits.

The provider was not complying with their duty to report to CQC any abuse or allegations of abuse concerning people within the service. After we raised this with the provider, relevant notifications were submitted.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider worked with some external professionals however, partnership working was not consistently well‑coordinated or clearly documented. This reduced assurance that partnerships were consistently supporting safe, joined‑up care for people in the community.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

We found limited evidence of lessons learnt from our previous assessment because we continued to find gaps in the management of the service which was reflected in concerns found in the quality and safety of people’s care.

The lack of effective systems and processes to analyse data such as call monitoring data, accidents, incidents and complaints showed a failure to monitor the safety and quality of people’s care. The lack of effective quality assurance systems meant opportunities to identify areas for improvement were missed and issues were not addressed.