Rapid Care

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 continued breach of legal regulation in relation to governance at the service.

This service scored 57 (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’s culture and direction for the service had not always embedded into the practices within the service. Despite this, the provider had a shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

While the cultural values of compassion and person‑centred care were evident, this had not yet translated into consistently safe or robust governance systems. Since the last assessment, the provider had worked with external consultants and introduced new audits however, these changes had not always been timely or effectively implemented. This showed that the provider’s vision for high‑quality, well‑organised care was not consistently embedded and demonstrated that the service had a partially shared direction and culture.

Staff described a positive, caring ethos, and several spoke warmly about the commitment within the team. For example, staff said, “My manager is amazing. She is very approachable; she does listen and always tries to help,” and “[The registered manager] shows concern about you and people we support.” Staff described enjoying their work and wanting the best for the people they supported. People receiving care also consistently spoke about the kindness of the staff.

Although leaders understood the context in which the provider delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. This meant they did not always embody the culture and values of their workforce and organisation.

During the assessment, the nominated individual for the service changed. This change was to strengthen the leadership with greater input into the service. There had also been a newly appointed deputy manager with the aim of distributing the workload and allowing for more in-depth and timely oversight going forward. The newly appointed leadership team had begun developing a governance structure, strengthening audits and allocating clearer responsibilities for oversight. While these new steps showed potential for improvement, they were not yet sufficiently embedded to assure that the service could consistently identify and manage risks moving forward. We will check this at our next assessment.

However, leaders were described by staff as supportive and approachable, and people told us they felt able to raise issues or ask for help. A staff member told us, “[Manager] is very supportive… she gives a listening ear to us.” Another staff member said, “[The registered manager] communicates as much as possible.” This showed that leadership was caring but had not been sufficiently capable or organised to drive and sustain the required improvements.

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

Most people and relatives told us they had not raised any concerns or made any complaints regarding the service. A person and another person’s relative told us they raised concerns about staff using their mobile phones, which the service dealt with.

Staff told us they felt able to speak up, and they were confident that concerns would be taken seriously. They described an open environment where issues could be raised during team meetings or directly with the manager. A staff member said, “Yes, I can voice my concerns openly, and they do listen.” Another staff member explained that leaders encouraged staff to contribute ideas during meetings. This demonstrated a positive Freedom to Speak Up culture where staff felt valued and supported to contribute to improvements.

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

Staff described being treated fairly and being supported with personal needs where necessary. A staff member told us, “[The manager] adjusts the rota if we have a personal emergency.” Other staff explained they felt respected and encouraged in their roles. There was no evidence of discriminatory practice, and staff confirmed that training and development opportunities were accessible to all. This contributed to a sense of inclusion and fairness across the workforce.

The provider had not had clear responsibilities, roles, systems of accountability and good governance. They had not acted on the best information about risk, performance and outcomes.

The governance arrangements in some areas remained inconsistent and had not been fully effective in identifying or addressing ongoing risks and oversight. There was no evidence of audits of risk assessments and care plans to identify the gaps in care records we found at this assessment. The registered manager and the previous nominated individual told us they had checked people’s care records, but there were no records to demonstrate this. During the assessment, we raised serious concerns about this practice. The new nominated individual updated the auditing tools to better support staff in identifying areas for improvement and planned to increase the frequency of audits. This began during our assessment however, the changes required time to embed. We will check this at our next assessment.

Medicine audits had failed to identify the concerns we found, such as pain patches not being rotated in line with the manufacturer’s guidelines and medicines being administered without Medicine Administration Records. These issues had been raised at previous assessments and had still not been fully resolved. The provider took immediate action to correct these issues during the assessment; they made changes to the audit template to prompt staff to carry out more in-depth reviews and cross-checking. These improvements needed to be embedded; we will check this at the next assessment.

There had been some improvement to areas of governance since the last assessment such as governance around people’s care call monitoring and an increase in governance meetings to review practice at the service for areas which required improvement, patterns and trends as well as good practice. However, this required further development as the review of accidents and incidents had not identified where sufficient action had not been taken to mitigate future risks. We will check these at the next assessment.

People’s risk assessments and care plans for some needs had improved. For example, around catheter care and moving and handling support. The provider had focused on re-writing people’s care records and 91% of people’s records had been completed. Further work was needed to ensure more timely action was taken to address concerns in relation to people’s care planning and improve governance and oversight across the service.

The provider continued to understand 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.

Staff described positive relationships with external professionals, including occupational therapists, district nurses and local authority colleagues. A staff member told us, “We work well with Medway Council… Occupational therapy is very responsive.” Staff gave examples of seeking advice from district nurses regarding pressure care or catheter issues. Relatives and people receiving care also said staff supported them to access healthcare services when needed, and records showed appropriate referrals and follow‑up. This meant the service worked in a joined‑up way to support people’s health and wellbeing.

The provider had not always focused on continuous learning, innovation and improvement across all areas of the organisation. They had not always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They had not always actively contributed to safe, effective practice and research.

Although the service had improved in some areas of practice, which they had prioritised since the last assessment, improvements to the service had not been timely. A staff member told us, “Training has changed and we have improved looking at risk assessments and checking care plans to see if there are any problems. An inspection inspired the change, and new technology has also come along.”

However, the service had not consistently learned from previous assessments; some of the same concerns around medicines management and governance had not been fully addressed, and further work was needed. Patterns and trends had been reviewed by the management team each month, but did not reflect on whether there were patterns and trends following previous months.

Before the assessment, a new deputy manager had been appointed but had not yet started at the service. During the assessment, the deputy manager began in post, and there was a change of nominated individual to give more presence and oversight at the service. New governance tools and processes were created during the assessment to strengthen governance and quality assurance systems and processes. These had not yet been implemented long enough to demonstrate enough sustained impact.