Josh's Care Company 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.

This is the first assessment for this service. This key question has been rated outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 89 (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 a very clear shared vision, strategy and inclusive, innovative culture of continuous improvement. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

The management team was passionate about the ethos of the company, “Empowering lives through compassionate care”, which was embedded throughout the organisation and fully embraced by all staff.

The registered manager told us, “The company was set up to provide high quality support for a family member. This is what we want for all the people we support.”

One professional working with the company told us, “I have not been made aware of any concerns and can only pass on consistently positive feedback. It has been refreshing to work with a company who show their desire to really help [people], they go the extra mile to help people, and their families feel supported and comfortable”.

Staff were passionate about providing person centred support and were proud to work for the company and felt enabled to deliver high standards of care. One member of staff told us, “I wanted to speak to you [CQC Inspector] to show my appreciation for the company.” Another member of staff told us, “I definitely recommend the service, I am proud to work for the service.”

People consistently shared positive feedback about the provider and staff. People appreciated the family focussed way of working. One person’s relative told us, “The biggest improvement to [Name of relative] is staff are reliable, they know them well. Staff cheer [relative] up, staff are friendly and have become like family.” Another relative told us, “Staff know [relative] and the risks really well. We are like a happy little family; we have a very happy home.” The provider balanced their friendly, family focussed approach with training for staff to understand and implement professional boundaries in care.

A person told us, “No matter what, they [staff] are there to help, they enjoy doing it. Everyone [staff] enjoys their work. I have not come across anyone who doesn’t.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the inclusive, innovative culture of continuous improvement and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead highly effective and evidence-based care and support. They did so with integrity, openness and honesty.

The provider employed suitably qualified and experienced managers and leaders. The registered manager was visible to all people and staff and led by example; they knew the needs of all the people supported by the company and their families, as well as those of staff. The registered manager had oversight of the service and was able to mitigate the impact on people of emerging risks. A member of staff told us, “[Name of registered manager] is fantastic, amazing at their job. They offer support and lead an outstanding team. The leadership team is kind and compassionate.” Another member of staff told us, “[Name of registered manager] knows what good person-centred and empowering care is and can really provide it. Each client is provided with holistic care; they get what they need and want. The service is incredible.”

Members of the leadership team received supervision, support and training to promote their personal and professional development. Staff were offered development opportunities both to meet the needs of the care industry, the company and their own development aspirations. A member of the management team told us, “I have learned so much about myself as a leader through 121 coaching”.

The provider understood the issues affecting the care industry locally and nationally. They worked with local education establishments and accepted student nurses on placement. This supported the development of the student as well as the opportunity for provider staff to access up to date ideas and practice.

All staff were positive about the support they received from their leaders and described an open-door policy where they were able to seek support when they needed it.

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

The provider maintained an open, transparent inclusive, innovative culture of continuous improvement encouraging staff to speak up without fear of reprisal.

The provider used various methods to embed the Freedom to Speak up process and remind staff how to provide feedback on anything happening across the service. For example, posters were available for display in people’s homes where they wished; each team member’s badge had a scannable QR code on the back to be used at any time; staff received appropriate training and guidance through induction and regular supervision and spot checks. Staff consistently told us they knew how to raise any concerns and were confident these would be addressed.

Staff told us they could speak up and voice any concerns and felt confident that any concerns raised would be acted on. Staff told us they were encouraged to share their views and provide feedback about the service. Where negative comments were received the service continued to address them.

The provider completed an analysis every six months of reports received through the speak up process. An action plan was developed to further improve service delivery. For example, additional training opportunities were facilitated for staff, including mentoring for team leaders.

The provider developed staff to be speak up guardians to support the team.

The provider strongly valued diversity in their workforce. They had an inclusive and innovative culture of continuous improvement which had improved equality and equity for people who worked for them.

The provider had policies and procedures for inclusion and diversity within the workforce. Managers understood their responsibility to recognise people’s protected characteristics and ensure appropriate measures were in place to support these.

The provider responded to national events and raised this with their workforce, sending out communication to remind staff of their values and offering support.

The provider arranged inclusive, innovative culture events where stakeholders were invited to join and learn about and celebrate people’s differences. Staff told us they valued and enjoyed this event.

The provider worked with staff to overcome barriers to their personal development. For example, following supervisions with team members and discussing their goals, a manager supported 2 staff members to apply for and attend university whilst being able to work flexibly alongside it. Both staff were doing their nursing studies and were supported by this team member as English was not their first language, and they needed some support with the application process and working their rotas around attendance.

The provider reviewed their recruitment and retention statistics and identified that leavers tended to be within their first 2-6 weeks. To ensure staff were supported during this time the provider implemented wellness calls at 2 weeks to check in with staff. The talent acquisition team contacted staff to see how things were going, ensure any concerns were escalated and actions taken if needed. This reduced the leaver rate during this period and staff reported better experiences with their onboarding process.

Managers had also noticed staff were nervous about their first shifts, a pre-shift check call was introduced to make sure staff had an overview of the person, who they were working with/shadowing and any house rules they needed to be aware of such as taking their own tea/coffee etc. This helped staff feel assured and less isolated on starting their care role.

The registered manager was involved in a study with a university in relation to understanding attracting, recruiting and retaining younger people. The provider identified they had 20% of 18–25-year-olds employed against the industry average of 8%. The provider was carrying out a review of how young people were attracted to and retained by the company. The provider carried out surveys and interviews with young staff to identify why they worked for the organisation and what they wanted from their workplace.

Following interviews and speaking with staff one of the things the provider identified was staff members valued being supported, particularly at times they were struggling, at home or personally. The provider integrated a new app to allow managers to flag staff as being at potential risk if they mention they are struggling, and this prompts management to check in with them, complete signposting and send employee assistance details. A member of staff told us how this had been implemented, and their worries had been addressed by a manager which had supported their wellbeing and continued participation in work.

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.

The provider implemented robust governance systems. Regular compliance audits were carried out. Actions were identified and addressed to improve the quality of the care provided, promoting best outcomes for people. For example, the provider facilitated monthly audits in people’s homes to review care records, including medicines.

The provider encouraged the teams within the company to work together to promote best outcomes for people. For example, the talent acquisition team worked with the training team and clinical team to recruit the right staff to support people well.

People trusted the provider to ensure care was provided to meet their complex needs and were confident the provider took action to address any concerns they shared. People told us they did not often share negative feedback as the provider engaged with them regularly, giving people the opportunity to resolve issues as they arose. Where people had raised a concern, they told us this had been promptly addressed with a satisfactory outcome.

The provider was committed to growing the business whilst being able to deliver high standards of care. The registered manager told us, “We have achieved growth over our operating period, and we are happy with where we are as an organisation. We have developed individual development programmes for leaders which means when we do grow, we have our own team able to fulfil management roles to ensure the values and embedded practice of the company remains clear and unchanged.”

The provider clearly understood and carried out their duty to collaborate and worked in partnership, meaning services worked seamlessly for people. They always shared information and learning with partners and collaborated for continual improvement in line with the provider’s vision and values.

The provider developed and maintained strong external partnerships to ensure outstanding outcomes for the people they supported and the wider population.

A professional who had worked with the organisation told us, “Josh’s Care Company is particularly skilled at setting up care packages quickly with the appropriate skill mix. They manage family dynamics and challenging behaviours with professionalism and sensitivity. They report issues and exceptionally safeguarding concerns promptly”.

Another professional told us, “Any concerns with regard to patient safety or family stress has been shared and they [the provider] have made referrals themselves to ensure the patients’ needs are met (example: referring to tissue viability local nurses for any concerns). They [the provider] have work alongside key professionals in the NHS to ensure care plans remain exceptionally safe and up to date. The care agency has shown consistent care cover, a consistent safe and highly effective standard of care along with a genuine desire to help and care for [people].”

The registered manager had developed extensive local networks, offering and receiving support from other managers and professionals. The registered manager also gave talks at local colleges, to share an introduction into care for students to support their understanding. The registered manager also ran a monthly networking and training session for local care leaders, offering training on leadership skills and ways to support their services.

Members of the management team attended opportunities to be involved with other professionals. For example, giving talks to support university sustainability projects, carrying out mock interviews to help prepare students for the workplace, and offering talks to people looking to enter the sector to share tips and advice.

The provider was involved with local community groups and charities. For example, participating in and fundraising for a boat race and working with a charity to deliver bespoke training, hosting coffee mornings, and inviting the local community into the office for a chat.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to exceptionally safe, highly effective and evidence-based practice and research.

The provider had an outstanding understanding of how to make improvements happen.

The provider identified learning from feedback and incidents and took actions to make improvements. For example, a manager told us, “Following a lesson learned from a staff member going from one package to another we became aware there were different expectations from people and their families, which the staff member was not aware of. We identified that understanding people’s house rules was very important and for us to identify these and communicate them to our staff teams. We now collect house rules during the onboarding of a client’s process to ensure these can be communicated to staff when working with new clients.” This ensured people’s wishes and preferences were known from the onset and fully understood and respected by all staff.

The provider shared, “You said, we did” information with stakeholders to identify the improvements they had made in response to feedback they received. For example, the provider introduced more drop-in sessions with managers; introduced new area nurse manager roles and sent out monthly newsletters as ways to improve communication.

The provider worked with all the necessary stakeholders to ensure best outcomes for people. One professional working with the service told us, “We have encountered some challenges that led to recurring issues; however, the introduction of regular monthly meetings has significantly improved communication and collaboration. These meetings, along with prompt email correspondence when needed, have helped maintain openlines of communication.”

The provider gave opportunities for stakeholders to share feedback and was working to improve the response rates to their engagement surveys and planned to use a mixture of mediums to engage with a wide range of staff. A manager told us, “We rely on honest feedback, it helps the package to work.”

The provider links with stakeholders, charities and community groups had given them the opportunity to identify there were gaps in training for carers providing support for their family and friends. The provider arranged and delivered opportunities for members of the community to access relevant training, free of charge.

The provider introduced Champions in the organisation to further support the improvement of services to meet people’s complex care needs. Champions received additional training in certain areas, including end of life care to equip them to be the people keeping up to date and promoting best practice.

The provider aimed for continuous improvement to service delivery and in support of this was in the process of setting up a care committee, to promote people’s involvement and support opportunities to hear the voices of people in how things are done. A person who received support had volunteered to help the provider and was involved in developing the committee.