Archived: Qualified Care 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 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 and failure to submit notifications of incidents.

This service scored 25 (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. The provider did not respect the human rights of the people, or of their staff. People were being given care and treatment that was unsafe and had not considered their health or social needs. They had failed to identify that some restrictions on people had been made without appropriately assessing if this was in their best interests, or that anti-psychotic medications were being given in a way that also acted as a chemical restraint as the grounds for their usage were not clearly stated or effectiveness monitored.

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 provider told us they did not have any systems in place to monitor how many hours staff were working, however staff told us they had raised their concerns about the unsafe nature of the hours they were expected to work. Management had failed in their duty of care to their staff and to people being supported, as staff were working hours that did not allow them to operate safely. The provider was not fully aware of their responsibilities to ensure risks to people were being safely managed, and did not put in place risk assessments for how to manage people’s health needs until after we conducted our inspection.

People did not always feel they could speak up and that their voice would be heard. Staff explained to us they knew how to speak up, with one staff member telling us, “Yes if I have any concerns I would speak to the manager or deputy. I am comfortable in doing this, and there are regular meetings and supervision sessions”. There was a policy in place detailing other organisations staff could approach to share any concerns. However, where staff had raised concerns about unsafe working practices, these had not been addressed meaning where concerns were raised action had not always been taken to ensure people were safe or that staff were listened to.

The provider did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them. We saw no evidence demonstrating how the provider has considered the diverse needs of their workforce and how they could support them. There was no evidence of how they had considered any adaptations needed to ensure their staff were safe, and had exposed them to extremely unsafe working hours and expected them to provide care with little information on how to safely support people’s needs.

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. Both the manager and deputy manager at the service told us they had other full-time employment, which meant they did not have the time to effectively manage the service or monitor the quality of care being delivered. We were told some audits of medication and spot visits had been conducted, but no evidence of these could be provided. The systems in place had not identified that risks to people’s health were being poorly managed and had placed them at risk of significant harm, and the care documentation we reviewed was outdated and lacked sufficient detail. For one person although they had received care visits every day in July up to the date of our inspection, there were only records completed for 3 days. Therefore, the provider had no knowledge of what care had been delivered on the other days. Despite this having been discussed as a concern at staff meeting in June, the records of care being delivered were often still not being completed or only completed several days later. We were told this was because some staff had other employment and did not have time to complete these, which the provider had failed to address. When we discussed the people being supported, management were not aware of what care was actually being provided due to their lack of appropriate monitoring systems.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement. People’s care plans contained little detail of any other agencies involved in their care, and how staff should work alongside them to support people’s health needs and to live the best possible quality of life. For example, where people had conditions including dementia, constipation, diabetes, wounds, limited mobility, heart conditions or were at risk of falls there was no guidance for staff to support them around signs and symptoms to look out for, and when they should escalate these to other organisations for advice and support. Where medication was prescribed for people by professionals, staff were not given guidance to ensure this was being safely administered or monitored to allow these to be given as prescribed. Where incidents had occurred, they had not followed their statutory duty to notify the CQC.

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. Where incidents had occurred, there was no learning taken from these to identify why they may have occurred and any changes the provider could make going forward. Despite multiple people having had recent falls, their care plans were not updated to reflect people’s current needs and how to prevent and respond to them. Staff we spoke with were uncertain about their responsibilities with one staff member saying, “No it isn’t our responsibility to assist somebody up after a fall. We would wait for the ambulance.” But despite this staff were documented as helping people to raise from the floor after a fall. The governance systems in place had not identified the lack of clarity for staff despite multiple opportunities where this could have been identified. The provider could not share evidence of any audits or monitoring they told us they had completed or tell us about improvements they had made as a result.