Courage Healthcare 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 newly registered- amend as required service. This key question has been rated 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 breach of legal regulation in relation to governance at the service.

This service scored 50 (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 shared vision, strategy and culture, based on transparency, inclusion, engagement, and understanding challenges and the needs of people and their communities. However, we found that not all parts of the service reflected this in practice, and whilst the provider aspired to this, some areas of the service still needed further development.

The provider had a shared vision and culture which aimed to promote person-centred care and positive outcomes for people. Leaders described a clear idea of the culture they wanted for the service and staff we spoke with understood the service’s purpose and values, including promoting independence, choice and safety for people. Whilst the provider and staff promoted these values, we found that in practice people had not always been supported to have maximum choice and control as legislation to support this, including the MCA 2005 had not always been followed.

Staff described the service as a “good team” and spoke positively about how they worked together to support people consistently. Feedback from staff indicated they understood the service’s mission, which was accessible to them electronically and they were able to explain how this translated into day-to-day practice. Staff told us care was delivered in a way that reflected people’s preferences and routines, including supporting access to activities in the community and maintaining familiar staff teams.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leadership and oversight was not always effective. Leaders were not always able to demonstrate effective monitoring of staff workload, as staff often worked many days consecutively without sufficient rest. Although the provider had engaged with other providers locally and with an external consultant this had not resulted in sufficient improvement of the service. The provider had implemented some improvements including for example the incident monitoring system, however they did not have the knowledge to implement these systems without external support in a timely way.

Leaders were knowledgeable about the people supported and demonstrated compassion and commitment to delivering personalised care. Staff told us they felt supported by management and described leaders as approachable. The provider showed a willingness to learn from the inspection and implement improvements. The provider was aware of some national guidance, including “right support, right care, right culture”, and STOMP.

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

The provider promoted an open culture where staff felt able to raise concerns. Staff consistently told us they felt comfortable speaking up, including about safeguarding concerns, incidents, or poor practice. They were able to describe how they would escalate concerns to the provider, deputy manager or external professionals if required.

The provider did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. The provider valued diversity in their workforce.

Leadership and oversight of workforce equality was not effective. There was limited evidence of how leaders reviewed equality data, staff experiences or reasonable adjustments to ensure inclusive practice was consistently embedded. Appraisal and supervision processes were not always robust, which reduced opportunities to identify and respond to individual staff needs, including those related to protected characteristics. As a result, equality and inclusion were not always actively monitored or improved at a strategic level. There were no systems in place to ensure staff did not work excessive hours.

Staff had received training in equality, diversity and human rights training for staff. Recruitment records showed that equality monitoring forms were in place, and staff told us they felt treated fairly and supported in their roles.

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.

Governance systems were not effective in ensuring safe, high-quality and sustainable care. Although the service had recently introduced systems to learn lessons from incidents, they had not been embedded for enough time to demonstrate an impact. There was limited oversight to identify patterns, trends or recurring risks. There was a lack of oversight to identify that systems were not in place to review restrictions and ensure the correct legal frameworks were being complied with.

Care plans and risk assessments were not always sufficiently detailed or consistent and audits were not robust enough to identify these gaps in a timely way. Leaders were not always able to demonstrate effective quality assurance, which placed people at risk and limited the provider’s ability to sustain improvements. Oversight of quality, audits, and governance processes was still developing, limiting leaders’ ability to consistently show improvements across the service.

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.

Partnership working was not always clearly reflected in documentation. Care plans did not consistently outline shared responsibilities where multiple providers were involved, which could lead to confusion for staff. Although the provider told us they worked well with other providers, staff did not have access to the information to enable them to carry out their roles. This reduced the effectiveness of joint working and continuity of care. Leaders had begun to engage in partnership forums to share learning, but these arrangements were still developing.

The provider worked with other external professionals, including social workers, district nurses and other healthcare professionals, to support people’s needs. Staff described positive working relationships and told us external professionals were supportive and accessible.

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

The provider had not yet embedded an effective learning and improvement culture. While staff could describe learning from individual incidents, systems to capture, analyse and act on learning across the service were newly in place. Leaders did not have effective processes to review incidents collectively or to identify themes and preventative actions. There was limited evidence of innovation or service-wide learning to improve outcomes for people. As a result, opportunities to improve quality and reduce risk were missed.