Quality Homecare

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 good. At this assessment the rating has remained good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (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. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The registered manager had a clear vision about the future of the service that placed people at the centre of any changes or developments. They were keen to develop and increase the number of people supported with complex needs. The registered manager told us this area worked well but there was a continued demand for support in the community. Business continuity policies were in place which supported this vision. Support for staff was a key element of the future development of the service. The registered manager showed us details of staff retention rates at the service, which were high and which inferred a positive working environment. Staff told us that the culture at the service was inclusive and supportive of all staff including those with ambitions for development as well as staff content in their current roles. Contingency policies and procedures were in place to cover events such as extreme weather conditions, computer systems failure and pandemics.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The registered manager provided a visible presence to their staff and put staff issues, concerns and conversations first. They provided support with all aspects of the service including occasional visits to people’s homes to meet people and to support staff. The registered manager told us they wanted to provide an inclusive working environment where staff felt comfortable to approach and raised concerns and suggestions. Due to the size of the workforce different layers of supervision had been introduced so that all staff had a direct line manager with clear responsibilities for their welfare and development. Other senior staff had specific roles for example, assessment, training an office manager. This hierarchy worked well, regarding support for staff, overseen by the registered manager. Staff spoke highly of the registered manager and wider management team. Comments included, “Very supportive, lovely, always responsive,” “I’m given a good work life balance” and “Very approachable.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff were able to speak up and provide feedback about the service. They had a variety of ways to do this and they were encouraged to raise both positive and negative issues. Staff told us they were confident that they were listened to and taken seriously and that if actions were possible, they would be taken. There was a regular itinerary of meetings, some for mangers and others for all staff. Due to the size and geographic spread of the service, staff were grouped into areas and area staff meeting were held, chaired by managers. Staff told us there were annual staff surveys but also ‘satisfaction forms,’ which they could complete at anytime and about any issue. In addition, staff had regular supervision meetings where they could further discuss issues one to one with a supervisor. The registered manage maintained oversight of all staff feedback and monitored any themes or trends in their observations and suggestions. Minutes were kept from all meetings, and we saw that there were actions taken and feedback provided at subsequent meetings.

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. The registered manager had created a workplace culture that embraced and celebrated difference. The workforce had representation from many cultures, backgrounds and faiths and all worked alongside each other and respected the people they worked with. Similarly, staff living with neurodiverse presentations for example, dyslexia, were supported and encouraged and made to feel welcome and part of the working team. The registered manager told us, “I am passionate about people and difference. We have had clients who have requested staff only from certain cultural backgrounds. This is not always possible and we work with people to understand their concerns and then allay their fears.” Staff told us they felt comfortable and supported working for the service. They told us their different backgrounds and beliefs were respected and they were given time to celebrate and to observe important dates in their calendars. Comments from staff included, “The teams are really supportive,” “I support people from different backgrounds and work with staff from different backgrounds, it is always good” and “I feel supported and my needs are catered for.”

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. Due to the size of the service the registered manger delegated several tasks to team leaders and office staff. This included some auditing processes, however, they maintained oversight of these processes. All key areas were audited for example, accidents and incidents, complaints, care plans and risk assessments. A recent move to electronic care plans and medicine administration forms had meant that supervisors had immediate access when carers inputted information into care notes. Although these new processes needed more time to fully embed it was already noticed how changes to peoples’ needs and any issues with medicines were being picked up quicker than when using paper records. The registered manager told us that regular management meetings were held where all aspects of auditing were discussed and any actions required were documents and taken forward. We saw evidence of this from meeting minutes. In addition to these oversight processes the registered manager and their team carried out telephone monitoring and direct observations of staff. Telephone monitoring was a series of random telephone calls to people each month to dip sample how people were feeling with regard their care and support. Most of the responses were positive. Observations of staff or ‘spot checks’ were carried out as unannounced visits to observe and support staff when on care calls. Records from these visits showed in most cases no issues but occasionally advice and learning were provided to staff as a result of management observations.

The provider understood 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. The registered manager worked well with statutory partners from both health and social care. The registered manager told us, “The Brokerage Team (local authority) work well with us and we have a good rapport with many teams including district nurses and occupational therapists.” Feedback from professionals was similarly positive. Comments included, “They give us all the background information we need, they communicate well, and I have not had any issues with them,” “I have had the pleasure of carrying out joint visits with A1 with more challenging clients to mitigate risks and ensure consistent and cohesive support” and “If I asked for any interim changes in packages of care, this would be actioned in a timely manner.” Some care plans contained notes made during joint visits with other professionals with agreed action points and short-term goals for people, making sure they received the best care available.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research. The registered manager and wider management team responded well when things were found to have gone wrong. For example, all complaints made about the service had learning outcomes recorded. A recent example related to staff documenting gaining consent from people when carrying out tasks. Although there was no suggestion that consent was not being sought, it was however not consistently being recorded. The registered manager told us this was an area that needed attention and that there was learning to share with all staff. Learning was shared using different means for example, if the message was urgent, staff telephone messaging would be used. This was then backed up through team meetings and during supervision meetings to make sure everyone had received the message. The registered manager, similarly, maintained oversight of all safeguarding issues that were raised and again made sure any learning was shared. To maintain continuous improvement, positive issues were also shared. Best practice learned from other branches or other services and advice from the local authority were all noted and shared with staff.