Premier Care Limited - Specialised Services

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 changed to 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.

This service scored 32 (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. They did not understand the challenges and the needs of people and their communities.

The vision and values of the service were not person-centred and did not include values such as compassion, dignity, independence, respect, equality and safety.

Before the very recent management changes, staff at all levels, did not have a well-developed understanding of equality, diversity, and human rights, and the service had not prioritised safe, high-quality, compassionate care.

The feedback from staff about the culture of the service was very negative. They did acknowledge this had recently changed and they had a more positive experience since changes had been made to the management team. Staff told us, “…poor management practices, low staff morale, and inconsistent communication could indirectly affect the quality and continuity of care. When staff feel unsupported or unfairly treated, it can impact their ability to perform their roles effectively” and “Until approximately three months ago, when an inexperienced temporary management team was introduced, the service struggled with poor leadership, inconsistent communication, lack of transparency, and unfair disciplinary processes. Staff experienced intimidation and bullying, which damaged trust and created an unsafe workplace culture.”

The new leadership team recognised and understood the shortfalls and measures were being taken to improve the service.

The provider did not always 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.

Poor leadership had resulted in a poor service and referrals being suspended by the local authority. The provider had acknowledged that senior members of staff who have since left the service did not have a background in providing this type of service. They did not have the skills, knowledge or experience to lead effectively. Staff told us the previous management team did not always lead with integrity, openness, and honesty. We requested records to demonstrate how the previous management team were recruited and supported. No records were provided.

Recent improvements had been made. A new senior team with the right skills and experience had started improvements by restructuring the service. This included recruiting into new senior roles including the registered managers role.

Staff reported improvements. They told us, “The guys in the office now are great. They are supportive, more relaxed and welcoming. If I have issues, I feel I can come to them”, “Definitely issues before but the office staff now are good, although this is not a set team yet…and we are not clear who the manager is currently” and “A few months ago there were issues with the management. They were ignoring things and not responding. Some service users use [illegal drugs] and the office were not responding, they would blame us for situations beyond our control. They are good now they are listening, and they are responding.”

Staff did not always feel they could speak up and that their voice would be heard.

Staff reported a toxic culture and told us they did not feel able to speak up. The situation has improved recently but trust had been damaged, as many staff felt unfairly treated and told us human resource polices had not been followed correctly.

Despite recent improvements, we could not be assured there was an established culture, where staff could actively raise concerns and be supported, without fear of detriment.

The provider had failed to implement an inclusive and fair culture by improving equality and equity for people who worked for them.

The importance of promoting an inclusive workplace, where staff were treated equally and fairly had not been achieved. Policies to ensure equality and diversity were promoted in the workplace not always been followed.

Staff of all backgrounds did not feel valued or treated fairly by the previous management team. They told us this had improved recently. Some of the feedback had been very negative. They told us, “I believe management should receive further training on safeguarding employees from racial abuse and harassment, and on creating a safe, respectful workplace culture” and “No, I do not believe I have been treated fairly. I have experienced public humiliation, threats…My manager told me I could only have my previous rota reinstated if I agreed to work additional hours, which I consider unfair and discriminatory.”

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.

The provider had failed to operate effective governance systems. This had placed people at an increased level of risk. Audits and oversight had not been effective at identifying the shortfalls in the service until it reached crisis point. We found multiple breaches of regulations related to person centred care, safe care and treatment, premises and equipment, staffing and good governance.

Previous leaders did not have the skills, knowledge and experience to lead effectively. They did not lead by example. They did not lead with integrity, openness and honesty. A new senior team was in place, and some positive changes were being made. However, there were significant issues that needed to be addressed, and any improvements made also need to be sustained. Recruitment to new roles in the management team are still ongoing at the time of the assessment.

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.

Poor leadership meant working in collaboration and partnership work had suffered and this impacted negatively on people’s experience of care. Services did not work seamlessly for people and previous leaders had not been open and transparent.

There had been a marked improvement since the new management team had started, and they were working in partnership with the local authority commissioning team and the safeguarding team to improve the service.

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. They did not actively contribute to safe, effective practice and research.

Improvements were needed at this service. It was not currently in a position to contribute to improvement and innovation across the local system.

When incidents, accidents or complaints had occurred, it was not clear if investigations had been carried out to understand the cause and see if anything could be done differently in the future.