Top4Care Services 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 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 61 (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, equality, human rights, diversity, inclusion and engagement, and an understanding of the challenges and needs of people and their communities. People, relatives and staff spoke positively about the support provided and described leaders as approachable and responsive. Staff understood the provider’s values and demonstrated how they promoted people’s independence, choice and dignity.

Leaders encouraged open communication and worked in partnership with people, relatives and staff to develop and improve the service. They held regular meetings with people and staff to gather feedback, discuss issues and provide opportunities for others to share their views. We reviewed records of meetings with people and found some language could have more clearly reflected a person-centred approach. However, this was not reflective of the care people told us they received or interactions we observed.

Leaders were committed to providing person-centred care and support and demonstrated a willingness to improve the service. However, we found leaders did not always demonstrate the knowledge and understanding to ensure all aspects of the service were managed effectively.

For example, leaders were unable to consistently demonstrate an understanding of when Deprivation of Liberty Safeguards (DoLS) applications may be required. Leaders had also not ensured key policies and procedures were in place to support consistent practice. For example, there was no policy to guide staff on the use of CCTV, including how people’s privacy and rights would be protected. The provider also did not have a clear procedure outlining how people would be supported if they wished to change care provider, meaning there was limited guidance to ensure people's choices and continuity of care were consistently promoted. The provider acknowledged the absence of policies and since the assessment has developed and implemented these to strengthen oversight.

Staff and leaders demonstrated an understanding of the key principles of Right Support, Right Care, Right Culture through their approach to supporting people to maintain their independence, make choices and be treated with dignity and respect, although they were not familiar with the guidance by name.

Relatives spoke highly of the registered manager and told us they took time to listen, responded promptly to concerns and demonstrated a commitment to people’s wellbeing. They told us, “I can contact [them] at any time. [They] help to support me” and “Even when [the person] is not in their care they can phone [registered manager] to reassure him he’s ok. I can’t put it in words. I genuinely feel like they are family. I’m reassured.”

The provider fostered a positive culture where staff felt they could speak up and their voice would be heard. Staff meetings, supervisions and regular communication with leaders provided opportunities for staff to raise issues and contribute to improvements. Evidence showed regular discussions about care quality and practice, including person-centred care.

Staff understood whistleblowing procedures and how to raise concerns should the need arise. Leaders completed regular spot checks to observe staff practice and people’s experiences of care. These provided opportunities to identify any concerns and ensure care remained person-centred.

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 provider created opportunities for staff to develop their skills and take on additional responsibilities within the service. Staff received training and guidance to help them understand equality, diversity and inclusion and how this should be reflected in day-to-day practice. Policies and procedures were in place, and staff told us they felt confident discussing concerns with leaders. This was also reflected in their feedback through staff surveys.

Leaders demonstrated an awareness of inclusive practice and a commitment to fair treatment, supported by staff feedback and organisational policies.

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.

Medicines audits had not been completed weekly in line with the provider’s policy. The absence of these meant the provider was unable to identify concerns we found during the assessment regarding staff competencies to administer medicines and the storage of medicines. This meant the provider did not have effective oversight of medicines, or ensure risks were identified and addressed. The provider took prompt action to make improvements.

Systems for monitoring people’s finances were also not robust. Financial records did not always provide a clear audit trail and supporting documentation could not always be easily traced. This meant the provider could not consistently demonstrate how people’s money had been managed or provide assurance that appropriate financial controls were operating effectively. Since the assessment, the provider has begun to review systems for recording people’s finances.

Quality assurance processes failed to identify and address these issues before our assessment. This meant leaders did not always have effective oversight of key areas of the service.

The provider understood their duty to collaborate and work in partnership to help ensure people experienced coordinated care and support. The provider worked effectively with a range of health and social care professionals, such as GPs and Community Mental Health Teams to ensure people received coordinated care and support. Records demonstrated good communication and information was shared appropriately to support people’s health and wellbeing. Relatives spoke positively about communication and working with the service.

The provider did not always focus on continuous learning, innovation and improvement across the organisation. Systems were not always effective and had failed to identify or address the concerns found during this assessment.

Audits had not been completed regularly, which limited management oversight of the service and reduced opportunities to identify risks and drive improvement. This meant the provider could not always demonstrate how learning and improvement activity had been used to drive better outcomes across the service. We identified several issues, as described throughout the report, had not been recognised through the provider’s governance processes. This demonstrated that existing oversight arrangements were not sufficiently robust to provide leaders with effective assurance about the quality and safety of the service. Following the assessment, the provider responded positively and took prompt action to address the concerns identified. Evidence provided demonstrated improvements had been made to strengthen systems and processes.

Despite these issues, the provider regularly sought feedback from both people and staff to drive continuous improvement. They held regular meetings to provide opportunities to discuss what was working well and identify areas where improvements could be made. We found feedback from these was listened to and used to inform changes within the service.