Carters Green Healthcare Services Limited

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 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 good governance.
 

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 culture which was based on engagement with people and relatives in order to meet the needs of people.

Leaders worked closely with relatives and staff to create an inclusive culture. There was a complaints and equality and diversity policy in place, staff received training in both these areas and told us they were able to speak to leaders should they have concerns. Staff meetings were completed by the registered manager on a regular basis which, in raising and discussing areas for improvement, reinforced the values and expectations of the service. Leaders also used satisfaction surveys to obtain the views of staff to shape how people received care.

Relatives told us staff consulted with them on a regular basis regarding the care their relations received; that their views were obtained via their relation’s care plan reviews and satisfaction surveys, and that they felt able to raise concerns and were confident leaders would take the appropriate action. One relative stated, “We have telephone reviews. They visit the house, and there’s a questionnaire that’s sent out every few months with suggestions for improvements and it does help. I can just ring them up if I need something changed. It’s instant, rather than waiting for a form.”
 

Leaders did not always demonstrate the skills and knowledge to lead aspects of the service effectively.

Leaders had mostly failed to identify and / or effectively address the concerns we have detailed within sections of this report, which included: incident management and care records not always providing information which accurately reflected people’s needs and risks. This meant the service was not always managed effectively at the time of the inspection and while there were areas in which leaders demonstrated effective leadership, there was an increased risk to people using the service.

Leaders were compassionate and supportive. The registered manager understood the importance of providing a positive, inclusive and supportive environment, and staff feedback supported this. When speaking about the registered manager, 1 staff member said, “I feel listened to and supported - very supported.” Other staff comments regarding the registered manager included they were accessible and approachable. Senior leaders were also present in the service, and the registered manager told us they worked well with them.
 

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

Staff and relatives were clear they could raise concerns and knew who these could be raised with should they need to. Posters were on display within the office environment which reminded staff and visitors what they can do should they ever have concerns.

Relatives told us their relatives received safe care from staff and they were confident any issues would be taken seriously and acted upon by leaders. For example, 1 relative said, “Iwould have no hesitation in contacting the office, management are understanding, work with the family’s needs and provide good and quick responses to any issues we have.”

Where concerns were raised, records showed these had been responded to promptly, investigated and informed future practice.
 

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.

Staff described a positive and supportive environment where colleagues were treated fairly and with respect. One staff member told us, “The registered manager is very supportive and approachable.”

In addition to the registered manager promoting an open environment in which staff felt listened to and supported on a day-to-day basis, the service also sought to use staff voices to shape service delivery in other ways. For example, staff surveys were issued to staff and the registered manager explained to us what these views were and what they intended to do to support staff further.
 

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Effective systems were not always in place to ensure safety events were managed well or care records contained accurate person- centred detail. Systems also failed to highlight the issues we found relating to consent, safeguarding and implementing statutory guidance . This meant governance systems were not always effective and exposed people to the risk of receiving poor care.

However, there were examples where effective systems were in place. For example, systems to ensure people transitioned safely into the service, medicines management oversight and safe recruitment systems .
 

The provider did not always understand their duty to collaborate and work in partnership in order that services could support people.

Safeguarding concerns were not always reported to external partners . There were instances in which events, such as allegations of abuse and those involving police involvement, were not always reported to the local authority and CQC. When this was discussed with leaders, there was a lack of understanding of the situations which required being reported to these stakeholders.

However, staff supported people to integrate within their local communities, such as partaking in leisure activities, which promoted inclusion, independence and wellbeing. Most relatives we spoke with told us the service worked in partnership with them.
 

The provider did not always focus on continuous learning and improvement across the service.

While there were some examples of learning in operation, leaders did not always have a good awareness and understanding of audit processes and how these can be used to effectively identify concerns and mitigate risks to achieve continuous learning and improvement.

As a result, leaders had mostly not identified and effectively acted upon areas of the service which required improvement. For example, those we have identified during our inspection detailed throughout this report. This meant there were missed opportunities to learn and make improvements to the overall quality and safety of the service.