Pathfinders Specialist and Complex Care

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 changed to 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 provider was in breach of the legal regulations relating to good governance and person centred care. We have asked the provider to take action to make significant improvement.

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. 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. We spoke with the owner of Pathfinders Neurological Care Centre to fully understand their vision of the home. They explained they had identified the need for more intensive care and support for people of all ages who had complex health needs. They felt they could offer this for people, with the holistic, therapeutic approach, where a person was ready to leave hospital. People and relatives supported this vision and culture and told us the services offered had been vital to them. One relative said, “I’m absolutely happy with my [relative’s] care. Prior to coming here, they had become bedridden in the hospital. [Name’s] personal care improved immediately on arrival here. They got to understand [name’s] situation and condition. The 2 ½ years of being here, I would describe as outstanding.” Another person said, “This type of care is in such short supply, I am so grateful for everything. We had tried other placements and no one could meet [relatives] needs, this place is everything.” A professional who works with the service said, “The manager has always shown willingness to work with the patient to meet their needs even when “out of the ordinary”.

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 openness and honesty.

While there was an extensive management structure in place, who staff stated to us were supportive; there did not appear to be clear roles and responsibilities in relation to care planning, reviews and quality monitoring. For example, where care plans had not been developed in line with the provider 48 hours process, the care plan had been viewed daily by various levels of staff and management and concerns had not been highlighted or raised. This meant the opportunity to identify and mitigate risks had been repeatedly missed and guidance for staff had remained lacking despite staff having recorded these concerns with records such as daily notes.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. There was a complaint policy in place and people and staff told us they knew how to raise a complaint. However, some staff told us they had been supported to raise concerns about staffing levels but said no action had come from this. One staff member said, “I have raised this a couple of times, it’s not unsafe but it’s difficult at times. The feedback is taken but nothing seems to change.” Another staff member said, “I can raise any concerns or issues, sometimes we don’t get any feedback though.”

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. One staff member said, “In the 6 years I have worked here I have never felt unsafe. The Pathfinders community is a welcoming warm safe environment that I think we can be proud of. All the external students that we accommodate on placements here always commented how welcoming and comfortable they feel throughout their placements,” and “I have had great support with training opportunities to further my career progression and feel a well-established member of our team/family here. I love the atmosphere we have, and all teams work fluidly together for the greater outcome of our patients. As far as job satisfaction goes, I will be working at Pathfinders Neurological Care Centre for many more years to come."

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. Throughout the assessment, the team requested copies of management audits and quality control monitoring processes, however we were not provided with any. This meant we could not be assured that all relevant referrals such as safeguarding’s were consistently reported or reviewed for lessons learned.

There did not appear to be any clear line of responsibility for regular auditing. Where the provider had received feedback about areas of improvement from other professional, no clear action plans had been developed and issues remained on this assessment.

The provider and registered manager were open and transparent about this area of concern and welcomed the feedback to allow and support them to develop and implement these systems to ensure methods were robust in identifying issues in the future.

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. While most professionals praised the level of complex care and support the provider was able to offer, some professionals told us they struggled to obtain documentation at times. Because of this, they were not always confident their professional recommendations were followed. For example, one professional said, “I would suggest that staff listen to my professional advice but may not always action it as requested. I have found some weeks after requesting certain actions happen this has not been the case, and no one has come back to me to advise of issues. If I had not followed up people would have been affected by the lack of responsiveness of staff.”

The provider did not always focus on continuous learning, innovation and improvement and encourage creative ways of delivering equality of experience, outcome and quality of life for people. The provider and management team missed multiple opportunities to identify and learn from incidents and concerns due to the lack of oversight and quality monitoring. At times the provider acknowledged that electronic monitoring processes and software issues had impeded this further. Where staff had raised issues and recorded concerns these had not always been acted upon and improvements had not been identified.

However as staff were supported with an extensive training package and had an in-depth knowledge of people needs and wishes they were able to keep people safe despite the lack of formal governance processes.