Bramble Home Care LTD - Cinderford

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

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. The provider was in breach of the legal regulation relating to good governance. The provider was no longer in breach of this regulation. At this assessment the rating has remained Requires Improvement.

This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care

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 service had a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They understood the challenges and the needs of people and their communities. However, we identified further time was needed to embed the provider's values.

The manager told us, “I see and share the vision of the provider to improve the service. I have taken a lot of compliments from the clients. I think we can make the improvements needed to give excellent care. It's really about governance and we need the staff and value the staff.” The manager explained how they were aware of the current barriers to achieving their strategic goals and what actions they were taking to address these. For example, the service did not want to use agency staff, however as there have been recent staffing issues, some agency use had been required. Due to the recent change in management, the staff were not clear on how they promoted the values of the service. Staff felt comfortable with their roles but did not always indicate they felt part of a wider whole. Staff were optimistic the new manager would help foster greater focus on teamwork.

Leaders understood the context in which the service delivered care, treatment and support. They embodied the culture and values of their workforce and organisation. However, we identified some areas where further improvements were needed.

At the time of the assessment, there was no registered manager in post, and the manager was newly recruited. The new manager told us the importance of leading by example, ensuring staff felt supported and acting quickly on any issues they identified.

The manager had regular and on-going support during their induction and access to on-going development. There was a system in place for managers and staff to have regular contact with senior managers when they started work. Although the manager was new in post, they were supported by a long-standing group of staff in the office. The provider and registered manager demonstrated positive interpersonal qualities but lacked the systems, oversight and consistency required to ensure safe, well‑led care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff and people told us they were comfortable raising concerns. People knew how to contact the office and were aware of arrangements for out-of-hours.

The manager investigated concerns, whether relating to people using the service or staff members, sensitively and confidentially and lessons learnt were shared with staff. For example, a recent concern relating to potential financial abuse had been investigated and lessons learnt were shared with staff though a staff meeting and messaging system. The head of operations was the freedom to speak up champion of the service.

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.

Policies were in place to support workforce equality, diversity and inclusion, including flexible working arrangements. The manager had plans to introduce English language qualifications for staff whose first language was not English. This was a way to help staff improve their communication and recording skills.

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

The provider had internal audits and quality monitoring checks in place; however, these had not identified all the concerns we found at this assessment, for example, staff not staying for the full allocated time, poor management of medicines, care records and daily notes, using terminology which was not person-centred. While internal audits had begun to identify areas which required improvements, these had not been fully implemented at the time of the inspection. We found inconsistencies in monitoring of care plans where copied and pasted information was not addressed. The provider had recently introduced a new governance action plan, however this had not been fully implemented at the time of the assessment.

However, we did find there were appropriate systems and processes in place to ensure the manager was submitting notifications to CQC and making appropriate safeguarding referrals to the local authority.

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.

People told us the service supported them to access their local community and attend local groups. People told us, “I go to a local community centre twice a week, staff come and pick me up. I usually get a three-course meal and some cake” and “I go out into the local community at least three times a week.” Policies were in place which emphasised collaboration and continuous improvement.”

The service 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 contribute to safe, effective practice and research. However, we identified further time was needed to embed new practices

The provider was involved in multiple accreditation schemes and were members of both local and national groups for adult social care. The service employed staff who were ‘dementia leads’ and who wore a different coloured uniform to distinguish they had enhanced training. The head of operations had produced bespoke training guides for staff on their computer system to show staff using screen shots how to access and use different areas of their digital system. Regular robust quality assurance systems were not always in place to ensure there was oversight on care and support as we found shortfalls with risk assessments, medicine management and staff support. Lack of quality assurance systems meant it would be difficult to identify and act on shortfalls to ensure there was a culture of continuous improvement. Further learning and improvements are needed to ensure the delivery of consistent, safe and effective care.