1-2-1 Live In Care Ltd

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• 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

During this assessment we found the service management and leadership and the oversight of the quality monitoring systems was not consistent.

Systems of oversight of the service were either not in place or not always effective and robust to assess, monitor and improve the quality of care people received. This was a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Feeback from staff and people was very positive in relation to the management of the service. Staff felt well supported and people complimented the responsiveness of the management team.

One relative told us; “The management are as `good as gold`, no problems at all and any questions are answered within 2/3 hours! They make sure he is well looked after and comfortable and his welfare and needs are met. I would 100% recommend, they don’t leave you in the lurch, they are very efficient and whatever they say they will do. I would Highly Recommend!!”

Healthcare professionals working with the service who provided feedback to us were equally complimentary of the management of 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.

Staff were clear of the vision and values of the service and confident in relaying this to us. One staff member told us; “They promote dignity, respect and make sure families are involved as we ourselves are if we need to.” Another staff member described the service as; “Enable people to live at home and have the assistance they need to do this. Respect, duty of care, open choices, respect home and always put their (people’s) care paramount.”

The service had a statement of purpose which described the vision and values of the service. The services guide for clients described the mission of the service as; “To provide outstanding care that we would expect for our own family and be valued, recognised and remunerated for doing a great job.”

Managers and staff were passionate about delivering quality care and support and promote a positive culture. Their approach aimed to achieve good outcomes for people.

Staff unanimously told us they fell well supported by the management team. They also told us that they felt listened to and able to provide feedback. One staff member told us; “They (management team) are really good, supportive and understanding. Really easy to talk to.” Another staff member told us; “They are always there when we need them.”

The deputy manager told us they were proud they knew all their clients and staff well. They said they did not just want to be a good care company, but somewhere where everyone matters and they felt they mattered.

The provider understood the requirements of the duty of candour. This is their duty to be honest and open about any accident or incident that had caused or placed a person at risk of harm.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our assessment there was a registered manager in post.

The service had a management structure in place with defined roles and responsibilities. From the beginning of the assessment the registered manager discussed with us about a sad event which impacted on the management cover of the service for the last couple of months. They were in the process of recruiting for another member of staff for the office team.

There was a schedule of quality assurance systems in place to support the management team review and assess the service delivery. However, the processes which were in place to ensure oversight and quality assurance were not always robust or in place.

Staff were confident to speak up should they needed to and were confident action would be taken, this included any whistleblowing concerns.

The service had systems in place for staff, people and their relatives to raise any concerns or make comments. Feedback we received from people and their relatives indicated that when concerns have been raised, the management team took action without delay and resolved these favourably.

The management team provided us with examples of how they supported people in their roles and in their personal life. For example, the deputy manager told us about creating a cookbook for a staff member whose cultural roots were different from the client they were supporting, to aid them in their work. Other examples included support with religious beliefs.

Staff also discussed with us the flexibility the service was offering them in relation to providing them with a rota which supported their desired work/ life balance.

The service promoted fair and equitable treatment of staff. Training and development opportunities were available to everyone. One staff member told us that if they were to identify they needed specific training, the management team would facilitate this. The service had flexible working arrangements in place for staff.

Staff provided positive feedback about the management of the service and found them supportive.

Some systems were in place to monitor the quality of care and service provided to people, however these was not effective in identifying the shortfalls we found during the assessment, for example in relation to care documentation. The service was monitoring accidents and incidents and qualifying, for example the number of falls, however this was not person specific, so there was no evidence how any patterns were monitored and what action had been taken. Audits identified actions, however there was no evidence if these actions had been completed. Some of the actions were re-occurring but there was no evidence of how these have been addressed so they do not re-occur, one of the examples being medicines audits. The oversight of training, supervision and observation of practice was not robust enough to assure the registered manager these needs were met. Policies and procedures were guiding leaders on systems and processes they should have in place; however, these were not always followed. For example, in relation to medicines and risk management. The recruitment policy did not reflect regulation requirements. We discussed with the registered manager about the benefits of adopting a service improvement plan (SIP) to assist them to monitor improvements. A SIP can be used to record all actions needed for improvement and provide information about how and when those actions are due to be completed and if they have been completed. Systems of oversight of the service were either not in place or not always effective and robust to assess, monitor and improve the quality of care people received. This was a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager took our feedback on board and started looking into the concerns we highlighted to them.

People and their relatives did not share any concerns in this area.

Staff and the management team told us they worked in partnership with other organisations such as healthcare professionals and commissioners to support the care provision. Records showed evidence of this joined up work.

We received positive feedback from healthcare professionals working with the service. One professional told us; “The contact I had with [registered manager] was very professional, informative and timely. Another said; “Out of all the agencies I have dealt with over my 25+ years working as a [job title], this agency shines above the rest.”

The provider worked in partnership with other key stakeholders. This included the local authorities who commissioned packages of care with the provider, as well as other healthcare professionals.

The registered manager told us that, for example, learning from any accidents or incidents would be discussed with individual staff through supervision, reflecting on what could have been done differently and what action would be taken if this was to re-occur.

The deputy manager told us that they recognised there was always room for improvement and that they would be able to improve a lot following our assessment.

One staff member told us that learning was very good in the service. They said, “If we have an incident, they (management team) are good at offering support.”

Following our feedback, the registered manager confirmed they had identified some learning. They told us; “I think some of the information you’ve given me has been really helpful and we can make a lot of amendments and how we do things and evidence things clearly, we need to do better.”

The service had a system in place to seek feedback from people, both formally and informally. In 2023 the service sought feedback formally from people, however where improvement had been identified, we have not seen evidence of an action plan and how any actions had been addressed so the service provided could be improved. Meetings were taking place within the management team and the service had started to implement virtual team meetings for staff. The registered manager told us that e-mail correspondence and memos were being sent to staff when they needed to communicate updates. The service did not have a robust system in place to share learning with the staffing team. While meetings were taking place within the management team and a handover process was in place for individual clients when staff changed over, we did not see any evidence of how staff were being kept up to date with any learning across the service. The service's quality monitoring systems were not always being used effectively to promote continuous learning and improvement and ensure evidence based practice and good practice guidance was imbedded in the service. People and their relatives confirmed that the service was responsive to their feedback and provided examples of individual changes which had been made to the service they received.