Archived: Care at Hand 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.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained 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 and the submission of statutory notifications to CQC.

This service scored 46 (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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

We received mixed feedback about the culture of the service, with many staff sharing changes to management and processes had negatively impacted them in their work. A member of staff told us, “I don’t have any involvement in the management at all. We have all received a mission statement only recently. Since the management team are based 100 miles away, we do not have any communication unless they want something or there is an issue with rotas or clients.” Another member of staff told us, “I’m just confused, I don’t know who we are working for.”

The provider had a service user guide and statement of purpose. However, it was not clear how this was shared with people and staff. We found both documents required review due to both containing inaccurate information regarding the service address, the management structure and the registered manager post being vacant.

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 integrity, openness and honesty.

We received mixed feedback from people and staff regarding their experiences of management and leaders at the service. Whilst some expressed no concerns and would recommend the service to others, other people and staff expressed concerns and a feeling of disconnection. A person told us, “I am happy with them and have nothing to complain about. I would recommend this agency to other people.” Another person told us, “I have never met anyone from the office although I have spoken with a few of them, sometimes they are helpful and sometimes not. I have not had to ever do a feedback form or been asked over the phone about how it is going.” A member of staff told us, “We’ve lost the manager. You can’t co-ordinate with an office so far away when they’re not involved. We are all confused.”

The service did not have a registered manager in post. At the time of this assessment the position had been vacant since May 2025. The nominated individual was managing the service on a day-to-day basis, along with input and support from senior staff from another service where they were registered. The nominated individual intended on applying to be the registered manager but had not yet submitted an application.

It was clear from the feedback we received and the findings of our assessment changes in management and the operation of processes at the service had created instability. By failing to have effective oversight of the service, the nominated individual had not ensured the service was running safely or ensure action was taken where needed to make improvements.

People did not always feel they could speak up and that their voice would be heard.

We received mixed feedback from people. A person told us, “Management are very good at listening.” Another person told us, “[Name of staff member] from the office came recently to see if I am happy with the service. Nothing has changed as a result of what I told [them] which was [the same concerns] I am telling you now. I believe the manager has left and that [staff member] that I spoke to was the new manager but [they don’t] seem to have made any changes yet.”

Staff also shared differing feedback. A member of staff told us, “I feel that I can (speak up) even though I feel there is a lack of support due to their (managers) location.” Another member of staff told us, “I wouldn’t know who to speak up to these days.”

The nominated individual shared with us recent feedback from telephone surveys conducted with people. They had summarised the findings stating, ‘Most clients expressed satisfaction with their care overall.’ We reviewed the individual feedback received, and with the exception of one person, all others had raised concerns. It was not clear how the nominated individual had determined most people had expressed satisfaction.

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 service had a diverse workforce.

The provider had policies in place to support equality, diversity and inclusion.

Staff meetings, surveys and supervision had not consistently been completed. However, where they had been completed, these provided opportunities for staff to provide feedback on their experiences.

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.

The provider’s processes to monitor the safety of the service were not effective. Quality assurances checks and audits were undertaken, but these were not being completed accurately by the nominated individual. As a result, failings found at this assessment had not been identified or acted upon and the provider was in breach of 4 regulations. This included the provider having not notified the CQC of all safeguarding incidents, as described in the Safe section of this report, which is a legal requirement.

The service had an improvement plan which had been drawn up following internal audits and checks undertaken. Due to the inaccuracy of the audits and checks completed, we found the actions would not address the failings we found. The local authority had completed a review of the quality and safety of the service in July 2025 and found concerns with the quality and safety of service delivery. They determined a high number of improvement actions were required. These findings were not included in the service improvement plan, and actions had not been completed to address the concerns shared with the provider in the 2 months prior to this assessment being undertaken.

The nominated individual shared with us the most recent audit completed on behalf of the provider. This stated the audit was completed ‘based on evidence gathered through audits, surveys, logs, and feedback during August - September 2025.’ The summary concluded, ‘This provider-led audit confirms that systems are in place to monitor safeguarding, medication, training, care planning, staff support, and feedback. Issues identified were acted on promptly, with clear evidence of governance and service improvement.’ This was in stark contrast to the findings of this assessment.

Staff told us they knew their roles and what was expected of them. However, we received mixed feedback regarding the management processes with most staff not able to confirm any part where they felt able to contribute in driving improvements at the service.

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.

Care plans and associated records did not demonstrate involvement with partner agencies, or collaborative working with people and those important to them as limited information was included.

Feedback was limited from partner agencies and people’s relatives. However, a relative told us, “I had a meeting with [local authority team] about a month ago as [person] cannot articulate what is going on regarding me having access to [care records application] so I can see what goes on. When it (recording of care) was done via paperwork it was all so much easier to monitor. One of [their] carers is marvellous and keeps me informed but the company don’t contact me at all.”

The provider did not always focus on continuous learning and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Processes were failing to ensure learning happened when things went wrong. As described in other areas of this report, inaccuracies in information, audits and checks were not leading to improvements being made where needed.

Systems were not ensuring the care provided to people was consistently positive and safe, and that all reasonable steps had been taken to mitigate risk. The provider failed to ensure people, relatives, and staff were involved in developing and improving the service. A member of staff told us, “I have, and do give ideas and feedback. As they (management) do not know the clients I would expect them to use my knowledge, but they don’t.”