QUALITY LIVING CARE LIMITED

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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

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 inadequate.

This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of 1 legal regulation in relation to good governance at this service.

This service scored 32 (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 an effective system to ensure equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

In their failure to take consistent and timely action in response to risks and concerns, the provider had not prioritised safe and high-quality care or the promotion of a culture focused on learning and improvement.

Staff meetings, supervisions and spot checks had not been completed robustly for all staff to effectively identify where additional staff support was required. These had not been completed for all staff and followed up once additional support or learning was required. For some staff we spoke with, we found their ability to tell us about their learning from training was limited demonstrating a lack of knowledge and understanding. This meant we could not be assured the current training met the needs of all staff.

Procedures in place for developing and reviewing people’s care plans did not demonstrate a fully inclusive and collaborative process.

The provider’s training for staff did not reflect people’s individual needs or fully promote equality and diversity. We found risk assessment and care planning processes did not fully reflect or acknowledge people’s individual needs or risks and required further development.

The registered manager told us they welcomed and supported an open culture which staff confirmed in their feedback to us. Staff had not received training in recognising closed cultures and could not effectively tell us what they would do if they witnessed poor practice by the registered manager and how they would escalate this. They said they were confident if they reported concerns, that it would be acted on by management. People and relatives told us staff were kind and compassionate.

The provider did not have leaders who understood the context in which they delivered care, treatment and support. Leaders did not have the skills, knowledge, experience to lead effectively.

During our assessment the registered manager engaged with us during the onsite visit, feedback on our findings and responded to our requests for information. However, due to a lack of organisation and poor systems and processes in place some information had to be requested up to 3 times. The registered manager was receptive to our feedback and took some steps to immediately improve shortfalls which we identified during the assessment. They told us that they were glad we had been out as they had learnt what they need to do now. This did not demonstrate a robust understanding of their regulatory requirements associated with their role.

Actions identified from audits the provider had completed were not added to any action plan. We found the provider could not demonstrate that some required actions in relation to improvements in staff knowledge had been completed in a timely way or even at all.

The registered manager presented us with a number of audits, all of which were undated. This meant we could not be assured of when these had been completed. However, we found many of these to be ineffective in identifying where actions were required or ensuring actions were completed. This meant shortfalls and priorities for the quality and safety of people’s care had not been improved. We found where the registered manager had delegated tasks to other office staff, they failed to ensure that team members had the appropriate skills, knowledge and support to carry these out effectively. For example, the senior carer had additional duties but had not been trained or supervised in carrying out these tasks.

Supervisions which had been completed included discussions with staff around training to carry out their roles and provided the opportunity for staff to identify additional support or development needs they may have. However, the registered manager could not demonstrate they had carried out such supervisions with all staff, in line with their own policy.

People and their relatives told us they knew who the registered manager was and spoke positively overall about them telling us they were approachable.

Staff told us they felt supported and valued by the registered manager and understood their roles and responsibilities.

The providers lack of systems and guidance did not demonstrate they gave people the opportunity to speak up, be listened to and act upon information.

The provider’s approach in gathering feedback from people to give them the opportunity to share any concerns they may have was not fully effective.

We saw feedback had been gathered but was not analysed to identify themes and trends. Some people or their relatives told us they had not been asked for their feedback.

The provider did not implement a whistleblowing policy until we requested this. This meant we could not be assured they had a process to follow if staff or people spoke up and that their voice would be heard.

The staff training records did not demonstrate staff had received whistleblowing training and not all could tell us what whistleblowing meant. Not all staff knew how to escalate concerns should the registered manager or provider not take any actions.

Staff told us they could raise concerns with the registered manager at any time and felt they would be listened to and actions taken.

The provider did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider did not demonstrate a clear knowledge and understanding of workforce equality and diversity. There was no policy in place, and the registered manager could not evidence they had assessed staff members diversity to ensure inclusivity. The registered manager failed to effectively and proactively engage in the gathering of information in relation to identifying if staff members had any protected characteristics. This meant the provider could not demonstrate they worked with staff members to promote and support equality in the workplace.

Although records demonstrated staff received training, we found this training was not adequate to ensure they had the appropriate skills to safely fulfil their roles and meet all people’s known support requirements and needs.

We saw from records provided staff had not received equality and diversity training to improve their awareness of these principles. In addition, the provider had failed to implement a robust process to assess staff knowledge and skills and how they applied this in the service. The registered manager told us if staff required additional support with learning, they would facilitate this. However, we found there were some shortfalls in staff members’ ability to describe their learning and understanding of certain key topics. We saw and were told there had been some consideration and adjustments made to how staff training was delivered, which was mostly on-line. For 1 staff member who required additional support we saw they had received this to support in building their confidence with personal care needs. Our findings demonstrated further improvements were required to staff training to demonstrate they were effective.

Staff told us they were happy working for the provider.

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, or share this securely with others when appropriate.

The provider failed to implement effective processes and systems to monitor the quality of care provided and drive improvements. Audits which had been completed had not identified the concerns we found in the service, and so we could not be assured these were effective. For example, we found inaccurate and unclear information in some people's care and risk management plans. There was poor guidance for staff on, and oversight of, medicines management, and a lack of effective monitoring. The ineffectiveness of their procedures meant opportunities to drive improvement in the service to benefit people and ensure their safety had been missed.

We saw the provider had failed to fully assess environmental risks and implement suitable assessments. Policies and procedures were not consistently implemented in the service or accessible to staff. We found in many areas the provider failed to adhere to their own policies. This meant their actions were not always fully reflective of current legislation.

The provider did not complete comprehensive staff recruitment checks which was unsafe. This included a failure to consistently explore gaps in employment or obtain suitable references.

The effectiveness of staff training was not assessed, and there was a lack of checks to demonstrate staff were competent to carry out their roles. The lack of oversight by the provider meant they could not assure themselves that staff were skilled and had the necessary knowledge to undertake their job roles safely.

We found support plans and risk assessments did not contain adequate information and they were not formally or effectively audited, as demonstrated by the discrepancies and missing information we found. This meant people were placed at risk as the provider's systems failed to provide staff members with robust information to keep people safe.

The provider had considered how the service would continue to operate in the event of staffing levels being affected. However, their business continuity plan included out of date information such as staff members who could support in the event of an emergency. This meant we could not be assured that people’s calls would still be fulfilled and their care needs met.

Whilst we recognise the provider was receptive and responsive to our findings during this assessment, the systems in place should have been comprehensive enough to identify the shortfalls in the service and enable them to make the necessary improvements.

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.

The involvement of healthcare professionals such as district nurses or equipment providers was not always recorded in people’s care records. Neither was it clear how the provider engaged with others, so people could remain safe and independent.

Staff told us they could make referrals to health and social care professionals via the management team. Relatives we spoke with, and the provider confirmed, relevant health and social care professionals were involved with people’s care. A relative told us how they liaised with health professionals for their loved one then updated the staff.

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

The lack of effective or robust systems and processes to monitor the safety and delivery of services did not demonstrate there was a system to identify shortfalls and take lessons learnt from such findings.

There were shortfalls in the quality and safety of people’s care which were identified at this assessment. Our assessment identified breaches of good governance, gaining consent, safe care, staffing and fit and proper persons employed.