South Manchester Care 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 good. At this assessment the rating has changed to 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 legal regulation in relation to governance at the service.

This service scored 29 (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 shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The provider failed to share relevant safeguarding information with CQC and did not consistently report safeguarding concerns to local authorities in a timely manner. Staff feedback reflected these concerns. One staff member told us they had raised concerns about a person receiving care but did not believe the information had been passed to social workers.

These findings demonstrated a closed culture in which leaders did not consistently share information and staff lacked confidence that managers would act on concerns raised. This increased the risk safeguarding concerns were not identified, escalated or addressed appropriately.

As a result, people's safety relied too heavily on the actions of individual care staff rather than effective leadership oversight, robust governance systems, and an open and transparent culture which promoted accountability and learning.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Not all leaders were able to demonstrate sufficient knowledge of whether people using the service received a regulated activity. Leaders told us they understood their responsibility to report concerns but had failed to do so because they experienced difficulties with electronic systems. They had not explored alternative methods to submit information. This reduced our confidence in their ability to maintain effective oversight of the service. These findings did not assure us leaders had the necessary skills to manage the service effectively.

Staff and family members also raised concerns about leadership, communication and operational management. One family member described the impact of poor rota management and communication relating to planned activities. They told us, “The carers aren’t always told what activity it is so they may not have a swimming kit, and sometimes one carer hasn’t been told but the other has. The manager should tell them what they need to bring. This should’ve been ironed out in a couple of months and not be ongoing as it is. The activities, when they are cancelled, makes me feel[name]is a low priority because that’s how it feels.”

Another person described concerns about the reliability of staff attendance and the impact this had on their ability to plan activities. They told us, “The (carers) are not always reliable so I have to check if the staff are going to turn up as I have to buy tickets and if they aren’t coming it becomes very expensive. So, it’s still a concern to check if the day is going ahead.”

This feedback demonstrated the ongoing impact poor communication, ineffective leadership and inconsistent management arrangements had on people's experiences of care and support.

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

Although the provider had a Freedom to Speak Up policy and included speaking up training within staff induction, staff experiences of raising concerns were mixed. Some staff told us managers were approachable and listened to concerns. However, other staff described barriers to speaking up and raised concerns about how managers responded to feedback.

One staff member told us, “I would be careful what I spoke to them about, they can be unpleasant.” Another said, “The company sweep it under the table, you tell the management and they just say do what you can… We are not being listened to.”

This feedback did not reflect a positive speaking-up culture and indicated elements of a closed culture within the service. When staff do not feel safe, supported or confident to raise concerns, there is an increased risk issues affecting people's safety and quality of care are not identified and addressed promptly.

As a result, the provider could not demonstrate concerns were consistently used to drive learning ,improvement and safer care.

The provider did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider employed a culturally diverse workforce. However, we found limited evidence leaders actively recognised, valued or embedded this diversity within organisational practices, policies or culture.

Staff raised concerns about how the provider treated some employees. Staff told us certain employees were being "pressurised" or "bullied" into passing a driving test within a specified time frame or risk losing their employment. Other staff reported being told raising concerns about rota arrangements could result in them being removed from shifts. These accounts suggested some staff did not feel able to raise concerns without fear of negative consequences.

The provider's Equality, Diversity and Inclusion(EDI)policy had not been reviewed. The policy contained outdated terminology relating toa certain group of people and did not reflect current inclusive language or best practice.

The policy focused primarily on the historical context of EDI and provided limited practical guidance for staff. For example, it did not clearly define individual responsibilities, expectations for promoting inclusion, or processes for reporting discrimination, harassment or concerns. As a result, the policy did not provide staff with an effective framework to support an inclusive and respectful workplace culture.

Taken together, these findings demonstrated leaders had not embedded EDI principles across the organisation. This limited their ability to create a culture where staff felt valued, respected and empowered to contribute to service improvement.

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.

Although governance and audit processes were in place, they failed to identify significant and widespread concerns. Audits had not identified where care documents did not reflect people's current needs and risks. Medicines audits also failed to identify inaccuracies in medicines records.

Recruitment governance was ineffective, with significant shortcomings in recruitment processes demonstrating poor quality assurance. Leaders had also not ensured staff completed mandatory training, and competency assessments for clinical tasks had not been completed by suitably qualified staff.

Governance systems failed to identify significant concerns with care records. Daily records were frequently poor quality, repetitive and task-focused rather than person-centred.

Local authorities raised concerns about communication, information sharing, oversight of care delivery and the quality of information provided. One local authority reported incidents were not always communicated promptly, and family members sometimes informed them before the provider. Concerns were also raised about inconsistent care, frequent last-minute staffing changes and staff supporting children without sufficient knowledge of their needs.

The provider's policies and procedures did not support effective governance. Several were out of date, inaccurate or lacked clear guidance for staff. Leaders had not ensured policies reflected current legislation, best practice guidance or operational arrangements, increasing the risk of inconsistent practice and poor decision-making.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

Three partner organisations raised concerns about communication and information sharing. One local authority had withdrawn all care packages from the provider. Another local authority had removed a package of care because of concerns about the provider's performance.

One local authority told us the provider had not always reported incidents promptly and had sometimes shared information well after events occurred. This raised concerns about the provider's openness, transparency and ability to communicate significant events effectively.

The provider did not consistently collaborate with external professionals to ensure important information was shared in a timely manner. As a result, partner agencies could not always maintain oversight of risks, monitor care quality or respond promptly to emerging concerns.

These failings demonstrated ineffective partnership working and reduced opportunities for joined-up care, shared learning and service improvement. The concerns raised consistently across multiple organisations demonstrated a sustained failure to work collaboratively and transparently with external agencies. This reduced confidence in the provider's governance arrangements and their ability to achieve positive outcomes for people.

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.

Leaders failed to use governance processes, incidents and feedback effectively to identify learning opportunities and drive improvement. Audit systems did not identify concerns, and leaders did not consistently review incidents to identify trends, lessons learned or opportunities to reduce risk.

The provider did not demonstrate learning was shared with staff or embedded into practice. As a result, known risks and concerns remained unresolved, limiting opportunities to improve the quality and safety of care.

These failings demonstrated leaders could not effectively use information, feedback or learning to improve outcomes for people or support staff to deliver high-quality care.