Social Care Solutions (Raunds)

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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 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 good governance. The provider has failed to have sufficient governance and oversight arrangements in place to ensure systems and processes were effective to assess, monitor and improve the quality and safety of the care and support to service users.

This service scored 50 (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 from staff about the culture of the service. A staff member told us, “I love the job here. Working with people with a learning disability is really rewarding. Making people’s lives easier and putting smiles on their faces is a wonderful feeling.” Another staff member told us, “I feel Lifeways do care, but it has been difficult with the different managers, and I’ve not always felt supported.”

Staff knew the provider’s vision and values (CHOICE - caring, honest, one team, innovative, courageous and equal). However, we found these had not always been role modelled in the service by local leaders, and this had impacted on the culture of the service. Staff told us, “The dynamic was very toxic, it didn't feel like we were working together as a team,” and “Sometimes the culture is more reactional as opposed to it being a culture.” [Of collaboration]. Another staff member told us, “There was favouritism [from leaders] with residents and issues with professional boundaries.

Although the service had been through a challenging period, staff acknowledged there had been some improvement in the culture leading up to the commencement of the assessment. A staff member told us, “Things have improved - more is needed but we are a lot better.”

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.

At the time of the assessment there was a manager registered with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. However, the manager was absent from the service during our assessment.

We received mixed feedback in relation to the leadership and management of the service. The leadership of the service had been inconsistent and led to a decline in the culture of the service. A staff member told us, “You [staff] were just ignored when you raised issues, I was mentally and physically exhausted.” Another staff member told us, “It [the service] was unstructured and there were a lots of issues.” We were also told, “There was no respect for the team. [Manager] didn't listen.” and things were, "Brushed to the side." A relative who shared feedback on the management of the service told us, “Half the time the office [was] shut, and no one is in it.”

The provider had arranged temporary management cover for the service leading up to this assessment and the service was being supported by an experienced registered manager from another service and the area manager. The interim arrangements had been seen as a positive and supportive step by the staff team. A staff member told us, “The [interim manager] had addressed concerns, and you feel listened to.” Another staff member told us, “The [interim manager] was better and tackling issues.” We were also told, “[interim manager] Helped me a lot as covering manager, [interim manager] make time for me.”

Team leaders had been consistent during a challenging period at the service, and a staff member told us, “Team Leaders have been quite helpful and motivational.” Staff acknowledged there had been some improvements in the leadership leading up to this assessment, however, staff expressed uncertainty about the future management arrangements for the service.

Although interim arrangements were in place we found the leadership had been inconsistent and this had impacted the overall governance and culture of the service. Improvements were being made; however, more time was needed to embed and sustain a new management structure.

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

We received mixed feedback from staff in relation to leaders not always taking action to improve the experience of staff with protected equality characteristics. A staff member told us, “I don't think managers have always dealt with it appropriately.” Another staff member told us, “I have not always felt protected, and it gets blown over.”

The interim manager and area manager were aware of some concerns and were addressing these. We did not find any indication that the provider was deliberately devaluing their workforce. However, more work was required to evidence the support offered to staff and action taken to address concerns.

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

We received mixed feedback from staff in relation to leaders not always taking action to improve the experience of staff with protected equality characteristics. A staff member told us, “I don't think managers have always dealt with it appropriately.” Another staff member told us, “I have not always felt protected, and it gets blown over.”

The interim manager and area manager were aware of some concerns and were addressing these. We did not find any indication that the provider was deliberately devaluing their workforce. However, more work was required to evidence the support offered to staff and action taken to address concerns.

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

The provider had systems and processes to assess and monitor the quality and safety of the service (described in quality and compliance policy), however, oversight arrangements of these locally had failed to implement these effectively. This meant the provider had failed to assess, monitor and make improvements to the service and had not identified all the shortfalls we found during our assessment.

Audits completed by the service were not effective. We found all the audits shared with us during the assessment had scored 100% and had not been used as an effective tool to monitor the quality and safety of the service.

The area manager was new in post and was in the process of establishing themselves and told us they would be completing regular audits. The area manager also told us they had requested a provider audit from the quality team to establish a baseline for the service.

There was a business continuity plan and staff were able to tell us where they would access this in an emergency.

Our assessment found shortfalls in relation to the quality of the service, and we found these meant there was a regulatory breach in relation to good governance. The provider has failed to have sufficient governance and oversight arrangements in place to ensure systems and processes were effective to assess, monitor and improve the quality and safety of the care and support to people accessing 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.

We received mixed feedback from professionals who worked with the service. A social worker told us, “Communication from managers needs to improve”. Another professional told us, “I was unable to reach anyone at the service and my emails were not being answered”.

The local authority had increased monitoring of the care provided by the service due to the recent leadership concerns.

The provider did not always focus on continuous learning, innovation 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.

The provider, managers and staff recognised the importance of learning lessons from incidents, audits and feedback, as an opportunity to improve the service and people’s quality of life. However, we found audits had not been used to drive learning and improvement and quality assurance processes such as the provider’s tiered governance system had not been used effectively. For example, all the audits shared with us during the assessment had scored 100% and not identified the shortfalls we found during this assessment.

The provider told us that they had conducted a lessons learned review and progress was being made to implement changes following assessments completed by CQC at other locations. For example, an Operational Leaders programme had been rolled out and this was now being adapted for Team Leader development. Improvements were also being made to the systems and processes to ensure people’s specific health needs had been identified and staff provided with adequate training.

We found more work was required to embed the culture of learning, improvement and innovation locally. However, new leaders were in place and committed to driving change and improvement.

We found the interim manager and area manager to be receptive to feedback, enthusiastic about the future and they expressed a willingness to make improvements in the service.