AA-I-Care - 35 Southwell

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 improvements. At this assessment the rating has changed to good.
This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had established a positive culture that was person-centred, transparent, inclusive and empowering. Managers and staff, we spoke with, demonstrated a good understanding of equality, diversity and human rights, and explained how they prioritised safe, high-quality, compassionate care. Managers shaped the culture by engaging with staff, people, their relatives and others important to them, and with other stakeholders. They told us they genuinely welcomed feedback, even if it was critical, and demonstrated what action had been taken in response. People were involved in or consulted about reviews of concerns, accidents, incidents and adverse events and in planning to prevent similar incidents in the future.

We received overwhelmingly positive feedback from staff about the management team. Staff told us that managers were available, consistent, supportive and led by example. The providers policies and service agreement plan clearly identified expectations of how staff should support people to live well, placing people at the centre of designing their care. This was evident in people’s feedback about care and language used by staff in daily entries and care plans. Comments from staff included, “The management [team] are working with us, and we continuously learn from each other about the best way to adapt our services to people’s aims, needs and strengths in realistic and accountable way.”

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.

Managers and leaders were not always knowledgeable about issues and priorities for the quality of services provided and did not access appropriate support and development in their role. They did not always identify their own learning and development needs and did not make plans to address these. This meant managers did not always keep up to date with all relevant changes, which meant they did not communicate these effectively to their team. For example, managers did not apply recent learnings from safety events and did not identify or assess risk associated with flammable creams and emollients.

Managers did not always understand the requirements and recommendations made by CQC. They were not always aware of their own limitations and did not always access support and independent scrutiny when required. Although the managers had a good understanding of CQC requirements, in particular, to notify us, and where appropriate the local safeguarding team, of incidents including potential safeguarding issues, disruption to the service and serious injury, this knowledge had not always been applied into practice.

Managers had an open and honest approach to our findings and feedback, and were committed to making immediate changes, for example when people did not have consent documents in place. We will assess sustainability of those improvements at the next inspection.

We received overwhelmingly positive feedback about the management team. Feedback we received from people, their relatives, staff and professionals showed that leaders were compassionate and inclusive. One professional commented, “Based on my professional experience with both [manager’s names], I consider the service to be well-led. They have consistently demonstrated responsiveness to concerns and a commitment to delivering high-quality, person-centred care.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider had policy and procedures in place to enable staff to actively raise concerns. Leaders were open to feedback, and staff felt supported and encouraged to speak up and raise concerns about the quality of care.

There was a positive culture of speaking up. All the staff we spoke with felt confident to actively raise concerns, without fear of detriment. Staff told us they felt listened too, and there was an open and honest culture. One member of staff told us, “I would report any concerns to the office immediately. They would take it further, if necessary.”

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 provider had an equal opportunities, equality and diversity policy in place, which was fully embedded in practice. People were supported by a diverse workforce from different cultures and backgrounds.

The manager engaged with staff to involve them with running the service. Management ensured equity of opportunity and experience for the workforce within their place of work, and throughout their employment. Staff felt they were treated fairly and with respect.

Staff were happy in their job. Staff told us they were supported at work, encouraged to question practices and suggest new ideas or initiatives to help continually improve their practice. Staff were also supported in their personal lives. Comments included, “I feel supported and appreciated by the management [team] which motivates me to give out my best. I had a very challenging client, but the managers were able to support me and give me kind words of encouragement.”

Staff morale was high, and all staff took pride in their work for AA-I-Care. Comments from staff included, “I'm proud to work for AA-I-Care and I will always recommend them to people. They do provide the best service in Dorset” and “I am proud to work for them, because they are passionate about the care they provide, respect their staff and appreciate hard work.”

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.

Governance, management and accountability arrangements were not always reliable and had been inconsistent. Systems for identifying, capturing and managing organisational risks and issues were not always effective and not all legal requirements were fully understood by leaders. Systems were not regularly reviewed. Quality assurance systems did not always operate effectively in helping to ensure people consistently received safe and good quality care and support.

Audits completed at provider level by the management team had not identified the shortfalls found within the inspection. When the provider’s quality assurance processes identified issues, this had not always led to improvements, and risk mitigation measures were either not implemented or were ineffective. For example, the last 3 monthly medicines audits identified gaps in medicines administration recording and incorrect codes used for not administering medication. This was still the case when we visited. The provider took immediate action and worked with the supplier of their electronic medication administration recording system to rectify this issue and improve recording. We will assess the effectiveness of the improvements implemented at the next inspection.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider was transparent, collaborative and open with all relevant external stakeholders and agencies. Staff worked in partnership with key organisations to support care provision, enable joined-up care, and improve people's experiences, health, and wellbeing. The provider established effective processes to ensure partnership working with people, relatives and health professionals was maintained. We received overwhelmingly positive feedback about working in partnership from all 3 health and social care professionals who responded to our request. Comments from partners included, “They advocate on behalf of the individual to try and achieve the best outcomes for them. They work with individuals to maximise their independence where possible and then approach and involve professionals as needed” and “I have found them to be professional and clear with actions and responses. They employ compassionate and hard-working carers who are dedicated to the care work they do. I have always found the management and live-in carers to be working to a high standard.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider ensured that people using the service, and their relatives were involved in developing and evaluating improvement and innovation initiatives. People were involved and consulted about reviews of concerns, accidents, incidents and adverse events and in planning to prevent similar incidents in the future.

People were supported to enjoy a full life and be active members of their community. The management team and staff had established links with professionals and organisations representing people with specific conditions. This ensured staff had current information on best practice for supporting people. For example, they worked with the Diabetic Nurse to develop a tailored meal plan to support diabetes management for a person.

The provider had invested in electronic care monitoring, so all care calls and the care provided was instantly available for review. They had ensured, where there were gaps in information, this was followed up to ensure people were safe. The manager was able to easily monitor people’s care from the electronic records and identify any areas that needed to be addressed and raised those with staff. There were processes to ensure that learning happened when things went wrong, and from examples of good practice.

The provider had strong external relationships that supported improvement and innovation. One professional told us, “They have effectively managed complex family dynamics, responding promptly to concerns and working proactively to resolve issues. The team has remained professional and resilient in difficult situations and circumstances under which other providers have withdrawn from the package of care. This reflects positively on their dedication and adaptability.”