Caring with Dignity 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 registered 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.

This service scored 57 (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. One relative reported feeling unheard, stating, “I don’t feel particularly listened to,” and noting they were unaware of surveys or formal opportunities to provide feedback. Feedback also highlighted concerns about continuity of carers and inconsistent communication, particularly affecting people with fluctuating needs. This suggested barriers which impacted the service’s ability to fully achieve its strategic goals and indicated a gap between internal processes and peoples lived experience.

Despite these concerns, the provider demonstrated some positive cultural values. Leaders described clear values centred on enabling people to remain at home safely, promoting independence, and respecting individual choice, with the registered manager stating the key values included, “There is no place like home” and emphasising empowerment and safe support. Leaders outlined strategic goals focused on growing the service and expanding provision for people with learning disabilities. Staff interviews reflected a generally supportive and collaborative culture, with several staff reporting good communication, effective teamwork and feeling supported by leaders, stating there were, “No concerns” and the team “Worked well together.” Meeting minutes showed leaders communicating changes and expectations across the service.

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. Leadership oversight did not consistently translate into positive experiences or sustained quality improvement. One relative reported not feeling listened to or being unaware of formal opportunities to provide feedback. Medicine documentation errors, inaccuracies in care plans and discrepancies within the electronic care system indicated governance arrangements were not always effective in identifying and addressing concerns promptly. Although leaders were described as approachable and supportive, governance processes were not always robust enough to prevent repeated shortfalls.

Despite these concerns, evidence from staff interviews indicated leaders were generally viewed as supportive, approachable and accessible. Staff reported receiving updates, supervision and access to meeting minutes, and described an open-door culture where they felt able to raise concerns. Induction processes included shadowing shifts to support competence before working independently, and policies outlined clear managerial responsibilities including training, supervision, safeguarding oversight and quality monitoring. Recruitment records reviewed were completed in line with requirements, demonstrating key employment checks were undertaken.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. There were systems in place to encourage openness, including a whistleblowing policy and accessible routes for reporting concerns. Staff told us they felt able to raise issues and were confident they would be listened to. One staff member explained they would report concerns directly to management and knew how to escalate externally if required, demonstrating awareness of both organisational and regulatory reporting expectations.

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.

Staff described being treated fairly and reported no concerns regarding discrimination or unequal treatment. Several staff stated they had, “No concerns” and felt the organisation treated them equitably. There was evidence reasonable adjustments were made for staff where required. Policies relating to recruitment, training, safeguarding and whistleblowing demonstrated leaders had established frameworks aligned with workforce equality, safety and best practice expectations.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. Governance arrangements were not effective in identifying and addressing significant risks. Serious concerns were found in relation to medicines management, including inaccurate electronic Medicine Administration Records, inconsistent recording of ‘as required’ medicines and conflicting staff accounts regarding administration practices. Care plan inaccuracies further demonstrated quality assurance systems were not robust and had failed to identify or rectify ongoing issues.

Despite these failings, the provider had governance systems in place, including spot checks, audits, team meetings and electronic monitoring systems intended to support oversight. Meeting minutes showed discussion of operational matters such as training, rotas, timekeeping and Personal Protective Equipment, and there was some review of electronic reports relating to visit times and missed calls, indicating an intention to monitor service delivery.

The provider maintained active partnerships with external professionals. Evidence demonstrated ongoing communication with health partners, enabling staff to stay informed about clinical changes. Staff reported contacting district nurses or allied health professionals when concerns arose, showing willingness to collaborate for better outcomes. Staff also discussed care plans with families and worked alongside relatives to coordinate care where needed, demonstrating community and family engagement.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. Improvements often appeared reactive rather than proactive, and recurring issues indicated lessons learned were not consistently applied or sustained across the service. For example, incidents and complaints were investigated and learning points were identified, such as clarifying staff should not undertake tasks outside the care plan, but this learning was not embedded consistently in medicines practice. Records showed repeated failures to document reasons for administering ‘as required’ medicines, highlighting gaps in the application of improvements.

Despite these shortcomings, the provider demonstrated some structured approaches to learning and improvement, particularly following the assessment. Leaders implemented an action plan including reviewing medicine management systems, conducting home visits to verify medicines accuracy, creating paper Medicine Administration Records to address electronic discrepancies, and updating care plans and risk assessments where errors were identified. Audits and responses to concerns were carried out, demonstrating an intention to monitor, review and improve practices across the service.