Cheshire Support Services

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.

This is the first assessment for this newly registered 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 provider was in breach of legal regulations in relation to good governance.

This service scored 36 (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 and leaders had not created a positive and inclusive culture that supported the delivery of high-quality care. For example, roles and responsibilities were not clearly defined. When we requested information, there were inconsistencies about who held oversight and responsibility for key systems and processes, including medication audits. A range of policies and procedures were in place. However, we found the provider was not always working to these policies, examples include care and support planning, audits and medication policies.

There was limited management visibility in the service. Leaders were not always present to provide support, oversight and direction. Staff consistently described a negative working environment with some referring to the culture as ‘toxic’. Staff told us there was a lack of clarity regarding their responsibilities which created confusion and inconsistency in practice.

We shared our findings with the registered manager, and they demonstrated their commitment to improving the culture and shared future plans for increasing management presence in the office.

The provider had an inclusive leader, but they did not always understand the context in which they delivered care, treatment and support. For example, adequate quality assurance systems had not been implemented to ensure people’s care mitigated risks to their health, safety and wellbeing. Shortfalls were identified in areas such as care planning, assessing risk, staff training and medicines management. This did not demonstrate the provider fully understood the regulatory context in which they delivered care, treatment and support.

However, we felt assured the registered manager listened to regulatory feedback and demonstrated they had the right skills and experience to drive positive change in the service.

People did not always feel they could speak up and their voice would be heard. While policies were in place to guide staff on how to speak up, some staff told us where they had raised issues relating to their employment they had not always been acted upon. For example, when staff reported feeling under pressure due to workload demands and staffing challenges, our review of call data confirmed a lack of robust contingency plans were implemented to ease these pressures.

However, people and their relatives told us they felt confident if they raised concerns leaders would take the right action.

The provider did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them. For example, our observations and discussions with staff identified the provider had not promoted a culture where all staff felt included, valued and supported. Staff described division within the workforce and told us relationships with colleagues had deteriorated. They spoke of a breakdown in professional relationships which negatively impacted, teamwork and morale.

The provider did not implement effective governance systems. They did not act on the best information about risk, performance and outcomes.

Auditing processes were either not in place or not effective. Systems and processes did not enable the provider to identify where quality and/or safety were being compromised to ensure they could respond appropriately and without delay. We identified shortfalls in assessment, care planning, risk management, medicines, staffing and governance. There was currently no robust process in place to audit medicines or call data and care planning audits were several months out of date.

The absence of effective audits increased the risk to people as there was no manager oversight or assurance care was being delivered in line with people’s needs. Opportunities to identify concerns were missed, as evidenced by our findings.

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. The provider worked in partnership with the Local Authority, hospitals and other community partners to accept referrals into the service for people who required support in their own homes. We identified information shared by professionals in relation to people’s care needs was not always reflected within their individual care plans. For 1 person, we found evidence call times and support tasks had been amended without discussion and agreement with the relevant partners.

However, feedback from external professionals was positive in respect of partnership working. Comments included, “Cheshire Support Services engaged with the relevant professionals, and I personally feel we have built a good working partnership."

The provider did not focus on continuous learning, and they did not implement effective systems to promote positive outcomes for people. For example, a service improvement plan had been developed, but this plan failed to identify the extent of the shortfalls found at this assessment or the severity of risk these shortfalls posed to people. Where concerns had been identified, there was a lack of timely action taken to improve the overall quality and safety of the service.

However, the provider responded positively to CQC feedback demonstrating a clear commitment to develop more effective systems to improve the service. They outlined a series of actions they would take to ensure the culture and delivery of care met regulatory requirements.