Continuity Health Care Services PVT 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 inadequate. At this assessment the rating has changed to 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 remained in breach of legal regulation in relation governance at the service.

This service scored 46 (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 not yet fostered a culture of continuous learning and improvement. While some improvements had been made since the previous assessment, concerns remained in relation to the quality and oversight of care. Governance and quality assurance systems had not been effective in identifying and addressing all areas of concern, including issues previously highlighted. As a result, improvements had not been consistently embedded in practice, and the provider could not demonstrate that learning was being used effectively to drive sustained improvements and better outcomes for people.

Leaders did not demonstrate the skills, knowledge and oversight required to lead the service effectively and ensure people received safe, high-quality care.

The registered manager was not always able to provide assurance regarding key aspects of service delivery and relied heavily on the manager of another service to explain operational processes and provide information during the assessment. In addition, the registered manager depended significantly on senior office staff to undertake audits and quality assurance activities. These staff had also been responsible for oversight arrangements at the previous assessment; however, they had continued to fail to identify, escalate and address concerns that were subsequently identified during this assessment.

Despite some actions being taken following the previous assessment, improvements had been slow and insufficient to achieve sustained positive change. Concerns identified at the last assessment remained evident, demonstrating that learning had not been embedded and oversight had not been effective. While additional processes and monitoring systems had been introduced, these had not translated into improved practice or outcomes for people and had failed to provide the registered manager with an accurate understanding of the quality and safety of the service.

The provider's governance arrangements were ineffective in identifying and responding to risks. Concerns found during this assessment had not been recognised through the provider's own quality assurance systems, raising concerns about provider's understanding of the service and their ability to drive improvement. These included failures in incident oversight, risk management and care planning, where records did not consistently reflect people's current needs, risks and changing circumstances. The provider had not ensured incidents were subject to effective review and analysis to identify trends, learning or opportunities to reduce risk. As a result, leaders could not demonstrate they had sufficient oversight of the service, and people were exposed to the risk of receiving inconsistent and potentially unsafe care.

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

Staff and people told us they felt able to raise concerns and were confident these would be listened to. There were opportunities for staff to share feedback, raise concerns and discuss issues affecting their work through staff meetings and ongoing communication with managers. Staff told us they felt able to speak up and were confident their views would be listened to. A staff member told us, “We have teammeetings where we speak with managers.” Another said, “I think thingsare ok. Wehave staffmeetings etc, there are spot checks and reviews on clients care andsupport.”

The provider promoted an inclusive working culture where staff felt valued, respected and treated fairly.

Staff had received training in equality and diversity. They told us they felt they were treated equitably and were supported by management. Flexible working requests were considered and accommodated where possible, helping staff to achieve a positive work-life balance.

However, the provider did not always demonstrate how staff feedback was used to shape service development or influence policies and working practices. While opportunities existed for staff to share their views, concerns identified during the assessment showed that feedback, oversight and learning had not consistently resulted in timely or sustained improvements.

The provider did not operate effective governance systems to assess, monitor and improve the quality and safety of the service. Quality assurance processes were not sufficiently robust to identify concerns, ensure policies were followed, or provide assurance people were receiving safe and effective care.

The provider did not have clear systems of accountability to ensure risks, performance and outcomes were consistently monitored and acted upon. Auditing processes were in place; however, these were not always effective in identifying areas requiring improvement. The provider's own policies and procedures were not consistently followed. For example, medicines audits had not identified concerns relating to medicines management, including the management of medicated skin patches and gaps in risk assessments for people prescribed high-risk medicines. As a result, there was a risk people were not always protected from the unsafe management of medicines.

In addition, audits of daily care records had failed to identify that care was not always recorded as having been delivered in line with people's care plans. In some cases, records did not evidence required aspects of care had been provided, while in others there was a lack of recording altogether. As a result, the provider could not be assured people were consistently receiving care in accordance with their assessed needs and preferences.

The provider's governance systems had also failed to identify concerns relating to care planning, risk assessments and incident oversight, all of which were identified during this assessment and the previous assessment. This demonstrated governance arrangements were not sufficiently robust to drive improvement, ensure compliance with policies and procedures, or maintain oversight of the quality and safety of the service.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

Since the last assessment, the provider had worked collaboratively with the local authority, engaging with support, feedback and monitoring processes with the intention of driving improvement, strengthening governance arrangements and improving outcomes for people.

The registered manager was aware of the need to engage with professionals such as occupational therapists, physiotherapists, GPs and district nurses, and daily records demonstrated their involvement in supporting people when required.

However, care records did not always clearly reflect the involvement of external professionals. While daily notes referenced input from health and social care services, this information was not consistently recorded within people's care plans. As a result, care plans did not always provide a clear overview of the professionals involved in people's care, the support they were providing.

The provider did not demonstrate a culture of continuous learning, improvement and innovation. Governance and quality assurance processes had not been effective in identifying, monitoring and addressing areas where improvements were required.

The provider had not identified and acted effectively on a number of concerns that were identified during this assessment and detailed throughout this report. These included weaknesses in incident oversight, medicines management, risk assessment processes and care planning records. As a result, opportunities to identify risks, learn from incidents and drive improvements had been missed.

Not enough progress had been made since the last assessment. Some concerns identified at the last assessment continued to be evident at this assessment, indicating actions taken had not resulted in sustained improvement. Although the provider had introduced additional processes and monitoring arrangements following the previous assessment, these had not become fully embedded into practice and were therefore not operating effectively.

The provider did not always demonstrate a clear understanding of how auditing and quality assurance processes could be used effectively to identify concerns, mitigate risks and drive continuous improvement. Consequently, there were missed opportunities to learn from previous findings, embed improvements and improve the overall quality and safety of the service.