Hearts of Care Agency

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 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.

There were no effective governance structures in place at the service. There was no quality assurance, the processes of management oversight and monitoring were ineffective in enabling the provider to identify and address any improvement needed and risks to people in a timely way. This placed people at risk of receiving poor care and avoidable harm. There were no effective processes in place to ensure continuous learning and improvement. Therefore, opportunities to improve the service and learn lessons could be missed and shortfalls identified in this assessment were not recognised or actioned by the provider.

The provider did not have a robust system of communicating with partners including the local authority, healthcare professionals involved in people’s care or other support providers. Not all changes in people’s needs or concerns raised by them were appropriately shared with other partners and addressed. The business plan was generic and unrealistic. Staff told us they felt supported by the provider and the service respected the equality and diversity of its staff team.

The service was in breach of the legal regulation in relation to good governance.

This service scored 32 (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, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

The culture of the service was not always effectively supporting the delivery of good quality specialist care. A robust structure for the monitoring of quality and safety was lacking. Learning and improvement was not routinely undertaken. This meant opportunities to improve the service were missed, for example, around safeguarding people. The provider was not aware of specialist guidance relevant to their type of service, so the culture of the service did not always effectively focus on person-centred care and protecting people’s rights.

Although the director and manager could explain what vision they had for the service and what values they expected staff to show when supporting people, there was very limited assurance on how this was monitored and discussed with staff. In practice, the culture of the service was not always supporting staff and management to adequately recognise shortfalls in the service. For example, around mental capacity, choice or how to support people when they raised concerns.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered safe care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

We were not assured that staff overseeing the service had the appropriate experience and qualifications to effectively manage the service. Whilst they had experience in providing care, their management and oversight experience was limited and none had higher management qualifications such as level 5 diploma in health and social care.

The management team maintained ongoing communication with staff supporting people in the community, but did not ensure that risks were well managed, people’s rights were always at the forefront of the care provided and that people’s concerns were appropriately investigated at all times. The management team lacked understanding of improvement priorities for the service and although staff told us they were approachable, they failed to adequately support staff in their roles and to effectively monitor their practice.

The service was not always effectively led. The provider did not ensure the service developed and used an effective governance system, they were not aware of specialist guidance for services supporting people with a learning disability and autistic people and failed to identify shortfalls in the service, for example around risk assessments or managing safeguarding concerns. This meant risks in the service were not understood or managed well, which led to an increased risk of poor care.

People did not feel they could speak up and that their voice would be heard. The culture of the service did not support freedom to speak up. The director and manager were not aware that some feedback from staff constituted safeguarding concerns and had failed to action all concerns appropriately and timely. This posed a risk to people not being heard, concerns not being always appropriately recognised and investigated with lessons being learnt and acted on to protect people.

The provider did not always adhere to their complaints policy. For example, when a family member raised a concern, this was not recorded or investigated according to their policy.

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.

Staff told us the provider respected their equality and diversity and supported them when needed, for example to be able to follow their culture and religion. The manager gave us an example of how they supported a person to wear clothing relevant to their culture.

However, the quality of the training given to staff did not support them to develop professionally in their role.

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

The service was providing care and support to children and people with a learning disability or autism. Support for people with a learning disability or autism was specifically excluded from their registration. The provider has since applied to the CQC to remove this condition.

There was a significant lack of oversight and competent leadership which directly affected the safety and welfare of service users. The director and manager did not have a clear understanding of the regulated activity [personal care] which they were registered to provide.

Quality assurance processes were ineffective in monitoring and checking the quality and safety of care, and support being delivered. For example, audits had not found the widespread failing in care planning we identified during the inspection.

Safeguarding concerns and incidents had not been effectively recorded, investigated, or analysed to determine the root cause and to use this information to drive improvement. Appropriate safeguarding referrals to the local authority and Care Quality Commission notifications had not been made. This had not been identified by management team.

We found there were widespread and significant shortfalls in the way the service was led and the governance in place did not assure delivery of safe quality care. There was no robust analysis of information to identify trends and themes and to take mitigating action to prevent re-occurrence and drive improvement.

Thorough risk assessments had not been carried out routinely to identify risks in relation to people’s care and support needs.

No appropriate management cover was in place to ensure robust oversight of the service and to ensure people were receiving safe care that met their individual needs. The previous registered manager left their employment in September 2024. Since that time, the provider had not had sufficient oversight to ensure the service was running safely and effectively. As a result of this failing, people have been exposed to the risk of harm.

The provider did not fully understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

While people and their relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider did not work effectively or collaboratively with key partners to ensure people received safe and joined up care. This meant important information about people's health and treatment was not shared with professionals to ensure better outcomes.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Poor oversight of incidents, complaints and feedback meant concerns were not routinely identified, discussed and shared. The provider did not encourage creative ways of delivering equality of experience, outcomes and quality of life for people. They did not actively contribute to safe, effective practice and research. The model of care provision was not aligned with current best practice guidance including right support, right care, right culture. People were not enabled to always enjoy a full life or identify what goals and ambitions they had.