Darethealthcare UK 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 good. At this assessment the rating has changed to requires improvement
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.

This service scored 61 (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.

People told us they felt the service was professional and well led.

The registered manager told us the key values of the service were trustworthy, empathy and respect for people and ensure they are treated with dignity.

Staff knew the aims and values of the organisation and managers told us they went through the values of the service as part of the induction for new staff during training and supervisions.

Feedback from staff, managers, people and families showed that managers and staff had formed strong relationships with people and wanted them to thrive. Care was given in a person-centred way and there were examples of managers going over and above to support people who were either unable to leave their homes or needed to support to do so.

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.

The registered manager did not appear to know how people needed to be supported or how many care staff were required to support people safely. When we asked how the service ensured staff are competent in their role, they said staff were either asked to come to the office or observed by the quality assessor, but did not know what staff were assessed on.

Both the registered manager and the manager had been involved managing and running the service exceeding ten years.

However, we found the manager knew and engaged with people and staff very well. We saw a person come to the office for support with a task by the manager who took time to engage and provide help to them. They told us the manager was very helpful. Staff told us they felt very supported by the manager and would talk with them if they had concerns or needed support.

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

The service did not provide us with a policy on freedom to speak up or whistleblowing, however staff were provided with a handbook which outlined how to make a public disclosure.

The registered manager told us if issues were brought to their attention, they would let staff know they were protected and that they would be supported. They told us the team was supportive towards each other.

Staff told us they felt supported by leaders and they would be happy to raise concerns with them or to the local authority if required.

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.

Policies and procedures to promote diversity and equality were in place.

Senior management engaged with staff regularly to gain their feedback and support them with their individual needs and circumstances. The manager gave an example where a staff member had been supported when they had raised difficulties with travel to different peoples addresses and implemented an adjustment that facilitated their needs. The manager said they actively supported staff to increase their knowledge and attain higher levels in care qualifications; however, staff were expected to complete their training in their own time.

The provider told us they conducted a staff survey each year, however this did not address staff welfare but care delivery only. We saw the most recent survey, which was overall positive, and reflected positively on the values of the manager.

All staff said they were happy working for the service and they felt supported. All staff said they felt like the service treated them like family members and they would be happy to raise concerns if they needed to.

The service 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 provider needed to ensure their auditing processes were clearly documented and effective in promoting safety and good quality care. We asked for the annual audits mentioned in the provider’s policies as part of their governance procedures, but they were not all supplied. The audits we did see lacked detail and we had concerns about the effectiveness of those audits.

The staff survey focussed on care and did not include any questions on staff satisfaction, morale or engagement. Results of that survey were transformed into graph form, but no meaningful analysis had been created and no action taken as a result. i.e. staff disagreed with a statement on provision of training on end-of-life care and it appeared no action had been taken.

The service did not always recognise and manage complaints robustly. We found concerns raised by a person in a feedback document, but no action or documentation was found and it was not included in the complaints file.

The registered manager’s answers about quality assurance did not match those from the quality assurance lead. The registered manager said they did not know what tasks care staff were assessed on. They were also unaware of the level of support people the service cared for needed. For example, they told us that only 1 person required 2 staff, when in fact 3 people needed 2 staff to support them.

There was no robust quality assurance system, structure or routine for oversight of staff performance.

The provider did not know about the requirement for a delegated healthcare agreement with a qualified professional to support and oversee clinical tasks. They had not ensured that such an agreement was in place or that assessors were suitably trained to assess others in risks such as catheter care. In addition, the provider had not arranged training to deliver the specialist care needed to support people with specific needs, such as catheter care, even though their medication policy stated that staff would receive training if required. However, when these issues were raised the provider took positive action in provision of training and organisation of delegated healthcare.

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.

Records showed the leadership team and staff worked with health and social care professionals to meet people’s needs. Staff had referred people to health care providers for specific care needs as people’s needs had increased and made referrals to occupational therapists, dieticians, opticians, community nurses and GPs when needed.

Health and social care professionals told us they had a good relationship with the service and are fully engaged with them in supporting people.
The service had arranged for personal care needs such as hairdressers and daily life requirements such as booking appointments with Opticians and banks. The manager told us how they had supported people to be part of the community at social groups.
 

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

The provider and senior team wanted to improve their service and work towards continuous learning and improvement. Although the provider was motivated to learn and improve the service for people, their lack of established risk and quality monitoring systems meant they were not always alerted to areas for improvement.

However following our inspection, they were quick to respond to any shortfalls we identified and started to make improvements.