Archived: Caremark Swindon

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 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 service was in breach of the legal regulations relating to good governance and the suitability of the director.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a shared vision and mission statement which had been communicated to staff. The vision statement stated, ‘In our vision we will be recognised as the employer of choice, attracting and retaining top talent.’ However, we found many staff had left the company or were planning to leave, some due to the concerns within their employment. The company had key values and staff demonstrated some understanding of these. For example, staff treated people with dignity and respect. However, the service did not uphold some of the other values such as creating a positive and nurturing environment, as many staff were unhappy with the culture of the service and many staff had planned to leave.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered 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. The service was being overseen by the NI at the time of the assessment, as there was no registered manager at the service. Staff raised concerns about leaders’ understanding of the sector and service. One staff member told us, “If it wasn’t for [care supervisor] we would be floundering about.” Another staff member told us, “I believe [some leaders] need more knowledge.” The NI was not always aware of their responsibilities to ensure the service ran safely and effectively. However, leaders were open and transparent during our assessment and the NI told us, “I am fully aware we have gaps [in knowledge], we are working quite hard to fill those gaps and sort the issues out. It will be better when we get a registered manager in post.”

Staff did not always feel confident concerns would be appropriately addressed. For example, one staff member told us, “Unless I go in shouting and screaming! I’m joking. No.. They’ve been told. Nothing has been done.” There was a whistleblowing policy in place, however this was a template and did not contain key information about who staff should contact if they had any concerns. This meant this policy could not be effectively followed by staff. We asked the NI how they supported people to share any feedback about their care. They told us, “We complete telephone monitoring, this has been sporadic, [staff member] has now picked that up and will be completing these on a 3 monthly basis. We are trying to find a balance. There is also an annual survey sent out to people.” People and their relatives did not raise any concerns about being able to feedback about their care, however one person felt a complaint they had raised in relation to staff’s approach had not been addressed.

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. We received mixed feedback from staff about workforce equality, diversity and inclusion. One staff member told us, “I believe that managers have their favourite staff members as they are more flexible with their hours, but I personally don't feel that I've been treated unfairly or not equal to other staff members.” Another staff member told us, “Equality… well. No. [Leaders] have the favourites, and we know it. The 2 specific ones that never get told off - get all the hours, are hours late and never told off when they are.” Staff also raised concerns about the staff members not fully completing tasks set out in people’s care and support plans and that they had raised this with the NI but that these had not been addressed. One staff member told us, “We wanted to put [the staff members] on performance management, but [NI] turned this down because [staff are] available frequently to cover shifts. The NI told us there were no staff with any reasonable adjustments. There was a policy in place about mental health at work and equality and diversity at work.

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. Information was not shared securely with others when appropriate, and the NI was not aware of their responsibility to do so. We found there was one recorded safeguarding incident involving an unsafe discharge which had not been reported to Care Quality Commission (CQC). Additionally, the service had not notified CQC when people using the service had passed away, in line with their legal responsibilities. There was a lack of oversight at the service. We saw some audits had taken place by a quality manager within the company, which identified similar issues each time. This meant these audits were not effective in supporting improvement within the service. People’s care plans did not always contain adequate detail to enable staff to support people safely. The service policies had not always been fully completed, and key information was missing from these at times. Therefore, policies could not always be effectively followed by staff. However, the NI told us about the quality assurance checks which took place within the service. They told us, “We have daily note reviews, our field care supervisor completes quality assurance checks, meeting customers and doing checks. We complete quarterly telephone monitoring to contact customers to find out how things are going. We have team meetings with the staff.” We saw evidence of some team meetings with staff but did not see any evidence of any daily note reviews or telephone monitoring.

The provider did not understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not share information and learning with partners or collaborate for improvement. For example, we reviewed recorded daily observations of care for one person who had an identified risk of choking. This person’s records stated, ‘[Person] struggled with the soup and swallowing, so I took it away, I gave him some juice… he hardly ate anything because he struggled with swallowing, he preferred drink.’ This had not been referred to a health professional for review. Additionally, the guidance provided by the SALT team was not clearly recorded within the person’s care and support plan and contained advice which contradicted this. Despite the NI telling us they felt they had many gaps in knowledge, they had not sought advice or support from partners such as the local authority or other care providers. The NI provided some examples of where referrals had been made to request equipment for people, and we saw some evidence of this.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. Systems and processes were not in place to support this. For example, actions were not always recorded following feedback from people. Where people complained, actions taken were not always appropriate and had not been fully addressed. Although some audits took place which identified some actions, we found these had not been fully effective as similar themes and trends occurred, and not all appropriate actions had been taken. Staff were not able to talk us through processes which supported learning. One staff member told us, “I will contact the supervisor [following an incident] and anybody will show and up and try to help, depends on the situation.” Staff told us they had requested training to support their development, but that this had not been provided, and staff training records confirmed this. We saw some recorded evidence of team meetings, however, there was no process in place to share the contents of these with staff who could not attend to support their learning and effective team working. The NI explained, “We need to improve the logging of actions. Some of the actions have come through but I need to make sure they are followed through. I need to look at how we log these. I know I need to work on this.”