Caremark (Wokingham and Bracknell)

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• 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 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 legal regulation 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, 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 provider did not have a service improvement plan in place to ensure a structed planning process was carried out in collaboration with people who use the service, staff and external partners. The registered manager told us this was something they were looking into as they felt there should be a different structure in place. However, we expect providers to be continuously evaluating the service.

The provider did not demonstrate a positive, compassionate, listening culture that promotes trust and understanding between them and people using the service that is focused on learning and improvement. The complaints log did not contain information about actions taken, and if concerns had been investigated and responded to. They did not contain dates which did not allow the service to ensure a clear pathway of the complaint from start to finish which could result in delays to respond to failures identified within complaints.

The provider did not ensure risks to delivering the strategy, including relevant local factors, were understood and did not have an action plan to address them. They did not monitor and review progress against delivery of the strategy and relevant local plans. For example, records did not contain information about duty of candour. Actions plans in place were not filled out correctly, they did not identify the timelines for actions to be completed, or the action taken in order to monitor and review progress.

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, and they did not do so with integrity, openness and honesty.

Staff told us they were treated well by the office and received good support. However, leaders were not able to demonstrate a robust understanding of the issues and concerns raised during the inspection.

The leaders were not knowledgeable about issues and priorities for the quality of the service. Where concerns were identified during the inspection, the leaders were not able to demonstrate they were aware of these concerns or evidence how these issues were being prioritised and addressed.

Whilst the registered manager stated they involve people in care plan development; there was no evidence of this. The care plan spreadsheet provided only contained a list of people’s names and when their care plan was completed. This was not an audit to identify and respond to changing needs.

People did not feel they could speak up and that their voice would be heard. Staff told us they could discuss issues, felt safe and the whistleblowing policy was covered in the training. However, within people’s care notes, staff had not acted with openness honesty and transparency as they had not notified the office of their concerns. Daily notes did not evidence there was follow up when staff noted concerns, this had not been identified by leaders as there was no system in place to review daily notes.

There was limited evidence where staff and leaders actively promoted staff empowerment to drive improvement. Staff meeting minutes did not record staff concerns as there was no evidence staff were asked about concerns. Staff were given opportunities to fill out a staff survey, however there were no actions from this, and staff told us they were not always aware of outcomes of investigations.

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.

Staff told us they received training, could ask for more training and received “fair treatment.” The Registered Manager told us they have an open-door policy and support staff to work well together by ensuring different cultures work together.

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 did not have effective systems and processes in place to support oversight of the service and therefore was not doing all that is reasonably practicable to mitigate risks, improve practice and keep people safe.

The service did not have an effective system in place for reviewing and investigating safety and safeguarding incidents and events that go wrong. Safeguarding concerns continued to not always be recognised and appropriately reported.

The service failed to look at their own practices such as themes and trends to see where improvement could be made to ensure people’s safety was not compromised.

The service’s governance processes were not effective, and they did not undertake audits to ensure the service was safe. The service was not able to demonstrate clear oversight of risks to people’s health and safety.

People’s care records were not always detailed nor person-centred. Care records referred to people as client, did not always state how people were to be supported with their skin care, continence, care and personal care. Guidance provided to staff was task focussed and not always person centred.

Leaders were not aware of the quality of audits that took place and it was not always clear who was responsible carrying out audits.

There was no tool to complete care planning audits. When asked by us, the registered manager stated, ‘We would audit them [care plans] internally, if we felt that it didn’t look right, we would speak to the supervisor and say to meet with the family and make sure 100% correct, and upload that.’ This was not an effective system for identifying concerns with safety and quality of care plan documentation.

Systems were not in place to ensure robust management of feedback, concerns and complaints to ensure the necessary improvements were made. Staff were not always safely recruited.

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 or collaborate for improvement.

Professionals told us there were some concerns in relation to the low number of safeguarding referrals reported by the service. Professionals also told us they were not convinced the service had the capacity to document and follow up everything, and were not assured the service were identifying themes and trends and there were a few concerns in relation to staff not logging information.

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.

The registered manager told us lessons learnt are documented and discussed in team meetings. However, during the inspection, we identified the lessons learnt were ineffective due to poor recording. There was no oversight of the service, and records to support continuous learning and improvement to improve the quality of life for people. The service was unable to monitor and address ongoing risks or identify areas where the service could be developed and improved.