T Lives Healthcare Ltd

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 to rate this service.

This key question has been rated requires improvement.

This meant management and leadership were inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

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

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.

Leaders had created a positive and person-centred culture that focused on supporting people to maintain their independence, exercise choice and receive care that reflected their preferences. Staff spoke enthusiastically about the people they supported and demonstrated a good understanding of individual needs, routines and what mattered most to them. Staff gave examples of adapting support around people's interests, cultural backgrounds and personal wishes to help them achieve positive outcomes. People and relatives consistently described staff as caring, respectful and committed, and told us they valued the relationships they had developed with regular carers. This helped people feel comfortable, supported and confident in the care they received.

Leaders did not always provide effective oversight of the service. Governance systems had not identified or addressed concerns relating to medicines management, care planning, risk assessments and consent arrangements before the assessment. Significant inconsistencies in records and gaps in risk management had not been identified through existing quality assurance processes. The registered manager acknowledged there was evidence staff were not always reading care plans and provider information contained inaccuracies. These issues increased the risk that people did not always receive support based on accurate and up-to-date information.

However, leaders were visible and engaged positively throughout the assessment process. Staff told us they received supervision, spot checks and management support and felt able to raise concerns. Staff described an open culture where concerns were listened to and acted upon. One staff member told us management had an “open door policy”, while another described receiving support, observations and competency checks to help them develop their practice. Staff were able to explain their responsibilities in relation to safeguarding, consent and emergency situations, demonstrating leaders had provided guidance and support.

People and relatives were generally positive about management responsiveness. One person said, “I know how to raise a complaint, I feel very safe.”

Following inspection feedback, leaders acted quickly to review systems, develop action plans and introduce additional audit and governance tools to address identified concerns. While this demonstrated a willingness to learn and improve, the provider could not yet demonstrate that governance and leadership arrangements were consistently effective or fully embedded across the service.

Staff understood their responsibilities to raise concerns and demonstrated confidence in doing so. Staff were able to describe safeguarding and whistleblowing procedures and explained how they would escalate concerns both within and outside the organisation if they felt people were at risk. Staff told us they felt able to speak openly with managers and believed concerns would be listened to and acted upon appropriately. One staff member told us, “My manager has an open- door policy." Another said, “I feel able to raise concerns and believe that I would be listened to." Staff provided examples of leaders acting on concerns raised. One member of staff told us, “I once raised concerns about gloves and the management listened and ordered a different one same day." Staff also described feeling supported to raise concerns where people's safety may be affected, with one person stating, “I would feel confident raising concerns." This demonstrated an open culture where staff felt able to speak up and where concerns could be identified and addressed.

Leaders promoted an inclusive workplace where staff were treated fairly and felt able to contribute. Staff demonstrated an understanding of equality, diversity and inclusion through the way they described supporting people according to their preferences, culture, religion, language and life experiences. Examples included adapting communication, respecting personal choices and accommodating individual routines and interests. People told us staff treated them with dignity and respect and supported them in ways that reflected what was important to them. This helped people feel valued and supported as individuals.

Governance systems were ineffective because leaders had not identified or acted on significant risks to the safe management of the service. Quality assurance processes had not identified unexplained medicine-record gaps, inconsistencies in prescribing information, incomplete risk assessments, inaccurate care plans or unsigned consent records. Some relatives had not seen people’s care plans, and records did not always reflect known needs and risks. The registered manager acknowledged staff did not always read care plans, but existing oversight had not addressed this. These failures increased the risk of unsafe or inconsistent care. The provider introduced new audits, risk assessments and governance processes following our feedback, but there was insufficient evidence these were embedded or effective.

The service worked collaboratively with relatives and healthcare professionals to support people's care and wellbeing. Staff described liaising with social workers, healthcare professionals, memory services and families when people's needs changed or additional support was required. People and relatives confirmed they were involved in discussions about care and spoke positively about communication between the service and family members. Partnership working helped ensure people received coordinated care and support that reflected their changing needs and personal circumstances.

Leaders demonstrated a willingness to learn from feedback and act when concerns were identified. Following inspection feedback, the provider undertook a comprehensive review of medicines management, care planning, risk assessments, consent arrangements and governance systems. New auditing tools, medicines review processes, contingency planning documents, fire safety assessments and service improvement plans had been developed to address concerns and strengthen oversight. However, many of these improvements had only recently been introduced in direct response to issues identified during the assessment. While the provider had taken positive steps to improve, there was limited evidence at the time of the assessment learning had been embedded or that the new systems had been operating long enough to demonstrate sustained improvement across the service.