The Care Bureau- Home Support Service

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 requires improvement. This meant the service was not always consistently managed and well-led. Leaders and the culture they created did not always promote 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.

The management team told us the service they provided was to promote people’s individual needs, preferences and choices, as well as supporting people to work towards achieving any personal goals and aspirations. The staff team recognised people’s individual strengths, abilities and encouraged people and families to be play an active role in how care was provided.

It was clear from staff’s conversations with us, they were committed to their role and put people first, at times above their own personal commitments. One staff member said, “The client comes first for me - it's my responsibility.” Staff told us they enjoyed working at the service and working with people in their own homes and keeping people in touch with their local community.

The provider’s management team carried out spot checks, competency reviews and individual supervisions with staff to ensure expected standards were maintained. Staff said the agency was good to work for and staff said they got on well with those they cared for. One staff member said recognised the importance of caring for people, and those people who were more vulnerable. Staff took pride in their roles and put people first. Staff felt able to provide the quality of care they wanted, and they felt they made a difference to people’s lives. We were told about examples where staff went the extra mile to support people and to enrich their lives. However, staff were not always convinced they were treated fairly and valued. Staff told us the culture across both provider services was divided.

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.

The registered manager was committed to providing a service they and their staff team could be proud of. Overall, staff loved working at the service because they got on well with each other and those they cared for. However, staff said they did not always feel valued. One staff member said, “I have asked management for support, but nothing changes.” This staff member said at times, the job role could be challenging but offers for help when asked, were not followed up. This staff member also said there was limited opportunities for staff meetings which left them feeling isolated. Another staff member felt the same, saying, “No competency checks or observed practice for me. The pay rates not good (compared to other teams in the provider’s other service) and they should consider us a bit more.”

People and relatives feedback was that improvements had been made recently regarding the overall management of the service they received. One relative said, “It has got better and better. It was rough at the start. Staff have been magnificent.” Another relative told us, “The service is very good.”

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

The registered manager told us staff had access to a whistleblowing helpline as well as confidential helplines that could offer support and guidance. Staff said if they needed too, they would raise their concerns. Staff knew of the whistleblowing hotline. However, staff were not always confident when they shared feedback about things specifically related to them, it was listened and acted upon. For example, around planned days off and a lack of cover put in place. One staff member gave us an example, saying, “We need more communication and staff, we are frontline, so we get on with it, but management need to consider what we are doing and how it affects us.”

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.

The registered manager felt they had the right staff to care for people. The registered manager said staff had worked at the service for a long time, all of whom got on well with those they supported. The provider’s recruitment process provided new staff to the service with the opportunity to complete equality and diversity training. The registered manager said the provider had support measures for staff. They said, “We have a whistle blowing helpline and confidential support for staff. We also make reasonable adjustments for part time staff, and staff with caring responsibilities.”

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

The management team completed audits to assess the quality of the service. They checked people's care plans were completed and reviewed at set intervals, daily logs were completed accurately and that medicines were administered safely by staff who continued to be competent to administer them. However, we found these audits were more of a tick box than identifying and cross referencing across the service to identify improvements in the quality of service. For example, medicines audits were completed monthly, yet they failed to check application of topical creams, covert medicines and certain medicines due before food and fluids and whether these were administered in line with guidance.

We spoke with the registered manager and regional manager who agreed with our findings. The regional manager said they had identified audits as an area for improvement. The provider had processes to support performance through their internal compliance team, but these had also not identified the key issues for improvement. The registered manager and internal compliance team assured us actions would be taken across their quality assurance checks.

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.

Staff recognised the importance of family members and involved families when required to keep them updated. Relatives told us staff were ‘brilliant’ and it was clear from people and relatives feedback, everyone got on well, respecting each other’s contributions to provide the best care possible. People and relatives said staff were good at keeping them informed. Staff took people out if their home to maintain people’s important links to their local communities. Staff encouraged people to go out, to socialise and to maintain links with friends and family.

Processes for working with and alongside other health and social care professionals were considered and where those were in place, staff documented the support they provided to show people’s overall health and wellbeing was maintained. In some cases, more accurate record entries would help demonstrate what staff had done to meet people’s needs.

The provider was not always focussed on continuous learning, innovation and improvement across the organisation and local system.

During our visit, we found there were no effective systems to learn and improve across the providers services. Conversations with the registered manager, deputy manager, regional manager and the compliance manager showed a lack of joined up thinking to improve across both the providers services. The regional manager acknowledged improvement was needed across the provider’s quality assurance systems and had identified this as an area for improvement. We asked what external help, advice or training they had to support them, but found this was limited. We signposted the regional manager to Skills for Care and advised how they maybe able to assist, as well as training courses rum by the local authority. We also recommended to the registered manager and wider management team to consider how they learnt and improved across both provider services.

The registered manager agreed that they needed to improve and update ‘paperwork’. The registered manager told us they had an external quality assurance audit that found they needed to think more about the outcome objectives. However, we found audits did not focus on specifics, or what was being checked, so they did not identify the issues we found or any learning. There was a lack of understanding of what a good audit was, which clearly impacted on what could be learnt.The registered manager welcomed the inspection and through our inspection, the registered manager wanted to review how they could make improvements to those areas we discussed with them.