Ethica Care Hemel Hempstead & St Albans

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 newly registered service. This key question has been rated 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.

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

This service scored 57 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The provider had taken on a reablement service at short notice. This is a short-term package of support, designed to support people to regain their independence after a stay in hospital as an example. This was a very different and specialist service from the traditional homecare also provided. Feedback from staff about the strategy and vision of the service was variable. Some staff said they felt able to meet the challenges within the reablement service. Other staff said they were not prepared for the change and were not clear on how the service operated. One staff member said, “There was no reablement training provided to staff.” A second staff member commented, “We took on this reablement care, but nobody told us about it, we have had to work it out as we go along. We stop the reablement in March I think so I think it will be good to get back to our normal clients.” A third staff member said, “Ethica Care has a positive, caring culture where everyone is treated with respect and dignity. The values are about compassion, honesty, and putting people first. We work as a team to make sure clients get the best care and staff feel supported and listened to.” However, no staff member when asked to provide examples of a share culture or strategy was able to apply this to their role.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

The provider did not always demonstrate the understanding to ensure the service provided care in line with best practice guidance. During our inspection we identified improvements that we shared with the provider and manager. These were in relation to staff training, reporting incidents, monitoring of care, assessing people’s needs, the review of care plans and oversight of the service. These issues affected the provider’s ability to consistently monitor, identify improvements and take timely and robust action.

The manager since being in post had identified areas for improvement, particularly within the structure of the office staff. They were in the process of implementing clearer roles and responsibilities to senior staff, developing a new leadership structure, and reviewing those key tasks which were delegated to senior staff. However, time was needed to assess how effective the changes being made would be over time and how they would bring about consistent improvements to the care and support provided.

Staff feedback about managers was mixed as we have reported elsewhere. The manager had begun holding team meetings since October 2025 when they came into post. Although this was positive to provide staff with a forum to discuss topics important to them, improvements were required to ensure meetings addressed quality issues and actions arising from staff, people, complaints, safeguarding incidents, identified risks, overall actions from monitoring and professional’s feedback.

Some people and staff did not always feel they could speak up and that their voice would be heard.

During this assessment we received 2 anonymous concerns. Both concerns raised issues with how staff could speak up at work, and how they would be treated. One staff member said, “The carers are being threatened to lie to CQC officials if contacted that everything is okay.” A second concern then noted, “As carers we are very worried and concerned that the management is calling us to lie to CQC about the situation we are facing right now. Already, the carer who received a questionnaire from CQC has been asked to go to the office so that they tell them how to respond. Some of us received a call as well to inform the office if contacted by CQC so that they tell us what to say.”

One person told us they chose to not raise concerns with the provider. They said, “I did phone once [the office], but I have resisted speaking to them because I don’t want people to think I am just moaning all the time.”

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 provider had policies and procedures in place to promote workforce equality and diversity. Staff told us they were treated fairly at work and felt part of the wider team. Staff commented how their individual culture and diversity was embraced by others which helped them feel part of an inclusive team. One staff member said, “There are differences culturally, but we engage and work to embrace that and work from each other’s strengths.”

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.

Audits were in place to monitor the quality and safety of care. However, these were not consistently completed accurately. For example, care plans reviewed lacked assessments for specific health needs. The care plan audits did not identify these were missing. An example of this was where the auditor noted, ‘Robust individual care plans are in place, which clearly highlight the requirements of the service users. Care plans in place with clear detail.’ This was not in place in most care records reviewed.

Systems to monitor staff punctuality were not effective. People’s call times were not planned. For example, people requiring time critical medicines did not have their calls planned for the time they needed to take their medicines daily. A lack of oversight meant people had call times planned that were different week on week. This meant the management of the rota meant people could not plan from one week to another as the times changed. Those people who raised concerns with timeliness and call planning were clear that this was not due to staff, but a lack of management. One person summarised this and told us, “[Person] has said they are always looking at the clock. I think they must rush from one to the next. It’s down to the scheduling rather than the individual carers.” The provider told us a policy was in place that gave the minimum time care staff needed to attend, and what people would be invoiced for. People told us of times when their invoice was charged for the full call when care staff had stayed for less than this time. The provider acknowledged this was an area for improvement and said they would ensure anomalies in call times were adjusted prior to invoices being raised.

Audits and trackers used to monitor the quality of care did not use accurate information. We have referred to the care plans being incomplete, however other key areas of performance were equally lacking. The complaints tracker did not refer to the complaints people told us about and had contacted the office, or from the entries in people’s daily notes. The incident log did not record incidents we had identified from feedback or through the daily notes. The provider audited their call times, however, did not monitor for missed calls, double up calls or short calls for example. We found numerous examples of these that impact both the results of the audit and impedes improvement month on month. We saw from 1 complaint that timeliness of the care staff had been ongoing since August 2025. From the evidence reviewed, the monitoring processes had done little to improve this

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.

We received feedback from the local authority regarding ongoing concerns about the quality of the service. This feedback identified areas for improving and areas where the provider had worked well. They told us there had been a recurrent theme around a lack of reporting incidents, whereby the local authority held a meeting with the provider to discuss potential breaches of contract and improvements arising from those discussions. They also shared areas working well, for example they described a collaborative approach with the provider willing to meet and implement changes when concerns were raised. They also spoke highly of one person using the specialist dementia pathway where care is be structured to prevent hospital admissions and ensure continuity where they reported positive outcomes for the person who has been on this pathway.

The new manager gave us examples of how since being in post they had engaged with the wider community. They said this was to improve recruitment within the service. They had linked in with the local employment service and a local community engagement group. By increasing their visibility and explaining the organisation, the new manager was able to attract new employees who possibly would not have applied without the additional engagement.

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.

The provider had developed a service improvement plan in response to feedback raised by professionals including CQC. However, the service improvement plan was not robust. We were provided 2 improvement plans, 1 from the provider and the second from the new manager. Neither improvement plan contained the same priorities, and neither were sufficiently detailed about how changes would be made, how these actions would be measured, a reasonable timescale or the resources needed to achieve these improvements. The provider could not show evidence improvements were implemented quickly or effectively, with concerns found at this inspection being long standing or ongoing. Their systems to identify and implement improvements were mostly reactive and driven by feedback from external stakeholders. The provider’s internal systems did not always address key risks or develop strategies to make improvements needed.

The new manager was open to our feedback and discussed with us their initial observations and the improvements they had identified since being in post. They sent us their plans around staffing, staff development and improvements to governance and oversight. They had increased their visibility in the organisation to monitor areas such as capacity and call monitoring. They held a meeting with staff which showed a more structured and reflective approach, although to embed this to encompass the findings from this inspection would require further development, this work was in progress at the time of our inspection.