Efficiency Health and Homecare Services - Malmesbury

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 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 since it registered on 05 January 2024. 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 provider was in breach of legal regulations in relation to the governance of the service.

This service scored 39 (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 did not have an adequate business continuity plan for how they were going to manage this disruption to their service.

Staff induction did not contain information about the provider’s values during their induction. When we spoke to staff about the values of the organisation, they did not demonstrate knowledge of the values or that they understood what it meant for their day-to-day work.

Staff told us they could approach the care coordinator and team leader about any concerns and felt they would be listened to.

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

Leaders were not aware of relevant legislation for the service and nationally recognised good practice. During discussions with the leaders about governance it was clear they were not aware of all regulatory requirements. For example, during the inspection we were asked by leaders if the provider should re-employ a dismissed registered manager as a nominated individual. This meant that the CQC’s fit and proper persons regulation had not been considered when suggesting a person to become the nominated individual.

The manager was not familiar with the process of registering as a manager with the Care Quality Commission. The manager confused this process with the assessment process.

The provider had a whistleblowing policy and information regarding this was displayed in the office for staff to view. This provided staff guidance on how to speak up. However not all staff were clear of the staffing structure which meant that staff might not be able to identify who they should raise concerns with.

The provider induction was inconsistent. Some staff told us they had induction for a day while others told us it was 2 days. Only 7 out of 11 staff had completed equality and diversity training. This meant that people and staff were at risk of discrimination and in-equality.

Staff told us they attended team meetings. Records did now show staff feedback and involvement in these meetings. We also did not see evidence of staff surveys. This meant there was a risk of staff not being involved in the on-going development of the service.

There was an equality, diversity and human rights policy at the service which outlined the procedures and aims of the service.

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. Governance systems were not established or effective in assessing and monitoring the quality and safety at the service. There were no audits being completed which meant the provider was not effective in identifying shortfalls in areas such as medicines management, care records and risk management plans.

The provider had some policies and procedures but these were blank templates. We found care records contained inaccurate and conflicting information which the provider had failed to identify and address.

The provider did not always understand their duty to collaborate and work in partnership so services could be safe for people. Information was not always made available when requested by other professionals. This meant that there was a shortfall in information sharing and continuous learning. The provider did not always work with healthcare professionals to make sure people’s needs were met seamlessly. Where a person needed increased support with medication administration, records demonstrated leaders had not liaised with healthcare professionals to ensure training was delivered. This meant people were at risk of unsafe care.

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 provider was not aware of good practice guidance and relevant legislation for the sector. The provider did not have any external support to help guide them on good governance and oversight of the service. Relevant guidance and resources had not been made available to staff.