Senacare Ltd - Sutton

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 since their registration in January 2024. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 provider encouraged a culture at the service that supported staff to deliver high-quality care to people. A staff member told us, “I enjoy my role and always try to provide safe, respectful and person-centred care.”

Managers used spot checks, supervision and staff team meetings to make sure staff understood how the provider’s vision and values should be achieved through their working practices.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People spoke positively about the management of the service. A person told us, “The lady I talk to at the office is wonderful.”

Managers undertook continuous learning and development to maintain their skills and knowledge. They understood the needs of people using the service and how these should be met through the provision of safe, high-quality person-centred care. The registered manager said, “I am very hands on. We have a WhatsApp group for managers, and we share information on there. We also have a group for staff, and we share information there. We have an open-door policy, and all the staff have my number.”

Staff told us managers were experienced, knowledgeable and supported them in their roles. A staff member told us, “Managers are experienced and understand how to run the service and support staff and clients.”

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

People were encouraged to share their experiences of the service through management spot checks, telephone monitoring calls and quality surveys.

Staff were encouraged to raise concerns. A staff member told us, “We are told to speak up and report anything that concerns us.”

Managers made sure staff were given opportunities to raise concerns, without fear or consequence. The registered manager said, “Our carers are open and honest and will come forward if they are worried about anything and seek reassurances about the work they do. I listen to carers and try and be supportive to their needs.”

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 were treated equally and fairly at work. They received training to help inform their knowledge and understanding of equality, inclusivity and fairness in the workplace. A staff member told us, “I feel I am treated respectfully and supported by managers.”

Staff had equal opportunities to learn and progress in their roles. The registered manager told us, “We don’t discriminate against staff. We work to their availability. We are a small branch here. But in [provider’s other service] all our seniors started as carers. So, as we grow here we want to offer the same opportunity here.”

Managers had clear responsibilities and roles and were accountable for the provision of safe, effective, high-quality care to people. They used governance systems to undertake regular checks and audits of the quality and safety of care and support provided to people. Outcomes from checks and audits were used to make any changes required and support staff to improve their working practices.

However, oversight of the service’s compliance with regulatory requirements was not always effective. We found the provider had not sent information to CQC about a safeguarding concern raised about a person using the service. We discussed this with the registered manager during our site visit. We looked at records and saw they had worked proactively with the local authority safeguarding team when the concern had been raised to address the concerns found and there was no continuing risk to people using the service. We were assured they understood their responsibility for notifying CQC of these types of events and that this omission had been a genuine oversight on their part. After our site visit, they made sure all the relevant information was provided to CQC.

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.

The provider followed guidance and recommendations from health and social care professionals to support staff learning and improve the safety and quality of the care and support provided to people. A health and social care professional told us the provider was open to collaborative working and regularly engaged in local forums and local authority quality assurance processes.

The provider focused on continuous learning, innovation and improvement across the organisation and local system.

Feedback was obtained from people, relatives and staff to help the service continue to learn and improve. Managers used this feedback, along with learning from events and outcomes from audits and checks, to make improvements to the quality and safety of the care and support provided to people.

The provider also used learning from assessments of their services to make quality improvements. Following a recent CQC assessment of one of their other services, improvements were made to the information recorded in people’s care records about identified risks to their safety and wellbeing and accident and incident reporting systems. These changes resulted in better quality information to support the management of risks to people, and more meaningful analysis of accidents and incidents to support learning and continuous improvement.