A3 Care 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 for this newly registered service. This key question has been rated requires improvement. Leaders and the culture they created mostly supported the delivery of high-quality, person-centred care. However, the registered person had to ensure the service is consistently well-managed and effective quality assurance processes are embedded and sustained to support good oversight.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager and the staff 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 staff, the person and the relative spoke highly of the registered manager. The person and relative agreed the staff and the registered manager showed a positive and compassionate culture that supported them and each other. The person and relative said, “All the staff show compassion towards me, my [relative] and each other, all work well together” and “I do feel that all the staff show compassion and that they all work well together to offer a cohesive service with an open culture.”
The registered manager and the staff team demonstrated a shared responsibility for promoting the persons wellbeing, safety, and security. The staff team and the registered manager used regular daily communication to share and discuss any matters or what was going on in the service.Any changes were discussed together with staff and/or other relevant parties to make those changes. The registered manager praised their staff team for positive engagement and added, “[The staff] are a happy bunch to work with; they are supportive.” The registered manager worked with staff to ensure equality and diversity were promoted, and the causes of any workforce inequality were identified, and action was taken to address these.

The registered manager and the staff understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. The registered manager had the skills and credibility to lead effectively. They did so with integrity, openness and honesty.The registered manager and staff worked together to promote person's wellbeing, safety, and security. The person and relative said staff were happy working at the service. They said, “All the staff appear to be happy and speak positively about the manager” and “Staff always seem happy, laughing and chatting, [the registered manager] is like another colleague, no power struggle.” Staff were positive about their jobs and the registered manager. Staff gave examples of a positive culture that the registered manager supported staff to ensure they understood their training. The registered manager was available to talk to staff, and they visited the service to check on standards of care. The staff team was motivated to provide care and support to people as their needs and health were changing. The registered manager told us how they promoted a positive, caring, transparent and inclusive culture within the service. The registered manager was visible to the staff team, the person and relatives, and professionals.The registered manager added, “We have monthly meetings in person; spot checks are more often. I upskill myself with policies and training so I can teach our staff and help them. Making staff aware of our policies; staff are given an induction pack; how to work with people and how to practice according to CQC standards. Instilling the culture in [the staff] that we deliver safe care, and that’s why put so much effort into training the staff.”Staff felt listened to, supported and the registered manager was approachable. Staff worked together well and were positive about the leadership in the service.

The registered manager fostered a positive culture where people would feel they could speak up and their voice would be heard. The staff told us they knew how to, and felt confident, speaking up and sharing any concerns with the registered manager. Although they had not had to do that, but they were confident the registered manager would respond positively. The registered manager added, “We are a small service, and staff can call me about anything and I am not going to judge them. I encourage the staff to speak up when things go wrong…that will help to build the trust and [the people/families] can come to us. Good record keeping to ensure all things are recorded. You have to be honest and transparent, take responsibility for things and own up to your mistakes.” The registered manager told us the process when concerns or issues would be raised, and they would work together with staff and people and families to review and address these. The person and relative felt comfortable speaking to the registered manager or staff and felt they were listened to. They felt the service was pro-active in finding solutions. The person and relative felt the service would apologise if something went wrong and try to rectify it. They said, “No problems to report and the registered manager seems to be someone who is very open in [their] management of the company” and “Any wrongdoing would be acknowledged and sorted; I am sure.”

The registered manager valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for staff who worked at the service. The registered manager worked alongside staff delivering care so they could understand any issues staff encountered. The registered manager continuously communicated with staff about the service or any other matters to ensure staff were included and valued. This approach also encouraged an inclusive and equal workforce and mutual respect amongst the team. Staff described the registered manager as being available and visible to them. Staff said they had not experienced or witnessed any discrimination or inequality.Staff felt positive about the service and were confident to raise any concerns and ideas that could support the service. They felt supported, treated fairly and looked after by the registered manager.The working environment was inclusive, and staff’s wellbeing was considered. This ensured the service had a positive culture which supported better outcomes for people. Staff were able to share ideas and were able to contribute to the service.

The registered manager and the staff had responsibilities, roles, systems of accountability and governance in place. However, we identified some areas needing improvements such as medicines records, consent forms, parts of care records and right to work checks as part of the recruitment process. Some of the audits had inaccurate dates to show the correct period was covered for review. When reviews of care plans were done, some information was not updated in the care records to ensure staff had the most current information about person’s required care and support. The registered manager needed to ensure some of their learning was kept up to date according to current guidance. This meant systems and processes required embedding into practice more effectively to ensure issues we found would be proactively identified in the future. This was to ensure people remained safe and ensured compliance with fundamental standards.We discussed these points with the registered manager to ensure their quality assurance process was reviewed and picked up any issues in the future reviews. Following our site visit, they have provided further information of the changes they started making.

The registered manager worked alongside staff in the service. This way they were able to monitor practice regularly during the day and ensure appropriate action was taken to address any issues. The registered manager had different quality assurance tool to oversee the service and its quality such as monitoring call times, any incidents or accidents, safeguarding, complaints, concerns and compliments. They used audits and staff spot checks to review different aspects of care and support provided. The provider did not use surveys due to the size of the service as all feedback was shared via regular communications at this time.Staff had staff team meetings to discuss any items arising from running of the service and feedback received was shared with the staff team to help running of the service. The registered manager had an open-door policy and would welcome any feedback to support the service.The person and relative felt the service was managed well. They added, “[The registered manager] seems to manage well, does home visits and does spot checks on [their] staff especially new ones” and “Any change in care plan is fully discussed and my feedback is acknowledged.”

The registered manager and the staff understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They would share information and learning with partners and collaborated for improvement to ensure they achieved positive outcomes for people. Where necessary, external health and social care professionals would be or had been contacted for further support and advice or kept up to date with developments.There was a process to report, record and refer people for further support as and when needed to support people’s health and wellbeing. The person and their relatives added, “I am happy with the company and the care [my relative] receives, no concerns” and “Yes, I do feel that the company is well run to suit my needs, the manager regularly visits me…[the registered manager] would sort out any concerns or arrange if I need to see a therapist or pharmacist.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.The registered manager told us they were completing further professional development to support their business. They said, “When I [complete it], I feel I would be able to get better outcomes for people and safer practices, as it is all about safety.”The staff and the registered manager demonstrated a positive, compassionate, listening culture that promoted continuous learning and supported improvements. The registered manager was aware they would involve and consult other organisations to support the service and people using it. They proactively worked with the staff team, the person and their family, and professionals where needed, to achieve goals and outcomes that would have positive effects on them. The registered manager had a process to focus on continuous learning and improvement from recorded events, audits and information across the organisation and local system. As the service was still small, the current set-up was effective and communication between the provider and the person and their family was managed well. The registered manager communicated on a daily basis with the staff team to ensure all of them were aware of any issues, important information related to the service, actions to take and to pass on any feedback.The relative and the person said, “The company is small, so I usually speak to [the registered manager] in the office, no problem with communication. Never been offered a questionnaire yet” and “Any feedback of my care has been over the phone not a questionnaire and my views taken into account.”Whilst we did identify a few shortfalls during this assessment, the registered manager was responsive to our findings and acted on key areas of improvement.