Nottingham DCA

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. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. The provider was in breach of regulation in relation to governance. This meant people’s needs were not always met.

This service scored 54 (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. While we saw evidence of the providers vision and values and workshops they had undertaken to communicate this with staff, this information was not always retained or understood by staff. For example, most staff we spoke with could not describe what a closed culture was. A closed culture in a health or care setting isa poor culture that can lead to harm, including human rights breaches and abuse. We fed this back to registered manager who was proactive and formed an action plan to address this concern with additional training and further knowledge checks with staff to ensure understanding and help staff identify risks in the future.

The provider had inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Senior leaders in the organisation had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. However, there was a large number of new managers in place at individual locations. Some managers told us they had received no organised training or development to support with their role such as care plan writing or risk assessment which placed people at risk and meant managers had not identified the concerns found with documentation throughout the assessment.

People did not always feel they could speak up and that their voice would be heard. Most people we spoke with told us the provider was supportive and approachable. However, some concerns were raised about how people were treated historically when raising concerns and issues which they said impacted on them feeling able to speak up in the future. We spoke to the registered manager about this concern, who was disappointed anyone in the staff team felt this way. The registered manager immediately took action to address this, with meetings with staff to discuss the providers whistle blowing policy and confidentiality within the organisation to ensure people felt safe and supported to raise concerns.

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 told us they felt listen to and valued by the registered manager. One staff member said, “I can’t fault the provider, the induction training was brilliant, and I shadowed an experienced staff member until I was confident, and people had gotten to know me. This really helped me and the people I care for.”

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. Whilst we saw evidence of senior management oversight of audits, there had been no competency checks done with people who completed the audits and reviews in each individual location to ensure the quality and accuracy of the providers documentation and care plans. This had led to gaps in people’s risk assessments and care plans as demonstrated within this report which placed people at risk of harm and of not receiving care in line with their needs or wishes.

The provider clearly understood and carried out their duty to collaborate and work in partnership with others, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement. The provider held a weekly meeting referred to as ‘the hub’ where people, relatives and professionals could gather. This offered people a chance to build social relationships, improve confidence and participate in new activities of their choosing. Professionals attended the sessions to see people informally and share in celebrating achievements and success such as birthdays and other milestones. This reduced people anxieties of meeting with professionals and allowed them to communicate in a place they felt safe. One professional said, “I have been involved in the current hub that United Response run and these are attended by lots of peoplefrom different settings, again very person-centred groups where the emphasis is on the people and what they want to get from these sessions, they are very supportive groups.”

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. Whilst they encouraged creative ways of delivering equality of experience, outcomes and quality of life for people, they did not always actively contribute to safe, effective practice and research and did not accurately record or monitor this through effective governance such as audits. We spoke with the registered manager who was open and receptive to the feedback throughout this assessment. The registered manager acknowledged that care planning was lacking, and audits had failed to identify these risks. The senior leadership team immediately took steps to ensure people were safe whilst an action place was implemented to ensure care plan and quality monitoring processes were reviewed and improved.