Maisy Care at Home 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 service since the location changed. 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 68 (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.

Staff told us the management team demonstrated the provider’s values in the way they worked. All staff spoke positively about the culture of the organisation. Comments included “The culture is inclusive, open and transparent” and “Even when improvement is required it is not seen as a negative, but a collaboration to improve and build on”. Leaders promoted equity, diversity and human rights and ensured these principles were reflected in policies and in practice. Staff told us they felt empowered to challenge poor practice and racism as well as share ideas for improvement. This openness created a strong sense of trust and accountability across the service.

Leaders encouraged innovation and celebrated success, reinforcing a culture where learning was valued and shared.

However, none of the staff we spoke to were able to confidently speak about the values of the company. However, staff told us the management team demonstrated the provider’s values in the way they worked.

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.

The service had a manager who was registered with Care Quality Commission. The service was being managed by the registered manager and the deputy manager. Staff told us the management team were knowledgeable and provided them with the support they needed to do their job well. Comments from staff included, “The manager is competent and approachable and caring.”

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

The provider had speaking up procedures which staff could access if they needed. Details were shared with staff during their induction, staff meetings and supervision sessions. Staff told us they knew how to raise any concerns and were confident managers would listen to them and respond. Comments from staff included, “I feel we are listened to. I would raise any issues if I needed to and feel confident [managers] would act on them.” Team meeting notes demonstrated a culture where staff discussed any concerns, and these were shared with the team to reach a solution. For example, when 1 person had a hospital admission, staff met and discussed the best way to support the person’s hospital discharge.

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 processes for staff to request flexibility in their work patterns, for example to enable staff with caring responsibilities or those with health conditions to remain working. Staff were aware of these processes and told us they felt supported by the management team. The manager told us they tried to accommodate staff requests wherever possible.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always use these to manage and deliver good quality, sustainable care, treatment and support. They did, however, act on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Some systems and processes to assess, monitor and improve the quality and safety of the service were in place; however, these were not always consistently effective in identifying and addressing areas of risk. For example, complaints and compliments were not tracked effectively. This meant the provider did not have clear oversight of themes, trends, or outcomes, and was unable to demonstrate how feedback was used to drive learning and improve the quality of care. This also meant the provider did not have evidence that all concerns had been addressed and resolved adequately.

Audit systems were established but had variable impact. Regular checks of care documentation took place; however, these had not consistently identified all areas for improvement. For example, we found some documents, including supervisions and induction plans, had not been signed or completed fully by staff, while other documents such as staff competencies had other people’s names on them which were not the intended person

Further, We saw that documentation systems were in transition, with a mix of electronic and paper-based records in use. While this provided flexibility, it had led to a lack of a clear, unified structure. For example, some paper records we viewed had differing information when we viewed the digital versions of the document. This demonstrated that governance processes required further strengthening to ensure clear, accessible, and reliable records.

Although these issues had not always been identified through routine audits, leaders were open to our feedback relating to documentation and record keeping. Managers assured us they would review their oversight of the service and would prioritise themes such as incomplete records and inconsistency in recording practice.

However, there were positive aspects in how the service responded to feedback and managed risk. Provider-level audits captured themes relating to feedback from people and practice issues, and these were discussed within team meetings where all staff were encouraged to participate and discuss.

The provider maintained a risk log which was used to record and monitor concerns, including those relating to care delivery and care needs. Risks were reviewed and prioritised, and actions were allocated to reduce impact on people. This demonstrated that, although governance systems were not yet fully effective, there were developing processes in place to learn from audit findings, respond to identified risks, and drive improvement.

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.

Managers told us they worked in close collaboration with a range of professionals to help ensure people received continuity in their care. Examples included working with a dietician to support someone in understanding the importance of healthier meal choices, work with the pharmacy team to reduce people’s medicines, and working with the hospital team to support a person in returning home safely. This work was reflected in people’s support plans.

The provider did not always focus on continuous learning, innovation and improvement across the organisation. They did however encourage creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Systems for monitoring standards of support people received were used to identify areas of improvement and ensure some lessons were learned when needed. This included some auditing and quality assurance checks. The manager said the provider had support systems which enabled staff to share experiences and learn from each other. The manager told us the provider had focused on improving the quality of life for people by reducing restrictions and adapting living environments wherever possible.

However, while the provider demonstrated a willingness during the assessment to learn and make improvements, evidence of innovation and continuous learning was more limited. Some governance and recording systems were still developing, and audits had not consistently identified all documentation shortfalls. Leaders assured us they would take action to strengthen oversight, showing a responsive approach to improvement. This demonstrated that the provider was learning from experience and implementing changes to improve quality, but the evidence did not show new or innovative approaches that had led to a measurable impact on people.