I Straker Consultants 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

We rated well led as inadequate. We assessed 7 quality statements. The service did not have robust systems, governance and processes in place to effectively assess, monitor and improve the quality and safety of the care provided. The service did not have a comprehensive audit and assurance programme in place and had not identified the concerns we found. Record keeping processes and systems were inadequate. Records and documentation were kept in different places and the record keeping software was not indelible or secure. Records were not always complete, accurate or contemporaneous. We received mixed feedback on the leadership and culture of the service. Not all staff were confident to raise concerns.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Managers we spoke with were aware of the provider’s vison and values. However, staff we spoke with were less certain about these. They were able to describe in general terms how they sought to be caring and professional but were not aware of the provider’s vison and values document.

The service had developed a vision and values document. The vision laid out was ‘to provide a service that is accessible and responsive. We aim to ensure good quality ethical treatment is available to our diverse population by building an organisation that: Surpasses in quality, safety, patient experience; Attracts, develops and retains excellent people; Is recognised nationally as an excellent service provider.

The values that underpinned this were:

Care (treating others the way we want to be treated),

Individual Connection (consider individual need with every client contact),

Responsive (prioritising the client in every situation and communicating effectively),

Working Together (recording and sharing information for client care and learning opportunities),

Open and Honest (exercising our duty of candour and supporting the client process through transparency).

However, it was unclear how this was embedded into the service and shared with staff. Staff we spoke with were unclear about the vision and values, they were not displayed within the premises and they were not incorporated into induction, supervision or appraisal processes.

Feedback we received from staff during our assessment process in relation to capable, compassionate and inclusive leadership was mixed. All staff we spoke with told us that managers were a visible presence and accessible. Some staff told us they had no concerns around the services leadership and that they considered managers to be supportive. However, some staff were negative about the leadership and management at the service. They told us managers were not always supportive and that they considered them to be dismissive and intimidating. Some staff we spoke with told us they weren’t supported with stress or ill health and felt unfairly treated. Those staff told us managers placed unfair expectations on them in terms of workload and the roles and functions they were expected to perform in relation to the training and experience they had. However, managers we spoke with gave us examples of changes to working patterns that had been implemented to support staff previously, including changes to working hours. Managers told us there was an external Employee Assistance Programme and internal policies covering stress management, sickness support and workload accommodation.

We did not ask specific questions in relation to processes in this quality statement. Staff did have access to a health insurance policy once they had completed probation.

Feedback we received from staff during our assessment process in relation to the culture of the service was mixed. Some staff told us that there was a positive culture supported by the management. However, other staff felt that there was a poor culture in the service and told us that they would not be confident to speak up and raise concerns. Those staff described an intimidating atmosphere and told us they would fear reprisals if they spoke up. They felt some colleagues had been the victims of bullying and unfair processes.

The service had policies in place to support freedom to speak up and whistleblowing. Staff had easy access to those policies, and they were covered as part the induction programmes. However, not all staff felt confident to use those processes to raise concerns. The provider told us that they utilised an external Human Resources company and that staff could also raise concerns about the service and/or management thorugh that external company.

We did not ask specific questions around workforce equality, diversity and inclusion. The staff group did not raise any concerns around workforce equality, diversity and inclusion.

We did not ask specific questions in regards to workforce equality, diversity and inclusion.

Staff we spoke with during our assessment process were not aware of any governance structure. They were aware of some governance processes such as the reporting of incidents. Managers we spoke with told us there was a weekly managers meeting that covered governance concerns. They told us they felt assured about the quality of the service from their day-to-day observations and interactions with staff. However, they acknowledged there was not a formal structure around this or robust assurance processes in place.

We found that the service did not have an effective governance structure to assess, monitor, assure and improve the quality and safety of the care provided. At the time of our assessment the service did not have a regular audit programme and had not identified concerns that we raised. Following our inspection, managers provided audit templates for audits of case notes and prescribing and told us that these would be implemented. The service did not have clearly documented inclusion and exclusion criteria that had been shared with staff and were unable to provide assurance that robust processes were in place to identify patients who would not be clinically appropriate for treatment. For example, staff completing assessments and medication review did not ask female patients if they were pregnant or trying to become pregnant before or during the prescribing process. The service had record keeping processes and systems that were not fit for purpose. The record keeping software used by the service could be amended or deleted and was not indelible or complete. There were no limitations of access for staff regardless of their role. As a result, we could not be assured that records were secure and were only accessed, amended, or destroyed by those authorised to do so. Record keeping processes and systems meant that relevant patient information was not always available to the relevant staff to support them in safe prescribing. Following our inspection service leaders told us that this had been addressed and that all recorded patient information was available to relevant staff. Record keeping was not always robust, comprehensive or contemporaneous as required by legislation. We saw instances where not all information discussed in consultations was recorded. In one specific record, we saw a six-month review which recorded instructions to continue the current medicines regimen with no recorded information about the details of the consultation. We saw examples when consultation records had been completed in advance. Relevant consent to treatment was not clearly recorded in patient notes. We did not see specific informed consent obtained for using medicines 'off label'.

Service users we spoke with did not raise any concerns regarding partnerships and communities. Patients who had been referred to the service by GPs or other health professionals did not raise concerns. Patients we did speak with told us they had been given information regarding the shared care process and what to expect but we did not speak to any patients who had been transferred to shared care.

Staff were able to describe processes to engage with key partners including GPs and local safeguarding bodies. They were able to describe the process for requesting information and patient summaries from GPs and how patients were transferred to GPs under the shared care protocol when appropriate.

We did not receive feedback from partners.

The service worked with local GPs. There were processes to support the gathering of patient information from GPs as part of the assessment and prescribing process. However, we found that these were not always followed or completed before prescribing commenced. There was a shared care protocol in place to transfer the care of patients who had been titrated and stabilised on medication to their local GP. This included a certificate of diagnosis that was provided to the GP. The service operated a shared care log to track patients that had been transferred.

Staff we spoke with during our assessment process told us that any lessons learnt were shared at the daily team meeting or in 1 to 1 conversations. They told us that there were not many incidents that required reporting and did not give us specific examples of changes that had been made in response to incidents that had occurred in the delivery of the regulated activity. We did not ask specific questions around innovation.

Staff attended a daily meeting that was used to feed back any updates or learning. The daily meetings were minuted to ensure staff who were unable to attend were able to catch up. Following the feedback from our inspection managers initiated changes to address the concerns we had identified.