TLC Rehab

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• 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

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 inadequate. At this assessment the rating has changed to requires improvement.

The service was in breach of regulation in relation to good governance. The provider had made significant improvements in governance procedures and a change in operational leadership at the service. However, areas for further improvement remained. There was no clinical lead role within the service to oversee and drive continuous improvement and provide expert knowledge and guidance on best practice to the team.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The service did not have a clear shared vision, strategy and culture.

Recent changes in leadership meant there had been limited time for leaders to develop and embed a clear culture, vision and strategy at the service. Meeting minutes we reviewed did not document discussions about vision, values, or strategy, and it was not clear how the provider monitored its progress against those. Staff had limited opportunities to contribute to discussions about the strategy and development for the service. A lack of clinical leadership, and therefore expert clinical guidance in the team, meant there was no one with the appropriate clinical background and knowledge driving and ensuring high standards of patient care, supporting staff development, and safe, effective, and evidence-based practice.

Although there were now monthly team meetings, they had not taken place every month, and not all staff attended those. Some staff we spoke with said that communication and information sharing within the service could be improved.

The service 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. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Since our last inspection, the service had appointed new operational leaders. The new Registered Manager and Nominated Individual had the skills, knowledge and competence to perform their roles. There was also a new deputy manager. During this inspection, we saw improvements in the service’s governance systems. The new managers demonstrated a good understanding of the service they managed and of the areas that still needed improving.

Staff we spoke with described the leaders as supportive and approachable, although some staff thought the leaders could be more visible at the service and that communication could be improved.

There were ways that staff could speak up about areas that concerned them, but it was not always clear how this information was acted upon and staff said they did not always see changes happen as a result.

Staff we spoke with said they were comfortable to raise concerns with managers if needed. However, 2 staff members did not think that changes happened in response to the issues they had raised.

Clients had opportunities to give feedback on the care they received. The service organised weekly community meetings and collected feedback from clients. We saw examples of changes made as a result of complaints.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had now ensured that staff received mandatory training in equality, diversity, and human rights, and 94% of staff had completed it.

Staff said they thought the service was open and inclusive and did not raise any concerns about discrimination.

Staff we spoke with did not require any reasonable adjustments to enable them to carry out their roles. Some said they found the service approach generally flexible, for example in shift allocation or hybrid working.

Although there had been significant improvements with the governance processes since our last inspection, there were areas where these needed to be fully embedded to ensure the service was delivered to a consistently high standard.

At this inspection, we saw tangible improvements since our last inspection in the service’s governance systems and in how staff used them. The new operational managers demonstrated a good understanding and oversight of the service. Staff we spoke with said that the improvements in governance and processes had led to clearer documentation and more streamlined working. They said they were now clear on what they needed to do in their role. Staff said that checklists and documentation were now clearer and helpful to support them in their roles.

There was now a framework of what must be discussed in staff and managers’ meetings, such as incidents and complaints. Although gaps in managing incidents remained, there was now assurance that there was a functional system in place to report them and staff discussed essential information. We saw evidence of changes made as a result of learning. The service recognised that there was more work to do to strengthen all staff understanding of when something should be reported as an incident.

The service had improved its systems to manage risk. There were now a risk register and a business continuity plan in place. The risk register detailed an appropriate range of risks specific to the service and mitigations for these. Environmental risk management had improved, including improvements in fire safety and security of the premises.

There were now appropriate policies and procedures in place, including clear inclusion and exclusion criteria for admissions to the service. The discharge planning process had improved. The service had implemented a range of audits to provide assurance of the quality and safety of the service. The service now provided its staff with induction, competency assessments, training, managerial supervision and appraisal. The service collected data such as outcome measures. Managers had access to information needed to support them with their role, such as audits, performance, and staffing data.

However, despite the improvements made in governance processes, there was more work to be done to ensure the service always delivered safe and effective care. Some areas of risks remained, and some areas of governance still needed improving.

Care and treatment was not always provided safely and in line with the provider’s policies and national best practice guidance. Although staff now completed audits, in the absence of clinical governance structures, it was not clear whose role it was to follow up any actions identified. This meant there was limited assurance that audit results could be used to monitor and continuously improve the safety and quality of medically assisted treatments offered. There was a lack of clarity about the roles and responsibilities of the sessional doctors the service employed. Doctors did not attend team meetings, which limited effective information sharing about patient risk and clinical decision-making.

Whilst the service did link with some external services, this was an area for further development.

The service did not routinely work with external partner agencies. Managers told us about plans to develop some joint working in the future.

However, we saw evidence that staff had referred clients to more appropriate care when required, for example to the emergency department at a local acute hospital. A recently discharged client we spoke with told us about their discharge plan which included information on available community support. Clients could provide feedback to the provider’s leadership team through weekly community meetings.

Whilst there were early plans to develop aspects of the service, these were not yet implemented in practice.

Managers told us about plans to improve and develop some aspects of the service, including the therapy programme, aftercare, and provision for carers.

A range of audits was now in place, and we saw evidence where this had led to improvements in practice.

The service did not participate in research, quality improvement, benchmarking, or accreditation schemes at the time of our inspection.