Choices for Living Well (Reablement)

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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

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 registered service. This key question has been rated Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (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.

The registered manager was absent from the service at the time of our inspection. In their absence, a temporary service manager had been appointed. The temporary manager was skilled and proactive in her role, driving forward service improvement during the provider's period of transformation.

The service aimed to provide people with consistently good care while promoting their independence. It was evident from discussions with staff that they all demonstrated these values in their direct work with people.

Leaders did not always embody the values of the organisation. As a result, staff did not always feel well supported or that there was clear communication from leaders.

Not all staff felt there was enough support available from management. One staff member told us “I don’t feel supported by management”. It was evident from records that some staff had not received supervision for longer periods than others, with one staff member stating, “Not sure how often meant to happen but they don’t happen that often”. In addition, other staff members reported they did not always find their supervision sessions helpful. One staff member told us, “Every three months, due soon. If I had any issues would not leave it to the next supervision, personally don’t find them that useful.”

The service was in a period of transformation with the aim of driving improvement. The changes being made to the service were not always communicated effectively. For example, an electronic care planning system was implemented for a short period and was later withdrawn, with care staff returning to the previous system. The reason for this change had not been communicated. One staff member said, “We have gone back to paper notes, it has not really been explained why we aren’t using full system. A bit frustrating. Two teams had transitioned over fully to [electronic system] and now must change back to paper. Staff have been told about the change in paperwork but not been told what this is about.”

Feedback from people and their relatives was complimentary about the management and leadership of the service. One person told us the service had a “very experienced manager/team leader”. An allied professional also commented on the integrity and kindness shown by the current service manager. They stated, “Throughout my experience working with [Manager], they consistently promoted a culture of dignity, respect, and compassion”.

Not all staff felt if they spoke up and that their voice would be heard.

Most staff told us they felt able to raise concerns with management. A staff member said, “Managers are approachable and supportive”. This was supported by another staff member who stated, “Managers are good and I can speak to them – I find [Deputy Manager] really approachable”. However, some staff felt there had been challenges within the management culture due to the many changes taking place.

Opportunities were consistently provided to people who used the service, enabling them to share formal feedback about the care they received. Through discussions with people, it was evident they felt able to raise concerns directly with their care team.

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 worked well together, and people spoke positively about the nature of their role. One staff member told us, “Quite happy working for the team, I like the fact that we are out and about meeting new people, it’s nice”.

Staff who required reasonable adjustments to fulfil their role had these in place. Management told us a review of these had been undertaken to ensure they were effective, relevant, and supported the needs of the service and its staff.

The provider did not always have clear roles or systems for good governance. There was not always clear monitoring system in place to monitor staff performance.

During our inspection, it was noted that staff felt there was a lack of clear leadership, which was difficult as the service started to undertake many changes to drive improvement. One staff member expressed that, “[Registered Manager] has not been around for some time, there has been a lot of change; rotas have been taken off the coordinators, it is now not clear on processes. Been a bit messy”.

Upon reviewing the audits and systems in place, it was evident that management oversight required strengthening. For example, the training and supervision matrix was not maintained within 1 working document. There were 3 spreadsheets in place that offered conflicting information. In addition, the weekly review of MARs completed by the co-ordinators was not recorded. Therefore, we were unable to assure ourselves that this was taking place. The current manager of the service had identified these concerns independently and had plans to rectify them.

The provider was also in the process of reviewing management and co-ordinator roles. This formed part of the service transformation and was being undertaken to strengthen the oversight management had of the service overall, and the oversight co-ordinators had of the staff they line managed.

Where risks were identified using current systems, these were addressed promptly. These were also discussed at management meetings, with a clear focus on learning and prevention.

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.

The service worked closely with other partner organisations within the intermediate care tier and health services.

Feedback from professionals was overwhelmingly positive regarding the management of the service and the effective working relationships that had been established. One professional provided an example, stating, “[Current Manager] maintains a positive working relationships with health professionals, social workers, and other partner agencies, ensuring referrals and requests for specialist input were made in a timely manner. Any concerns relating to customers' wellbeing are appropriately escalated and followed through to achieve positive outcomes”.

Improvement was required across the organisation and local systems. Systems did not always actively contribute to safe, effective management oversight.

Any areas identified during the inspection as requiring improvement had already been recognised by management and were included in the service transformation document. The current service manager was keen to drive these changes and was actively involved in reshaping the service during the absence of the registered manager. An allied professional stated, “The team has improved significantly since the interim manager came into post, more questions are being asked, and they advise they feel more involved and less done unto. I would absolutely want a member of my family to be supported by this team”.

Although many changes had already been made, the service still had further improvements to make. We had confidence in the current management team and felt they would continue to drive forward the changes required to improve the service.