Archived: Nwando Domiciliary Care

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 service was in breach of legal regulation in relation tothe provider’s governance arrangements.

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 which was based on transparency, equity, equality and human rights, diversity and inclusion.

The provider and leadership team understood the importance of aligning the services values with the Care Quality Commission [CQC] ’Right support, right care, right culture’ guidance. The provider's ethos, vision and values were person-centred to make sure people were at the heart of the service. People using the service and those acting on their behalf were consistently positive about the quality of the service they received, with the exception of call visiting times.

People told us where staff had gone ‘above and beyond’ in their duties. A relative told us that staff had collected medication from the pharmacy for their family member in their own time. They said, “I don’t know what my [family member] and I would do without them [staff], we are very grateful.” Another relative told us, “They [staff] are always doing extra to what they are supposed to do. When they are about to leave [family member] will often ask for something else to be done, they always do it for them. They are so kind-hearted, they are perfect.” People told us they would not hesitate to recommend the service to others. Comments included, “This company is a big improvement on the domiciliary care service we had before, I would be really happy to recommend them to others” and “I would recommend them.”

The leadership team had the skills, knowledge, experience and credibility to lead effectively. Throughout the assessment the provider, who is also the registered manager and leadership team responded proactively and were receptive to our feedback. The leadership team were open and honest and willing to learn. There were clear management responsibilities and accountability shared between the registered manager and the leadership team.

People and relatives told us communication with the service was generally good, although some minor improvements were required. Positive comments included, “They [Nwando Domiciliary Care] are easy to contact, they answer quickly and respond promptly”, “Communication channels are really good, things have improved. They [Nwando Domiciliary Care] respond to and address problems” and “The office is contactable, 90% of the time I get a call straight back.”

The provider fostered a positive culture where people felt they could speak up. However, comments from people suggested their voice was not always heard and responded to in a timely manner. Some people’s relatives stated the service did not always contact them in a timely manner when they had telephoned the office and required a response.

Staff felt confident to raise any issues or concerns with the provider or leadership team. Staff told us they received regular formal supervision and had the opportunity to participate and attend monthly meetings. Staff spoken with stated they had the opportunity to contribute or raise concerns or suggestions. A member of staff told us, “To me ‘freedom to speak up’ means being able to raise any concern without fear of retaliation or judgement. At Nwando, we are encouraged to speak openly about issues. That gives me confidence and peace of mind.”

Following our assessment the provider wrote to us and confirmed despite the above that various processes were in place to encourage people to speak up and have their voices heard. For example, a 'Speak Up' champion is employed at the service to offer colleagues a safe space to share any concerns. Staff meetings are open for all staff to attend and for the organisation to share relevant updates and information. Regular surveys are conducted to enable people to provide feedback.

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.

There was a diverse workforce at the service, with staff employed from a wide range of backgrounds, cultures, and experiences.Staff told us they were treated fairly, felt supported and valued. Staff told us communication within the organisation was reliable and effective and they were an inclusive organisation.

Though governance arrangements were in place to enable the organisation to assess and monitor the quality of the service provided and to monitor the organisation's performance, not all elements were effective.

Specific information relating to the improvements required as part of this assessment is cited within this report and demonstrated the arrangements for identifying and managing these areas were not as robust as they should be and required improvement. Though staff were aware of the importance of reporting concerns and safety incidents at the earliest opportunity, this did not routinely happen in practice. Lessons were not always learnt to continually identify and embed good practice. Medicines management was not routinely safe, and improvements were required. Quality assurance arrangements were not effective to ensure staff visiting times consistently met people’s needs and preferences, monitored staff performance and ensured training was embedded. Not enough action had addressed these areas and to mitigate the potential risks of people receiving unsuitable care. The provider and leadership team were receptive to our feedback and findings. An assurance was provided to review the provider’s existing quality assurance arrangements, ensuring this was robust and effective going forward and better oversight achieved.

The service collaborated and worked in partnership with other services so as to promote effective joint working to meet people’s needs.We saw evidence of effective partnership working, information sharing and collaboration to ensure people using the service had a good quality of life.

The provider focused on continuous learning, innovation and improvement. The leadership team had a Service Improvement Plan in place based on the findings from internal quality assurance audits and ongoing monitoring of the service. Most actions were recorded where required to help ensure that areas of improvement required were implemented to enhance the quality of the service provided to people.However, as highlighted within this report, improvements were required to ensure lessons were learned to continually identify and embed good practice, and to identify shortfalls at the earliest opportunity.