L'Arche Bognor Regis

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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. At our last assessment we rated this key question good. At this assessment, the rating has remained 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 75 (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 provider promoted an inclusive and supportive culture, ensuring people participated in decisions about their care and that the focus remained on achieving the best possible outcomes for them. The organisation’s core values were embedded into the culture of the service through team meetings, staff supervision and observed practice.

At the time of the assessment, the service did not have a manager registered with CQC which is a requirement of their registration. However, the manager had applied to CQC to be the registered manager of the service, and their application was under consideration at the time of the assessment. A registered manager is a person who has registered with CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The manager had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness and honesty and embodied the culture and values of their workforce and organisation. The manager understood the context in which the provider delivered care and support and was familiar with the provider’s policies and processes. They demonstrated commitment to supporting people and improving their quality of life. We observed positive and respectful interactions between the manager, staff, and people. People appeared comfortable and at ease in their company and were clearly familiar with their presence in the service. Staff were very complementary about the manager. They told us they felt valued and respected. Comments included “We are learning from the best.” And “[Name] is wonderful, a very good manager, very professional and kind and considerate to everyone.”

The provider fostered a positive culture where people felt they could speak up, and their voice would be heard. Policies and procedures were in place to enable people, staff, and visitors to provide feedback about their experiences of the service. Processes were available for people to raise concerns anonymously or with independent support, such as through advocacy services, families, or wider support networks. Staff were aware of the procedures for raising concerns both within the organisation and with partner agencies. They were encouraged to share ideas and reflect on practice through team meetings and one-to-one supervision. The provider promoted openness and learning, and feedback was used to inform and drive improvement within the service.

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. Policies and procedures supported equality, diversity, and inclusion, and reflected relevant legislation and best practice guidance. Recruitment processes promoted fairness and ensured equal employment opportunities for all applicants.

Staff told us their individuality was respected and that they were treated fairly within the organisation. They described a positive and inclusive culture that recognised and celebrated diversity. Staff working on UK health and care worker visas felt supported and enjoyed working in the service.

The provider had clear responsibilities, roles, systems of accountability and good governance. There were robust systems and processes for quality monitoring and audit. Actions arising were followed up. Governance processes were used to manage and deliver good quality, sustainable care, treatment, and support. The manager acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate. There was operational oversight of quality monitoring and clear lines of accountability. This ensured good governance of the service and continued service 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. Staff worked in partnership with a range of organisations to support people’s health, wellbeing, and inclusion. Records showed staff consulted with healthcare professionals and other relevant agencies to ensure people received appropriate and coordinated care. This collaborative approach helped to ensure people’s ongoing needs were assessed and met.

People accessed community facilities and healthcare services for routine checks and medical treatment. The manager engaged with local provider forums and network groups to share learning and good practice, which was cascaded to staff through meetings and supervisions. People were recognised within their local neighbourhoods, and we observed friendly and familiar interactions between people and members of the community.

The provider focused on continuous learning, innovation and improvement across the organisation and local systems. Processes were in place to learn lessons and support change. Improvement plans had actions. Outcomes were monitored and learning was used to drive service improvements and people’s experiences. The culture promoted honesty and learning from mistakes and there was a clear understanding of the need to be open in the event of anything going wrong. Feedback was shared with people and staff to ensure lessons were learnt.