Lauriem Complete Care Limited - Ditton

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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 changed to 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.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 57 (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 was working to implement a new clear shared vision and strategy. However, their systems and processes had not always been operated robustly or effectively to ensure clear oversight.

The service had recently undergone a business change and changes to the management of the service. The management team had completed a full review of the service and had an action plan in place to drive improvement. The management team felt the changes were going to improve the overall service being delivered and were at the start of implementing new systems and processes. Staff fed back during the inspection that communication around the business changes needed improvement.

However, there was a culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. The provider understood the challenges and the needs of people and their communities. Staff told us the culture of the service was good. A staff member said, “I love working here, I love visiting my clients, this job gives me purpose."

The provider had inclusive leaders at all levels 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.

The provider had made recent changes to their management team and their deployment to better support the service. The management team were knowledgeable about people they supported and were eager to improve the systems and processes in place to ensure people received high-quality care.

The provider was aware of their responsibilities and had notified CQC in line with their legal requirement to do so in relation to any important events or incidents.

Staff felt confident in the current management of the service. A staff member said, “They are very supportive when it comes to handling emergencies, so I feel confident when I have to call them to report an emergency.” Another staff member said, “Manager is excellent, always responds to messages, and manages everything well. The only downside is that everything goes through her – it would help if other office staff were more accessible.”

Staff were aware of their roles and responsibilities. A staff member told us, “We have an app that will update us with any policies and procedures, this is updated often.” Staff were passionate about meeting people’s needs and delivering person-centred care.

The provider had fostered a culture where people felt they could speak up. However, people did not always feel like their voice had been heard or action was taken in a timely manner.

Staff were able to contact for emergency out-of-hours support if they needed to report concerns or seek guidance. Feedback from staff was mixed about speaking up. A staff member told us, “Carers can ‘speak up’ and I’ve not had problems raising concerns.” Whereas, another staff member said, “Emergencies are dealt with, but routine issues can be delayed.” Staff supporting people at the extra care service commented that communication had improved since arrangements had been put in place for direct contact to a senior member of staff rather than going through the domiciliary care office.

People and relatives felt some communication routes were more successful than others. People felt when they contacted the office their concerns were not always actioned. A person said, “There is no one person who is in control of the office. They just do what they like. I don’t feel that I can approach them or make a complaint. There is a complete lack of organisation. If I speak with them, they don’t get back to me.” Some relatives also shared similar feedback, their comments included; “I think should I chase that up tomorrow as I don’t know if they got the message.” And “I also find it difficult to get through to the office to speak to anyone."

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 told us, “We have training for equality and diversity.” Training records demonstrated that promoting understanding of equality and equity for people was part of their mandatory training practices. Equality and diversity questionnaires were completed during the recruitment phase for staff and staff told us the provider supported their protected characteristics. For example, a staff member told us, “When [I was] pregnant my needs changed, and the office made adaptations to help me."

The provider had not always had clear responsibilities, roles, systems of accountability or good governance. They had not always acted on the best information about risk, performance and outcomes.

The management at the service had recently changed and a full review of the service was carried out. The provider identified that governance systems and processes had not always been operated effectively, and they had not always maintained robust oversight of risk, performance and outcomes. The provider had developed an action plan at the time of our inspection and had started to introduce new systems and processes to support better management of the service.

During our inspection we found similar concerns to those identified by the provider. There had not been effective and robust systems to ensure people’s risks had been assessed and there was effective risk mitigation outlined in people’s care records for some time. The frequency of the service’s quality and governance processes were not effective to ensure people’s records had been reviewed and contained up-to-date information as required. For example, some people had not had a review of their care records, and they had not been audited in 18 months, some of those people’s care needs had changed. There had not been robust oversight of accidents and incidents or care delivered to people. For example, some accidents and incidents had not always been recorded and some notes on the system had not been actioned in a timely manner. The provider had created new processes that were being implemented in stages across the extra care and domiciliary care settings. Staff supervisions and observations were not all up to date. Again, the provider had an action plan in place, and they were beginning to address this. Although the action plan was in place, due to a high number of actions, this was taking time to complete. We could not be assured that this would be embedded in a timely manner. We will review this at our next inspection.

People and relatives had been complementary of the new management team who had good knowledge of the people the service supported. People and relatives were aware of some of the quality assurance and governance systems in the service. A person told us, “[Staff member] does spot checks and has been out a couple of times as a carer.” However, they felt there had not been regular formal processes in place to support them to have the best experience from the service such as regular care reviews or opportunities to formally feedback about their experience. A relative said, “There is no review visits or input by the office that could be something they could improve on.” The provider had an action plan in place to ensure everyone received a review and to implement more regular contact points in a 12-month period to ensure people had the opportunity to feedback about their care. We will review this at our next inspection.

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.

Feedback from professionals was positive about their experience of partnership working with the service. A healthcare professional told us, “We have worked alongside each other for a number of clients. [Staff member] is also professional, meets me at visits on time and responds to my emails in a timely manner. [Staff member] always meets me for a joint visit if a referral has been made for an assessment and will follow up any issues I have had.”

Care staff told us they felt they worked well in partnership with other professionals to meet people’s holistic needs. A staff member said, “Nurses are very good, and chiropodists are good too. Paramedics are very good. They listen and take us seriously. This has improved over years. It is refreshing that carers are now being taken seriously by medical professionals.” Another staff member said, “I work very well with the district nurses and very well with the hospice and paramedics."

The provider had not always focused on continuous learning, innovation and improvement across the organisation and local system. They had not always actively contributed to safe, effective practice.

The service had recently undergone changes to the business and management of the service. There had been a full review of the service and changes were being made to change the systems and processes to better support safe and effective practice. The provider was working alongside other services to research and improve their use of electronic care systems. They had created new forms, audits and processes to improve the service. However, the provider was in the early stages of their transition, and we could not be assured that their systems and processes would be embedded and effective. We will review this at our next inspection.