13B

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.This is the first assessment for this newly registered service. This key question has been rated 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.There was a positive culture at the service. The management team had a clear vision aimed at developing a less used approach to care, that was compassionate, inclusive and supported people to maintain their individual and diverse needs.

The provider and director promoted an alternative model of care where people could receive 24 hour support at home rather than moving into residential care. In addition to care and support the emphasis was on supporting people to improve and maintain independence, combatting loneliness and maintaining or returning to hobbies and interests they may have been unable to manage alone.The service could also be used short term, for example, as a respite service if the person’s regular carer needed a break or was admitted to hospital. Staff were involved in the development of the service. They told us they were able to bring ideas and suggestions and know they would be listened to and were able to affect changes.
 

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 management team included the provider, registered manager and director. They were fully involved in the day to day running of the service, the ongoing development of both the service and staff. They were supported by a manager who had a clear understanding of their own roles and responsibilities and how these roles worked together.All staff spoke highly about the registered manager and the management team. They told us they could approach them at any time. They had full confidence in the support provided.
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.There was a whistleblowing policy and staff received training. Staff told us they would be confident to report any concerns to any of the management team and be confident they would respond. Staff told us if this did not happen then they would follow the whistleblowing policy.
 

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.
people who worked for them.Staff received training in equality and diversity. The management team supported all staff to ensure they were not at risk of unfair treatment and discrimination due to their background, culture or individual needs. For example, staff were able to speak into the care planning system and ask questions of the tool in place of reading or writing. When staff started to provide live-in care to people, they were made aware that not all placements worked out. They ensured staff were aware that if this happened they and the person receiving support would be treated fairly and with kindness.
 

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.The provider and registered manager understood and demonstrated compliance with regulatory requirements. They also understood their responsibility to provide honest information, suitable support and to apply duty of candour where appropriate.
The registered manager had good oversight of the service. Systems were in place to check and audit the quality and safety of care and support provided to people. These were analysed and findings were used to make any changes required and support staff development and knowledge. The registered manager recognised these systems would become increasingly important as the service grew and developed. Contingency plans were in place, these included who to contact in an emergency, contact phone numbers and procedures to follow.
 

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 director was also involved in education and development projects in conjunction with other organisations. For example, the development of a tool to support people with cognitive decline. This learning would be used for the benefit of people and staff.The provider worked with a range of other services to enable learning and development across the service. They worked with various charities who supported people as they aged, local dementia cafes and other organisations who supported people with needs related to dementia. Where needed, people’s families were introduced to these organisations for support and guidance.
 

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.The senior management team were proactive in developing and improving the service through innovation and learning. They had introduced the use of a secure artificial intelligence (AI) tool. The director told us the tool was updated daily. Staff were able to use this and reduced the risk of staff using tools that were inaccurate or not secure.The AI tool was also used to support other aspects of the service. This included reviewing care plans and developing a supervision process. The director told us this was not a substitute for management oversight or professional judgement. However, it did help staff access appropriate guidance, identify risks and improve record quality.The director had created case studies on people who had used the service. These demonstrated how the service had supported people to improve their health, well-being and quality of life. These were used for learning across the service.