Jewel Home 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 inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

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

This service scored 36 (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 did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

The provider’s stated values included ‘caring without compromise’. However, the shortfalls identified during this inspection showed these values were not consistently embedded in practice, and people were exposed to a significantly increased risk of harm and compromised delivery of care.

The provider had previously been told what improvements were required, but new and similar issues remained when we returned to complete this inspection. This meant the culture was not one where learning was embedded and where people could be confident that problems would be identified and resolved quickly.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively.

Significant concerns with the leadership and governance of the service continued to be identified throughout this inspection. Leaders did not demonstrate effective oversight of people’s needs and the risks associated with their care. We were not assured leaders understood key risks for the people being supported. This was evidenced by gaps and inconsistencies in care records and risk assessments. Leaders within the service were unable to demonstrate they understood how to deliver care under Right Support, Right Care, Right Culture. We asked specific questions to a leader to ensure they understood how to support people with a learning disability and/or autistic people, and they incorrectly answered 5 out of 7 of the questions asked. This reduced assurance that leaders had a clear view of risk across the service and could identify deterioration risks in a timely way. Leaders also did not provide assurance records were accurate and aligned, which increased the risk of staff following incorrect guidance.

The provider had some systems in place to support staff to raise concerns. Staff records showed supervisions and appraisals had taken place, and there was a whistleblowing policy available. However, these arrangements were not fully robust and did not provide sufficient assurance that staff would be able to raise concerns safely and consistently, particularly where concerns related to management practice. The whistleblowing policy did not clearly explain what staff should do if their concern related to their line manager, as it directed staff to report concerns about colleagues to their line manager, without setting out an alternative escalation route. This reduced assurance staff had clear guidance on how to raise sensitive concerns independently and could discourage reporting in situations where staff felt unable to speak openly.

In the context of the wider concerns identified during the inspection, including weaknesses in oversight and uncertainty about whether staff had received appropriate training to meet the needs of people with a learning disability, there was a risk a closed culture could develop. This meant the provider needed to strengthen it’s arrangements for speaking up, including clear escalation pathways and reassurance that concerns would be listened to, acted upon, and used to improve practice.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

We were not able to gather care staff views during this inspection. We have therefore based our understanding of staff’s experiences on the evidence available to us, including care records, training records and correspondence. The provider could not demonstrate, through records and assurance systems, staff were consistently trained and supported to meet the range of needs of the people they cared for. Training information provided did not clearly describe what training staff had completed, and the provider did not provide the further detail requested. This reduced assurance staff had the right specialist knowledge and skills, including where people had complex needs or learning disabilities and/or autism.

Concerns were also identified regarding medicines training and competency, where staff who were waiting for the required level of training had administered high risk medicines. This meant the provider could not demonstrate the workforce was consistently supported and developed in a way which promoted safe and effective care.

The office staff we spoke with during the inspection felt supported, and trusted, by the registered manager.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider did not have effective systems of governance to identify, assess and manage risk, or to monitor quality and safety. The provider’s systems did not identify the concerns we found during the inspection. Risks had not been adequately mitigated, and records remained incomplete, conflicting or inaccurate in high-risk areas of care. In some cases, updated documentation introduced further confusion, including guidance that did not match prescribed medicines and guidance that prompted staff to record medicines inappropriately.

The provider told us they had completed actions since the last inspection, but when we returned to complete this inspection, some actions had not been completed, including high-risk medicines risk assessments. Leaders told us they had oversight through auditing, including medicines audits, however, the audits which were being completed did not identify the concerns we found. This demonstrated assurance systems were not robust enough to detect problems, and actions taken were not effective or able to be sustained. The provider was given further opportunity to submit evidence of improvement following the inspection, but the response did not provide assurance risks had been, and would be, addressed and mitigated promptly.

We also identified issues with some of the provider’s policies. For example, 1 policy had the name of another organisation, and another was written for a supported living service, and not domiciliary care. The lack of accurate and robust policies further weakened the governance of this service.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people.

Whilst we identified some good practice in the way information was shared with partner professionals, such as the GP, this was not consistently underpinned by clear and robust arrangements across the service. In particular, where people had complex conditions, records did not consistently identify which healthcare professionals held overall clinical responsibility for ongoing monitoring, review and escalation. This meant we were not assured partnership arrangements were consistently clear, clinical oversight was effectively coordinated, and escalation pathways were robust enough to help keep people safe.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local systems. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

The provider failed to demonstrate effective learning since the last inspection. The purpose of this follow up inspection was to review the actions the provider had told us were already complete and to confirm the provider was now operating within the legal regulations. However, we found the provider had not embedded learning in a way that prevented repeated errors. High risk issues continued, including inaccurate or missing risk information, gaps in clinical guidance, and conflicting information across care plans and medicine records. The provider was given an additional opportunity to evidence improvement, but this did not provide assurance the risks had been resolved or would be resolved quickly enough, meaning people remained at significant risk of harm.