Choices Care Ltd (Birmingham)

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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 requires improvement. At this assessment the rating has changed to 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 71 (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 shared their vision for the service with staff, who spoke positively about the service, its management, and the care delivered to people. Staff meetings demonstrated a culture of openness, with clear communication about changes that could affect staff. This enabled staff to make informed decisions about their future with the service, including considering adjustments to their working hours.

During conversations with staff, they consistently referred to ‘choices’, reflecting not only the name of the service but its underlying culture and ethos.

The registered manager said, “We choose to care, we genuinely do it because we care. Quality and safety does come into it, but if you don't care what’s the point?”

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.

Staff spoke positively about the service and described the management team as supportive and approachable. Managers emphasised their commitment to being available to staff at all times. Arrangements were in place to ensure that if 1 manager was unavailable, calls were diverted to another manager within the organisation to provide timely support. Staff confirmed this approach worked well and found it both helpful and reassuring, particularly as support was accessible out of hours. One member of staff told us, “We get support; we can get hold of on-call quickly,” and another said, “You can always get hold of someone; there is always someone on call.”

Staff meetings took place on a regular basis, providing staff with the opportunity to share any thoughts and concerns and have their voice heard. Topics discussed were varied, including the wellbeing focus around supporting people who used the service and ensuring cover was provided during popular bank holiday periods. We noted that the meeting where staff were advised of reduced working hours was conducted in a supportive and sensitive manner.

People and their loved ones all told us they would recommend the service. One relative added, “Even the girls who work there and come here praise the company they are working for. They always praise the manager.”

There was a culture of supporting and encouraging staff. A member of staff told us, “Management are always offering and encouraging training. We have supervision as well and they support our wellbeing – healthwise, any problems and they support us.”

People who were supported by the service gave positive feedback about their experiences. One relative told us, “I’m a nurse, I talk about them [Choices Care] at work, I say how good the carers are as they are so good.” Another said, “I would definitely recommend the service, 100%. There is nothing they could do better, they are absolutely fantastic.”

The registered manager and their team told us they felt fully supported by the provider. Systems were in place to ensure any areas of identified poor performance were identified through spot checks and managed by providing additional support and training where needed.

The management team had introduced a number of awards for staff, in recognition of their work and remained accessible to staff in an open office environment.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff were aware of the provider’s whistleblowing policy and were given the opportunity to voice their opinions through meetings and also an anonymous survey. Feedback from the last survey was positive. Minutes of staff meetings demonstrated staff were given the opportunity to raise any issues they may have and staff spoken with confirmed this.

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.

The provider had taken a number of actions to support and enhance staff experience. Staff shared several examples of the personal support they had received, including access to additional learning materials and guidebooks in their first language, as well as recognition of the importance of observing religious practices. For example, during Ramadan, discussions took place in staff meetings to ensure staff who were fasting were appropriately supported. Staff confirmed this approach.

Despite the provider having clear responsibilities, roles, systems of accountability and good governance processes, they did not always act on the best information about risk, performance and outcomes.

Although we could see appropriate action being taken in response to individual concerns, annual reviews of care plans and risk assessments were not robust and had failed to consistently acknowledge and record what changes had taken place during the previous 12 months. Information relating to risk management was not always consistently recorded, for example in relation to catheter care. Care records reviewed were difficult to navigate, making it challenging to locate key information needed to support people safely.

People’s medication care plans did not consistently include sufficient information to guide staff on seeking consent before administering medication. The registered manager confirmed this would be added to ensure care records were clear and supportive of people’s rights.

Audits in place had failed to identify these failings. We discussed this with the registered manager who confirmed they would review the existing systems in place.

People were supported by staff who understood their roles and responsibilities, and the management team had systems in place to provide them with oversight of service delivery.

Staff confirmed they were given enough time to travel between calls and regularly had their competencies assessed.

Systems were in place to ensure information was clearly shared and communicated to staff on a regular basis, through handovers, meetings and regular updates. For example, where an error had been made by the local pharmacy, this had been picked up by care staff. The lessons learnt from this incident were shared with staff.

A range of audits were in place to provide the management team with effective oversight of the service. These included medication audits, which identified errors and ensured appropriate follow-up action was taken. The service was in the process of transitioning from paper-based to electronic care records, with a phased approach to ensure staff maintained access to information and were supported to adapt to the new system. Staff spoke positively about the changes already implemented and said they felt well supported to use the system.

Monthly audits of people’s log books (daily records held in people’s homes) were completed, and where concerns or queries were identified, there was evidence these were followed up and resolved. Auditing processes continued as information was transferred to the electronic system.

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 service worked alongside other external stakeholders and agencies in order to ensure people’s care needs were met.

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.

Management had introduced the use of audits being carried out across the organisation by different managers to bring a fresh pair of eyes to the process. The registered manager told us, “Our audits are much stronger than before, we have managers from different branches doing those audits, we never did that before. Staff work from the bottom up and we have tried to involve them across all locations. We have come a very long way.”

Systems were in place to ensure lessons were learnt from any accidents, incidents or safeguarding events. Reviews of people’s care took place on a regular basis and people’s views of the service were regularly sought. Where accidents and incidents took place, follow up meetings were arranged with people to ensure they were happy with the actions that had been taken.

Staff were provided with the opportunity to request any additional or refresher training. A member of staff told us, “They [management team] are always encouraging and are great. They are like family and communication is great as well. I feel we have the scope to grow and learn and they give us the opportunity to do this.”

The management team were open and transparent throughout the assessment.