Bolton Supported Living

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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.

The provider was previously in breach of the legal regulation in relation to good governance. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

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 had a clear Statement of Purpose and vision and strategy for the service which the leaders were aware of. Values of the service were important to the leaders we spoke with, and they told us they were incorporated into everyday processes. A relative told us, “The managers I have met have been amazing; they always ring me up if there’s anything and keep me in the loop.” A staff member said, “Our values are to give people choices and let them lead the way, and to support people in the least restrictive way.”

Following our last inspection, leaders had worked hard on improving the staff culture. Team meetings had been held to provide an update on the CQC action plan; to identify from staff’s perspective any potential gaps in quality and to ensure as a service, the provider was prepared for this assessment.

Each area of concern from the last inspection was identified and tracked against a section for each issue titled ‘where are we now’ It was clear leaders had worked hard on engaging the staff team; a staff forum had been set up; staff engagement sessions had been completed, and an employee wellbeing strategy was in place. Satisfaction questionnaires had been sent to all people and their relatives, and the results had been analysed to support making improvements.

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

Staff told us the felt able to raise concerns and that they would be listened to. One staff member told us, “We can make suggestions and have regular meetings where we can put ideas forward.” Staff and leaders actively promoted staff empowerment to drive improvement; they encouraged staff to raise concerns and promoted the value of doing so.

There were mechanisms in place for staff to speak up and a culture in place to encourage them to do so. Good communication was in place through the on-call system, team meetings and formal one-to-one sessions to ensure staff had regular opportunities to engage with leaders. This was also supported by policies and information supporting staff to raise concerns externally if required.

People and relatives felt their voice was heard. The provider had an up to date freedom to speak up / whistleblowing policy in place. One relative said, “We have recently done a big meeting, and I can join in online because I’m not close by, so they make it work for me.” A second relative told us, “I’m very happy with them [the provider]; they’re always open to listening and learning. [Person’s] happy which is the main thing.” A person commented, “I’m loving it; been here nearly a year.”

We looked at the results of the most recent survey. Analysis of the survey results showed overall, people being supported were pleased with the quality of care provided and how they were treated by staff members. Responses indicated people were comfortable with staff. In conclusion, people were happy with the support provided, resoundingly feeling supported in living their lives and doing as they wished. People felt they were secure around staff members, and inclined to make their own decisions, with staff support.

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

Staff told us the felt able to raise concerns and that they would be listened to. One staff member told us, “We can make suggestions and have regular meetings where we can put ideas forward.” Staff and leaders actively promoted staff empowerment to drive improvement; they encouraged staff to raise concerns and promoted the value of doing so.

There were mechanisms in place for staff to speak up and a culture in place to encourage them to do so. Good communication was in place through the on-call system, team meetings and formal one-to-one sessions to ensure staff had regular opportunities to engage with leaders. This was also supported by policies and information supporting staff to raise concerns externally if required.

People and relatives felt their voice was heard. The provider had an up to date freedom to speak up / whistleblowing policy in place. One relative said, “We have recently done a big meeting, and I can join in online because I’m not close by, so they make it work for me.” A second relative told us, “I’m very happy with them [the provider]; they’re always open to listening and learning. [Person’s] happy which is the main thing.” A person commented, “I’m loving it; been here nearly a year.”

We looked at the results of the most recent survey. Analysis of the survey results showed overall, people being supported were pleased with the quality of care provided and how they were treated by staff members. Responses indicated people were comfortable with staff. In conclusion, people were happy with the support provided, resoundingly feeling supported in living their lives and doing as they wished. People felt they were secure around staff members, and inclined to make their own decisions, with staff support.

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.

Leaders provided flexible working agreements to staff to account for personal circumstances such as caring responsibilities and health issues and had put reasonable adjustments in place for some staff to help them carry out their role; this was confirmed by staff we spoke with. Leaders took steps to ensure staff were representative of the population of people being supported. Staff told us they were treated equally by leaders. A staff member told us, “There has been significant improvements and, more money over the years.”

Managers engaged with staff via appropriate forums such as supervision and staff surveys, to ensure their voices were heard. Most staff were confident they could raise concerns directly with their leaders, and had received training in equality, diversity and human rights. A staff member told us, “Over the years, all leaders have demonstrated a caring attitude and want staff to speak up and identify any issues with them. I love the job now and find it very rewarding. My line manager is great and I very much enjoy working here. The provider has been doing lots of improvement work as they knew things needed vastly improving; and now they have improved.”

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.

Staff were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The provider had improved the effectiveness of governance processes since our last inspection and had implemented a new audit schedule and process. The schedule detailed the audit or monitoring task, who was responsible and the frequency. A separate compliance planner was used to assist with scheduling of audits and tracking progress.

We looked at an ‘executive team business plan tracker sheet’, which identified different ‘projects’ and included the project title, the owner, the date completed and space for any monthly updates. Areas covered included a review of all mandatory training, a review and agreement of quality monitoring arrangements with local authority, the communications strategy and associated events, governance arrangements, buildings and facilities, people (staff), systems, finance and growth.

Data or notifications were consistently submitted to CQC or external organisations as required. There were robust arrangements for the availability, integrity and confidentiality of data, records and data management systems. Governance, management and accountability arrangements were now better organised.

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 and leaders were open and transparent and collaborated with all relevant external stakeholders and agencies. The provider engaged in various meetings with external stakeholders including the local authority. A communications lead was in place, with a focus on developing internal and external communication strategies. An environmental strategy had been developed to ensure compliance with regulations.

The provider updated and sought guidance and involvement from relevant healthcare professionals. The provider documented feedback, including meetings and meaningful engagements with staff, people and the wider community. Daily records identified any activities people had been involved in. For example, one person had a day out to Bury, and staff supported them; they then went swimming and then out for lunch after visiting a museum.

During our visits to people’s homes, we observed a very respectful VE day celebration being held in the back garden of 2 adjoining properties at lunchtime; people from the adjoining house attended and were freely moving back and forth between the 2 garden areas, with staff present. Everyone appeared to enjoy this event, and we noted very good staff interactions throughout; it was clear people got on well with the staff supporting them.

Feedback from stakeholders and other agencies was largely positive. A local authority professional commented, ‘The local authority have been visiting during the year, and have found some good practices are being embedded, but not necessarily across all houses.’

The provider focused on continuous learning, innovation and improvement across the organization 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.

All staff we spoke with confirmed leaders encouraged them to speak up with ideas for improvement and innovation and actively invested time to listen and engage. One staff member told us, “Leaders have done visits here and chatted to us, and did arrange for staff meetings to meet them.” The provider had a CQC action plan which they used to monitor and record actions taken to address issues noted at the previous CQC inspection and ongoing monitoring by the local authority.

Although we found minor discrepancies in some people’s care plan information, we determined no harm had occurred as a result of this and the provider corrected this information during the assessment visit. The quality of people's care plans was now more consistent. All staff demonstrated a good understanding of people's needs and were able to tell us about people's likes, dislikes, needs and preferences. A joint working protocol with the local authority appointee ship service was in place to help improve staff’s understanding of people’s financial information.

The provider now used a quality assurance system which enabled them to monitor the standards of the service and inform organizational learning and improvement. It was clear the provider had worked hard to improve learning across the organization and any learning from previous issues was now better shared with staff. Operational managers meetings were held to support the provider in better understanding what the organizational issues were at any given point in time and to develop plans to address these.