Desire Care - Burton

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 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 the overall governance at the service.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff shared a culture of working together to meet people’s needs, although a shared strategy was required to ensure improvements were identified and actioned across the organisation.

Staff we spoke with, promoted openness and transparency and ensured people were involved in their care. One staff member told us, “If we do something wrong, we redo the training to get it right. The managers talk to the clients and ask them how they feel about everything.” Another staff member told us, “It is amazing working here, the management have been really supportive, anything to help with the clients. When I inform them [Management] of anything, they do what needs to be done to ensure the client is satisfied.”

The provider did not have a clear strategy to ensure people’s care records always contained accurate and up to date information about people’s health conditions and any monitoring in place. Staff were not held accountable for daily records lacking required information, as the provider did not identify this was an issue.

Leaders did not all understand the context in which care, treatment and support was required to be delivered. The culture and values of their workforce and organisation was not always clear. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

The provider assigned specific staff members audits to complete, however there was no clear oversight of the audits in place, to ensure they were effective. This meant issues were not always addressed and placed people at risk of harm.

The systems in place were not regularly reviewed to ensure issues were identified and required action was taken to make improvements to the service and care people received. For example, care plan reviews were not effective at highlighting missing information in relation to people’s health conditions.

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

Staff we spoke with confirmed they were able to raise concerns and overall, they felt action was taken when they shared any issues. One staff member told us, “I am supported in my role, the company support me, if there are any problems they give us the information we need, it is very good, they give us good advice.” Another staff member told us, “We have the opportunity to make suggestions for how the care could be better, we do raise the concerns, sometimes we have to wait and see if they act on things.”

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 completed medical declarations for staff members as part of their induction to address any work-related health conditions.

Staff members we spoke with confirmed they felt supported by the managers. One staff member told us, “The company have really helped me, training and plans are ongoing which is helping me develop.” Another staff member told us how they support staff within their roles and feel supported within their own, “I try to resolve issues for carers and work on call if needed, I feel supported in my role.”

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.

Audits in place were not always completed effectively to identify risks or shortfalls, or issues we identified during the inspection. It was not clear from the audits in place of managerial oversight of the governance processes. For example, the medicine audit in place specified whether staff had enough information, such as a protocols, to give ‘as required’ medicines, ‘yes’ was ticked on the audits, however, the provider confirmed there were no ‘as required’ medicine protocols in place. This meant the audit was ineffective and actions may not have been taken to reduce risk, and lessons may not have been learned to avoid further incidents.

We also found with the medicine audits and the audits in place to review people’s daily records contained generic information which included repeated actions from the months completed previously. It was not clear if this action had been followed up previously or if any action was taken to avoid further incidents.

The audits in place to review people’s care plans did not identify where updates were required, or where dates for reviews had been missed. We requested a copy of the policy for reviewing care plans to ascertain your requirement for care plan audits; however, we did not receive this.

There was no audit in place for the reviewing of accident and incidents to identify any themes or trends or to help reduce the risk of reoccurrence.

Whilst there was had a training matrix in place, this was not up to date to show accurate completion figures. Staff had also not completed training in specific areas to ensure people’s individual health conditions and needs were met. The requirement for training in these areas had not been identified through the systems in place.

The systems in place to monitor calls were not effective. There was no audit in place of the monitoring, issues we found were not identified, and therefore no action was taken to address them. There was no record of identifying who was arriving early or late to calls, and we found the sign-in and sign-out times were not clearly recorded. This meant there was not a clear oversight of call monitoring.

The provider did not always understand their duty to collaborate and work in partnership at a high level.

Where health professionals had completed reviews or provided advice or guidance on people’s health conditions, people’s records did not clearly show the updates or where further monitoring was in place.

The provider did not work in partnership with the local authority to ensure they completed required actions from their recent quality assurance report. We found the same concerns identified within their report, including missing information within staff recruitment files and no evidence of best interest decision records within people’s care plans.

An external professional informed us, when they identified where improvements were required, the provider did not always act to ensure these were addressed across the service.

Whilst we found, records were not always up to date with professional input, staff we spoke with, however, confirmed they worked with external professionals to meet people’s needs. One staff member told us, “We work well with external professionals, we follow their advice and guidance.”

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system.

We were not assured the provider had a clear oversight of the service to ensure audits in place were effective to drive learning, improvement and innovation. This meant action was not always taken to provide people with a high standard of care.

The provider told us they had acted following us raising concerns during our inspection, however, they did not provide us with evidence of updated records or documents to demonstrate the improvements they had put in place.

People provided feedback on the service through regular questionnaires, which the provider analysed. This information was reviewed and inputted onto a graph with actions and outcomes recorded on a spreadsheet. We reviewed the responses and most contained positive feedback, and we saw where action was taken when a below satisfactory response was provided. This included office staff completing a visit, implementing actions with the relative to improve the care and informing all staff involved with this person’s care.