Homecare For You Dudley

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 service. This key question has been rated 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 governance at the service.

This service scored 57 (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 registered manager described the caring nature of the service as its key strength and discussed the services aims of supporting people to achieve positive outcomes whilst respecting their choices, preferences and individual circumstances. Feedback from people, and their relatives highlighted they felt the staff were caring and shared the values discussed by the registered manager.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders had not always ensured effective oversight of the service. Governance systems had failed to identify and address concerns relating to care planning, risk management, safeguarding referrals and statutory notifications. We found the registered manager did not fully understand their responsibilities in relation to submitting statutory notifications to CQC. Whilst leaders demonstrated a willingness to improve and a commitment to providing good quality care, improvements were required to ensure management oversight systems were sufficiently robust to identify risks, drive improvement and maintain compliance with regulatory requirements.

Leaders had failed to ensure compliance with their legal responsibilities. We identified several safeguarding incidents that should have been referred to the local authority but had not been. In addition, where safeguarding concerns had been raised, the provider had failed to submit the required statutory notifications to CQC. We found incidents involving police attendance had not been notified to CQC as required by legislation. Whilst one notification relating to a death had been submitted, other notifiable incidents had not been reported.

However, managers were visible, approachable and committed to supporting people using the service and staff.

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

The provider had systems in place to encourage people, relatives and staff to raise concerns, provide feedback and discuss issues relating to care and support. Staff working within the office told us people and their relatives regularly contacted the service to share feedback, raise concerns and seek advice about the care they received. A complaints policy was in place which outlined the process for raising concerns and the actions the provider would take in response. Most people and relatives told us they found the service approachable and were able to contact the office when required. Several people told us concerns they had raised had been addressed and resolved appropriately. However, people did not always demonstrate an understanding of how to make a formal complaint. Some people we spoke with were unclear about the complaints process, which indicated the provider could not be assured everyone using the service knew how to raise concerns if they were dissatisfied with any aspect of their care. This limited assurance the complaints procedure was fully accessible and understood by people using the service.

Staff told us they felt comfortable speaking up and raising concerns within the organisation. They said management was approachable, supportive and responsive when issues were brought to their attention. Staff were confident that concerns would be listened to and acted upon appropriately. Feedback from staff suggested there was an open culture where people felt able to share their views and challenge practice when necessary.

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.

Staff told us they felt respected, valued and supported in their roles. Staff spoke positively about their experiences of working for the service and told us they were treated fairly and with respect by managers and colleagues. Staff consistently described the registered manager as approachable, supportive and available when guidance was needed. One staff member told us,

"Management are well trained and really good, we get enough support from them, we want it to grow more for more experience."

We saw evidence staff were supported with regular supervisions and team meetings every 6 months.

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 completed a range of audits; however, these were not sufficiently robust to identify shortfalls in care planning, risk management and record keeping. Care plan audits primarily focused on whether documentation was present and followed a checklist-based approach. These audits did not consistently include all relevant documentation, such as falls risk assessments, and failed to identify where important information was missing from care records. For example, we found information relating to the use of bed rails was not reflected within care plans and no corresponding risk assessment was in place. We also identified examples where care plan review dates and completion dates had been recorded as the same, these issues had not been identified through the provider's quality assurance processes.

Systems for monitoring care records failed to identify concerns. Care note audits focused primarily on the quality and structure of recording rather than the content of records. This meant audits did not effectively identify omissions, inconsistencies, changing risks or concerns within people's care. Opportunities to identify themes, trends and emerging risks were missed, limiting the provider's ability to learn from incidents, prevent recurrence and drive continuous improvement.

We found recruitment files contained gaps, including out-of-date vehicle documentation and inconsistencies in the recording and follow-up of a staff disciplinary process. This demonstrated a lack of effective management oversight and record management.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider had been working with the local authority quality assurance team and had received support and guidance through improvement plans; however, limited progress had been made in addressing identified concerns. Issues found during our assessment, including weaknesses in care planning, risk management, safeguarding oversight and governance, indicated opportunities to implement and embed improvements had not been fully utilised.

However, the provider worked in partnership with a range of health and social care professionals to help ensure people received coordinated care and support. Records demonstrated staff communicated with external professionals, including GPs and social workers, when required. There was evidence of information being shared with relevant professionals to support people's health and wellbeing.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider's own audit and quality assurance systems had failed to identify issues found during our assessment, including concerns relating to care planning, risk assessments, safeguarding oversight and statutory notifications. As a result, opportunities to identify areas for improvement, learn from incidents and drive service development had been missed. The provider was therefore unable to demonstrate learning was consistently embedded within the service or that quality assurance systems effectively supported continuous improvement.

Staff received regular supervision and team meetings were held every six months, providing opportunities for staff to discuss practice issues, share experiences and receive updates about the service. Staff told us they felt supported by managers and were able to seek advice and guidance when required.

The nominated individual was receptive to feedback throughout the assessment process and demonstrated a willingness to improve. They responded positively to concerns raised during the assessment and took proactive steps to begin addressing issues identified by the inspection team including implementing new policies around unexplained bruising.