Gravesend Care Services

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 governance of the service.

This service scored 62 (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. Staff shared positive feedback in relation to the culture and morale at the service. Staff told us they felt supported by the management team and that there was a positive culture amongst staff.

People and their relative told us they were happy with the care they received and felt staff were supportive and kind.

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders did not all have the experience, capacity, capability and integrity to ensure that the organisational vision can be delivered and risks are well managed. We found risks were not consistently well managed at this service. Whilst staff understood their role, risk management was not always considered and fully implemented to support staff to ensure they fully supported people’s health and wellbeing. However, following the inspection leaders were proactive to address the concerns we identified during the inspection.

The provider had systems in place to support the recruitment and development of leaders. The manager was in the process of completing their CQC registered manager registration and was receiving appropriate support to carry out their role.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The manager told us, ‘The culture is excellent and the people are always listened to, they can speak up and they do. They are comfortable to do so. Staff are happy, they speak up to you with any worries, we are very much a team.’ Staff we spoke with shared similar positive feedback around feeling confident to speak up.

People and their relatives also felt they were able to speak up if they had any concerns. One person told us, ‘I would speak to the staff if I was worried.’

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 had access to a range of networks, including parent, LGBTQ+ (PRISM) and disability networks, which provided opportunities for support, shared learning and engagement. These networks helped ensure staff felt represented and included, while promoting equality, equity and awareness of issues affecting different groups of employees.

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. Whilst the manager told us they understood what ‘Right support, Right care, Right culture’ was, this had not always been fully embedded across the service. We found language used was not consistently person centred. For example, in one person’s daily notes it referred to the person ‘returning to the scheme’ rather than referring to the person’s homes.

The provider had not ensured there were clear responsibilities for their on-call system. During the inspection, staff were unable to tell us which senior member of staff was on call, and it was not clear who held responsibility for providing management support outside of normal working hours. This meant staff may not have been able to access timely guidance or escalate concerns appropriately when urgent issues arose. Feedback from relatives supported this concern. Relatives told us they felt there needed to be a clearer management structure for raising urgent issues and obtaining support when concerns required immediate attention.

The provider had not ensured governance and quality assurance systems were consistently effective in identifying and addressing areas of concern. Although regular audits and monitoring checks were undertaken, these had not identified the issues found during our inspection.

For example, there was a lack of effective oversight of epilepsy management, including failures to ensure risks were consistently assessed, monitored and managed. The provider's auditing processes had not highlighted these concerns, which meant opportunities to identify and address shortcomings at an earlier stage had been missed.

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 manager demonstrated how they ensured they kept up to date with current Health and Social care updates. The manger told us, ‘I am part of a number of social media groups, attend local authority registered manager forums, they are twice a year. We also part of Skills for Care.’ Skills for Care works with employers and the government to ensure the sector has the right people, skills, and support to deliver high-quality, person-centred care.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. Lessons were learned from incidents to drive improvements in practice.

The provider sought and responded to people's views when planning improvements. Staff told us that people preferred taking part in activities rather than attending formal meetings, and improvements were often based on what people accessing the service said they would enjoy. For example, people had requested new garden furniture and were actively involved in developing the garden, including helping with planting.