Archived: Lancashire Domiciliary Care Service

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 governance and oversight was inconsistent and did not always support the delivery of high-quality, person-centred care.

We found the provider to be in breach of legal regulation in relation to good governance.

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 were given information about the service’s visions and values as part of their induction; and member of the self-advocacy group read a poem to new staff, which spoke about respect for people living at the service.

Through conversations with the registered manager and staff, it was clear the culture of the service was person centred, inclusive and focused on enabling people to enjoy their lives. A staff member told us, “I like the connections with people. Making a change to someone’s life for the better.” Another added, “I enjoy the relationships I’ve made with every [person]. It feels like a family, not just work. I enjoy seeing them happy.”

The registered manager had introduced spot checks to monitor the culture across the supported living service; including late nights, early mornings and weekends.

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 confirmed managers and the registered manager were approachable, supportive and led by example. A staff member said, “I get on well with all the leaders and managers. I couldn’t ask for a better manager. We’ve built a good relationship. They are involved in the service and get on well with everyone.”

A manager explained ongoing training and support they received to improve their own knowledge and competence, saying the provider was, “Very good with training requests.” They were completing a level 5 qualification and had previously undertaken a variety of other training. Succession planning was prioritised, with career aspirations discussed at appraisals, and developmental opportunities available to staff at all levels.

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

Staff felt able to speak up and were given the opportunity to discuss concerns during supervisions and team meetings. A staff member told us, “There’s an open-door policy.”

The provider had recently reinstated the staff forum and representatives from different teams were invited. Topics included changes to processes, concerns around safety, staff wellbeing and new initiatives, with staff having the opportunity to provide feedback.

An annual staff survey was sent out and actions shared via, ‘You said, we delivered’. Recent actions included more regular newsletters, better communication and updates about the service, and improved computer systems.

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 took action to prevent and address bullying and harassment. Clear guidance was available in the bullying and harassment policy, and staff received training in equality and discrimination. Staff expressed no concerns about their treatment from the provider, managers or colleagues.

The provider was part of the ‘Disability Confident Scheme’, which recognises employers who recruit and develop disabled staff or those with health conditions. The registered manager explained reasonable adjustments made for staff with disabilities or other protected characteristics.

Staff received information during their induction about employee rights, to ensure they were treated fairly and equitably. The provider employed several overseas workers, systems were in place to track conditions of employment, and ensure these were met.

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 had a variety of checks and audits to ensure governance and oversight, but these had not been effective at identifying and/or addressing concerns found during our inspection. For example, gaps to care records and risk assessments, medicines management issues and health and safety concerns.

The provider’s quality audits had also identified people’s food and fluid intake, weights, sleep, activities, personal care and behaviour monitoring records were not always completed. Whilst repeat audits were scheduled, follow up actions had not been recorded, so we could not be assured gaps were fully addressed.

There were arrangements for the availability and confidentiality of data and records, but the integrity of information was not always robust, or used effectively to monitor and improve the quality of care. Information in care plans and risk assessments was not always correct, consistent or reflective of the support people received.

The provider had plans to ensure business continuity in case of an adverse event, and notifications were submitted to the appropriate agencies when required.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

The service was well embedded within the local community and considered a valued partner. Community cafes and an animal care centre, run by Lancashire Domiciliary Care Services, were accessed by members of the public. An on-site store recycled unwanted goods, free of charge for those in need.

The horticulture group provided gardening services for the elderly, and had won awards at local flower shows for their displays. Staff explained the group gave people a sense of community connection and pride, and improved various outcomes. For example, a person had previously experienced social isolation. The group had helped them develop planting skills, and over time they were encouraged to take a more active role in running the polytunnels and gardens. As a result, they had become more independent, confident and engaged.

The provider had built strong links with several local learning disability organisations and social clubs, to help individuals meet new people and form positive relationships with peers.

The provider worked with a local college to develop the educational provision, giving people living at the service the opportunity to attain skills and certificates in maths and animal care. They also worked closely with local special education schools to ease the transition between children’s and adult services; sharing information and providing work experience placements to young people.

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.

The provider ensured staff had access to training and support to develop skills around improvement and innovation. There were several ‘champions’ or leads who received enhance training, to enable them to offer support and guidance to others. For example, in health and safety, IPC and safeguarding.

There were different forums to ensure people, relatives and staff were involved in identifying areas of improvement and developing new initiatives. The self-advocacy group had been involved in reviewing easy read policies and there was evidence feedback had resulted in several changes. Additional wellbeing initiatives had also been introduced following a discussion at the staff forum.

Staff explained recent and planned expansions and improvements such as the adapted bikes, sensory rooms and the new café. The team were dedicated to continuously improving the service and opportunities afforded to people living at Lancashire Domiciliary Care Services.

The registered manager was open and transparent during the inspection process and was keen to implement necessary changes and improvements, following feedback. They explained learning from inspections was shared between the provider’s other services to help improve the quality and safety of care.