DICE Healthcare Limited

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 requires improvement. At this assessment the rating has changed to outstanding.

This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

This service scored 89 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

We spoke with the directors, both of which had clinical backgrounds, on site and off. There was a clear vision and culture for the service. One of the directors described the reasons for establishing the company. “[Name] was my boss in the NHS and her Mum had a care company and did nothing but complain that carers came when felt like it and didn’t stay the time and we ended up both saying we could do better.”

This vision was shared with the team through induction and information displayed in the offices. Staff had an excellent understanding of DICE Healthcare’s vision, values and culture. One told us, “Values of DICE are, we support in a way that is individualised, dignified, compassionate and exceptional.”

Another staff member said, “My main role is to support human rights, to make sure everyone is treated the same regardless of situation or abilities doesn’t matter, we are all the same, if I see anything which is a concern or abuse because of their disability I have to report it, you have to look out for someone and care for them, you have to be there for them, imagine if it was your sister or brother or grandmother I have to voice up for them in every way I can.”

We saw key chains that one of the care coordinators had created for staff which had the organisation values on them and after visit spot checks included a question for people about if they felt the staff member had demonstrated the values of the organisation.

We reviewed care plan documents which evidenced respect and understanding not only of people’s care needs but of their individual preference, social, spiritual and cultural needs. The registered manager and staff knew people well and were able to clearly explain how people wished to be supported and demonstrated they respected and valued people’s diversity.

The provider had an excellent understanding of the challenges of providing care and support to people living in the community both experienced by staff and people receiving care and support. They understood and supported staff with appropriate travel time as well as travel in the case of a car breakdown or adverse weather conditions. They understood that lone working staff, and people living alone in the community, could experience feelings of isolation and arranged social events and had designated an area of the office building for people to come and have a cup of tea, a chat and get involved in activities.

The management team were open and honest in discussion with the inspection team and demonstrated the values of the service.

The providers approach and strong values meant people receiving care, the staff team and external colleagues working with them were able to have open and honest discussion with the team and were respected and valued as individuals.

The provider had exceptionally 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 always did so with integrity, openness and honesty.

Staff told us the registered manager embodied the culture and values of the organisation, led by example and demonstrated the values of the service. One staff member said, “Yes, based on [registered manager] they are a person who doesn’t judge people, they listen – they are a good listener, for me we all have situations and think this is not fair for me but they [management team] have given us the freedom to be our self or say what we want to say.”

There were designated roles and responsibility which we saw the registered manager had mapped out, so it was clear for everyone. Staff knew who to go to but equally felt confident approaching anyone in the management team. Staff felt valued and spoke positively about the leadership team. One staff member said, “[Registered manager] makes sure everyone, not just the clients, are all ok, [name] also cares about us.” Another staff member told us, “I’ve always felt if had any problems they [management team] could help me through it or talk me through it, always got support here, they’re not unapproachable or scary in any way.”

The provider had implemented celebrations for staff birthdays, a reward scheme for carer of the month based on feedback from people using the service, a well-being fund for staff, and invested in providing all staff with medical insurance to further support them.

The leadership team were made up of 2 care coordinators, the registered manager and the 2 directors. They were all highly qualified with 3 members of the team being qualified nurses, 2 who had retained their nursing registration. The other 2 managers were NVQ level 5 trained in health and social care.

The approach adopted by the leadership team, led by the registered manager, empowered staff to increase their knowledge and develop their careers. It provided a knowledgeable team for staff to seek support and advice from, and the culture was underpinned by their open and compassionate approach which benefitted people supported and staff.

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

People and staff were able to speak up and felt they would be listened to. The provider had a robust Freedom to Speak Up policy which staff were all aware of. One staff member told us, “I never worry about speaking up, we have a whistleblowing policy, they have changed it now to the speaking up policy. I’m absolutely confident and comfortable [speaking up] if I felt the client wasn’t getting the treatment they deserved, I would speak up.”

All of the staff spoke passionately about being empowered to speak up and that they would always do this in the interests of the people they cared for. One staff member said, “Imagine if it was your sister or brother or grandmother, I have to voice up for them in every way I can, the office team support and external bodies, and if I need any information, we do have policies, they are in the office.”

This culture of openness in the organisation meant people and staff were more likely to speak up about any concerns and have matters addressed before they became a significant issue.

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.

We were given numerous examples of how the provider had created a culture which had improved equality and equity for their staff team. A number of overseas staff gave us examples of how they were supported professionally and personally on joining DICE Healthcare. One staff member told us, “They [management team] supported us [overseas staff] with food- we do have a food bank at work – if you need support, you can just go to the office and ask. I know it wasn’t just me, if you don’t have food for your break pop into the office you can have tea or something to eat, anything. We feel at home, just coming into the country and facing all of these things, for me, I really appreciate it a lot.” Another said, “They are really amazing they have given me a lot of support, they support with anything for example if I have a car problem, they will sort my rota and give me support I need, support with training if I don’t understand anything, I can go back, and they are ready help.” A further staff member described an issue when a person had made racial remarks to them and how the registered manager had challenged this and addressed it. They also told us about how the registered manager had been flexible and demonstrated they valued the person’s belief. They said, “I am really happy with DICE, they are supportive, and they listen. I go to church so I talked to my manager and said can I have Sundays off, and I get Sundays off to go to church [registered manager] respects my religion.”

We saw information displayed regarding external support that staff could access, including an employee assistance program that the provider funded for staff. One of the directors told us,“[Registered manager] ran drop-in clinics at the end of the financial year to help staff claim the initial mileage expenses from HMRC and certainly the international students found this beneficial, it’s a complex process and [name] gives them some guidance.”

The provider had an appropriate equality, diversity and inclusion policy and staff received training on this as well.Staff consistently reported feeling empowered to bring their whole selves to work, supported by a culture that celebrates diversity and fosters genuine inclusion leading to greater wellbeing, stronger team cohesion, and improved outcomes for the people they support.

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.

The registered manager had created a matrix showing the accountability structure which clearly defined the team’s roles and responsibilities so there was a clear understanding of who was responsible for specific pieces of work and timescales for completing this work.

At the last inspection the provider was moving from paper to a digital system. These systems were now fully embedded and clearly evidenced the registered managers oversight of processes and delegation of tasks. We saw meeting minutes from weekly management meetings where tasks were discussed, and any themes and trends identified discussed with a view to finding a resolution to any issues. Time keeping and attendance of care calls was carefully monitored to ensure people received their care at the time they needed or wished to have it and we saw any discrepancies were followed up and addressed with staff.

We reviewed information in people’s care records and email correspondence with professionals and relatives which was shared appropriately and in a timely way to ensure people received the care and support they needed and identified risk was responded to through the engagement of the right professional/person.

The good governance and management of the service meant issues were quickly identified and addressed, as well as areas of good practice, and this supported people receiving good quality care and support.

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.

We saw a variety of examples of the registered managers engagement with partners and examples of collaborative working to improve the service and to support other services to improve through sharing ideas and resources. One of the directors told us about some of the ways the registered manager networked with others in the local area.They said, “[Name] is part of the Mansfield and Ashfield Business Network, they put training on and link up with other businesses locally that might be beneficial or be doing similar things, [registered manager] has made a few contacts there. [Name] is also a member of the Chamber of Commerce East Midlands who do similar things but covering the whole of the East Midlands region.”

The provider also worked with the local community involving people to support their integration and provide them with meaningful activities to get involved with. For example, one person who enjoyed knitting made hats for premature babies which the registered manager took to the local hospitals baby unit.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation. They always 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 registered manager worked in a way that supported continuous learning which included clear review processes and actions taken from issues identified, as well as sharing information through team meetings with the wider team to support their learning and avoid recurrence of any issues identified.

We saw that the registered manager logged not only complaints and compliments, which were shared with the team, but also informal feedback. They told us, “Any little niggles I put them down, if you can learn from it, it’s still a complaint”. Staff confirmed that information around learning and improvement was shared with them, and they also had the opportunity to contribute ideas for improvement of the service.

We reviewed evidence of a number of innovative pieces of work the registered manager and team had implemented to support learning for the team and improve the quality of people’s lives. The care coordinator spoke with us about a specific piece of feedback about staffs cooking skills. They said, “It was one of our very first complaints and we did cooking lessons with staff and then pictorial menus came hand in hand with this especially for clients with dementia and other barriers to communicating, maybe they can point [to what they want]. We sort of delved into doing pictorial menus even [Name] has one and they loved it, they felt very special.”

Staff told us how the cooking sessions had upskilled them and made them feel more confident. We also saw that the management team had created reference information for staff about different foods and provided pictures of what this would look like. One staff member said, “I remember we had a cooking lesson with [care coordinator] and [registered manager], we made poached eggs and everything. It was brilliant and they made it so it was for everyone, not everyone is confident to cook, it was really really helpful.”

The registered manager had successfully applied for a grant to purchase a number of interactive artificial pets, cats and 1 dog. We saw some of these at the office, but most were with people in their homes. The management team had recognised that some people living alone found having a pet comforting and provided company, but many were unable to care for an actual dog or cat themselves. These substitute pets was an innovative idea to provide comfort to people living in the community who felt lonely. We reviewed the care plan and daily records of one person who lived with depression and had been given a “pet”, we saw positive outcomes and interaction was recorded. The registered manager said, “Outcomes are recorded to help manage [People’s] medical conditions. It makes [Name] happy which improves their mood”.

We saw other examples of innovative practice introduced to support people’s wellbeing including events that people could attend at the office and sensory items available to people that staff could take with them when visiting people. The registered manager also cooked and took a Christmas meal to people living alone during the festive period.

Applying creative and innovative ways of working and a focus on continuous learning and improvement demonstrated the providers desire to provide the best service possible to people which actively improved equity of access and quality of life.