Willow Home Care Ltd

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 inadequate. At this assessment the rating has remained inadequate.

This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to the governance at the service.
 

This service scored 32 (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 did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The provider had failed to create a positive and open culture which placed people at the centre of their care. People told us the service did not always meet their expectations, particularly with regards to care call times and the lateness of these, and some had a lack of confidence in the leadership of the service. Most people we spoke with were unaware of who the registered manager was and incorrectly identified a senior staff member, indicating poor visibility and engagement from those responsible for leading the service.

People and relatives told us they did not want the provider to know they had spoken with us because they feared repercussions. This demonstrated a closed culture where people did not feel safe to express concerns or provide honest feedback to the provider.

The provider and managers had a differing opinion of the culture of the service to that of most of their staff. Most staff reported a closed culture, with office staff not being approachable, the on-call and office telephones not answered, not feeling supported by managers, not receiving adequate breaks and extra calls added to their rotas without consultation. One staff member told us, “I don’t really know who the boss is, they don’t speak to you when you go into the office.” However, another staff member had a much more positive experience of the culture at the service and told us, “Before the atmosphere was rubbish, but now it's amazing.” The registered manager told us they felt the culture of the service and the morale of staff had improved since the previous assessment. They told us they did not have a vision or values statement for the service at the moment, but they expected staff to provide “safe and adequate care.”

The provider had not identified risks to care delivery, including relevant local factors, and had not developed action plans to address or monitor these. Leaders were unable to demonstrate a clear, shared direction for managing risks and driving improvements. As a result, there was limited assurance of a culture of proactive planning, learning and continuous improvement.
 

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Leadership at the service remained ineffective, with a lack of clear direction, planning, and oversight to drive the improvements required. Although the registered manager had implemented some changes, there was no structured service improvement plan in place to identify priorities, allocate responsibility, and monitor progress. This demonstrated inadequate leadership and a failure to establish effective systems for continuous improvement. Without the provider having a clear and coordinated approach, improvement efforts were reactive, lacked sustainability, and could not be effectively evaluated to determine whether positive outcomes had been achieved. The registered manager told us, “I’m working on everything as much as I can.”

Feedback from staff about the leadership at the service was mixed. One staff member spoke about the office staff and told us, “They don’t really know how to be managers. They are friendly which is nice, but for important things you want them to be professional, and sometimes they come across as unprofessional. They text like a friend. They tell us not to text them privately but then will text us privately.”

At the previous assessment, we found concerns with staff competency records being inaccurate. At this assessment, leaders had again failed to ensure staff competency was consistently assessed. One staff member had not achieved full competency in a medicines assessment. Although the record stated this would be reviewed, there was no evidence of this, and the staff member was marked as competent on the provider’s training matrix the same day. This failure of leaders to ensure staff are competent in their roles placed people's health and welfare at risk.

Leaders did not have a clear and viable approach to governance. Although we were told quality assurance activities happened and we viewed audits and spot checks, the outcomes of these were not used to create any service improvement plan. After our previous assessment the provider sent us an action plan of the improvements they were to make to the service. At this assessment, the registered manager told us this was no longer in use, and they had no service improvement plan. This meant areas of concern we identified at the previous assessment had not been effectively evaluated by the provider and leaders. The provider had not set strategic priorities, and the quality and safety of people’s care was not monitored.
 

We had differing feedback from staff about their confidence to speak up, with some telling us they did not feel supported or listened to when they raised concerns. One staff member told us, nothing happens to bad carers, it’s not acted on. Managers will say they’ll do something, but they don’t. They put it in the group chat, and it is directed at everyone. It creates poor morale.” However, another staff member told us they could tell the registered manager if they felt improvements could be made and were confident their voice would be heard.

The provider had a Whistleblowing policy in place which stated, “All staff receive whistleblowing training at induction and during ongoing updates.” When we viewed the provider’s training matrix it was not clear if staff had received this training. However, staff we spoke with understood what the term whistleblowing meant and how they could do this.
 

The provider had not demonstrated how equality, diversity and inclusion information was used to support or develop the workforce. Potential staff completed an equal opportunity form as part of their job applications which asked for information on protected characteristics such as disability, religion and nationality. The registered manager told us they only reviewed the information, "just so I'm aware." They told us the information was not analysed or used to understand workforce demographics, address potential inequalities or inform inclusive workforce planning.

The provider employed some staff whose first language was not English and struggled to communicate in English proficiently, which affected their ability to understand and respond to people’s needs. Despite these staff having been employed for several months, and the provider having received complaints that people were not always understood by staff, no support had been provided to help staff improve their English language skills. During our assessment we were told the provider was considering English lessons for these staff.

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.

The provider still needed to make significant improvements and they did not have an established governance framework, sufficient oversight of service performance or a clear strategy for achieving and maintaining compliance with the regulations. The provider did not have a service improvement plan in place and there was a lack of clear objectives, timescales, accountability and monitoring arrangements to support effective service improvement. After our previous assessment the provider sent us a service improvement plan. However, the registered manager told us this was no longer in place. This did not demonstrate consistency in driving and maintaining required improvements.

There was a significant concern the issues we found on this assessment had not been identified during audits. Although some audits were completed, the provider’s lack of effective governance systems meant audit findings were not translated into measurable actions. Therefore, the outcome of audits were not used to inform and drive improvement for the service.

The provider failed to ensure oversight, data analysis and risk management of people’s care calls and staff rotas. Despite concerns identified at the previous assessment, call data showed people continued to experience a high number of late care calls. Staff were not always allocated travel time between calls, and some were rostered to be in two places at once on numerous occasions. The registered manager told us after the previous assessment they tried to record missed calls but, “gave up after a couple of months”. They told us care calls were monitored daily, but findings were not recorded. This lack of management of care calls put people’s health and welfare at risk.

The provider had made some improvement since our last assessment, such as with staff recruitment records. They also had updated their care plan format; however, these were not completed consistently by senior staff, which resulted in a significant variation in the quality and level of detail recorded. The registered manager was not aware of this variation which demonstrated a lack of oversight. This meant people did not always have clear and comprehensive information available to support the delivery of their care.

The registered manager told us staff documentation had been identified as being poor, so a check was now included in staff spot checks. However, these spot checks did not include senior staff who completed care plans. We found care records often contain multiple significant spelling errors which could impact on staff understanding of a person’s care and treatment.

The provider failed to submit statutory notifications to us as required. These ensure we are aware of important events and incidents which affect services or the people who use them. Providers have a statutory responsibility to submit these, and they provide us with crucial information to monitor the quality and safety of services. The provider did not notify us of a serious injury to a person and an allegation of abuse. Failure to submit these notifications prevents us responding to potential significant incidents and taking action to protect the welfare of people.
 

Engagement with health, social care, and community resources was variable, and the involvement of healthcare professionals such as district nurses was not always recorded in people’s care records. When people experienced skin breakdown it was not clear what engagement staff had with other professionals, if any, to support care provision.

The local commissioning authority told us the provider had been working closely with them to improve their quality of care. They had advised the provider to ensure they made regular contact with relevant partners to discuss any concerns about people’s care needs.

The quality assurance officer told us they signposted unpaid carers to a local service who could help them access free online services and support. They also had started to engage with a local dementia organisation to improve staff training and provide information to relatives who supported family members with dementia.
 

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

The provider had not demonstrated they had learned effectively from previous inspections. Despite repeated opportunities to address identified concerns, the service had not achieved a rating of Good since October 2019. This indicated leaders had not sufficiently analysed inspection findings, developed effective improvement plans, or embedded sustainable changes in practice. As a result, the same or similar issues continued to reoccur, demonstrating a lack of organisational learning.

The provider had no quality improvement processes in place to evidence continuous improvement of the service. They did not demonstrate learning or identify themes and actions to improve safety in the service. Staff recorded when people had incidents or injury, but this information was not used to evaluate patterns, causes, or risks associated with the incidents. This demonstrated a significant gap in governance and risk management, undermining the provider’s ability to protect the health, safety, and welfare of those in their care.

The provider’s approach to making improvement happen was not consistent and did not include measuring outcomes and impact. Although the registered manager told us they had viewed national best practice guidance this was not evident. The provider had no action plans or evidence of ongoing development for the service. This meant the provider could not show how the service had improved over time or how it was committed to delivering high quality care.