Care 4 All 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 remained 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 provider was previously in breach of the legal regulation in relation to governance. No improvements were identified during this assessment, and the provider remained in breach of this regulation.

This service scored 46 (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 always have a shared vision, strategy and culture based on transparency, equity, equality and human rights.

Leaders had failed to ensure that all staff had received the necessary training to develop the skills required to meet the needs of people with a learning disability or autistic people. The service's training and development policy did not mention the requirement for staff to complete learning disability and autism training, including Oliver McGowan mandatory training, despite this being a specialism of the providers’ registration with CQC. This meant the training policy was unsuitable.

Staff need to know how to interact appropriately with autistic people and people with a learning disability to ensure everyone is at the centre of their support when decisions about their lives are made. Closed cultures are an active discussion, so if they start to develop, staff would be able to identify these quickly.

People did not receive care that was always high-quality or person-centred. While the staff we contacted provided similar feedback on how they ensure they consistently deliver person-centred care, our assessment found that people were not being supported in line with expected standards and that this did not always reflect the service’s objectives as set out in its statement of purpose.

However, the registered manager confirmed the key values of the service were to provide compassionate, dignified and empathetic care. They stated that to promote equality and diversity within the staff team, there would be no recruitment restrictions, and new staff would be employed based on their passion for helping people. This meant new staff would contribute positively to the service.

The registered manager told us their goal was to further improve the care being delivered, in line with individual requirements, and to commit to working with all professionals involved in the person being supported and their relatives.

A staff member said, “I provide person-centred care by respecting people’s protected characteristics, preferences, choices and adapting support to their needs.” Both the staff and leaders demonstrated a positive, compassionate and listening culture that promoted trust and understanding between them and people using the service. Staff understood the importance of equality and diversity and prioritised safe and compassionate care.

Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty. We identified breaches of legal regulations and concerns in areas such as safe care, suitable staffing, obtaining consent, and governance. This meant that leaders had not always identified and taken action to ensure that people received care which met legal requirements.

At our last assessment, we found poor leadership at the service, which failed to drive improvements. During this assessment, we identified similar concerns relating to safe care and governance, as well as the additional breaches described above. This raises concerns about the leader's ability to implement, embed, and sustain the required changes and improvements.

The registered manager demonstrated a lack of understanding when it came to supporting people with a learning disability or autistic people. At the start of our assessment, the registered manager was unable to verify a definite diagnosis for 2 people using the service, despite having cared for them for several years. During another interview, the registered manager confirmed the service only provides ‘personal care’ and relies on relatives to guide staff and provide information on how to support people with a learning disability or autism. The service was not following the principles of the ‘Right support, right care, right culture’ model of care.

However, staff felt that the leaders at the service possessed strong communication, organisational, and problem-solving skills, and had the necessary knowledge, experience, and expertise to lead effectively.

The provider fostered a positive culture in which people felt they could speak up and have their voice heard.

The registered manager respected the care staff and was willing to provide support whenever needed, encouraging them to speak directly if they had any worries or concerns. They also confirmed that supervisions and yearly appraisals provided staff with another opportunity to talk openly with management. However, we did find concerns relating to the recording of these 1-1 meetings.

Staff confirmed regular team meetings, supervisions and handovers took place to enable them to share information effectively. Any ideas for improvement were welcomed and considered. A staff member told us, “The leaders encourage speaking up by actively requesting feedback and assuring us it’s safe to share openly.”

The provider valued diversity in their workforce. They worked towards creating an inclusive and fair culture by improving equality and equity for their employees.

The registered manager confirmed they always treat their workforce equally. There were no signs of discrimination, and staff had not reported any concerns.

A staff member we spoke to said they were always treated with respect, fairness, and dignity. Another staff member said, “I feel that all the staff are treated fairly and equitably. Leaders provide support, listen to feedback and recognise contributions, creating a positive and respectful working environment.”

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’s governance systems for auditing the service were ineffective in identifying or addressing areas for improvement, which resulted in people being placed at risk of receiving unsafe and inappropriate care.

The service's quality assurance systems included regular audits. These included support planning, health and safety, quality values, safeguarding, pressure care, physical health, and eating and drinking. However, there were gaps in the system, and the registered manager audits had failed to identify the concerns we found relating to medicine records, people’s care plans and related care records, supervision and appraisal records and the lack of oversight and ineffective monitoring of people’s care calls. No equipment checks were taking place in people’s homes. In addition, there were no clear and concise records for the staff. The staff contact lists we received listed different staff names, and the records of staff training were not consistent.

The registered manager told us 5 quality monitoring visits took place in June 2025; however, the service had only completed 1 record, and the information contained within this record related to only 1 person. This meant the feedback gathered from 4 other people on the quality of care had not been recorded in line with the provider’s quality, governance and risk policy.

Furthermore, mental capacity assessments were often inaccurate and lacked detail. We found concerns relating to safe staff recruitment, with several pieces of missing information.

Management oversight was lacking in terms of staff training, incidents, accidents and safeguarding. (See the ‘learning culture’, ‘safeguarding’ and ‘safe and effective staffing’ sections for more details). We could not be assured that staff had been trained to provide safe and effective care. Staff competency assessments had not been completed in line with the legal regulations.

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.

At the point of commencing care for an autistic people or people with a learning disability, the care provider did not contact social care professionals to discuss care needs and relied on the family to share reports they had previously received from the individual's GP or community healthcare teams. Initial assessment records showed no evidence of co-production in care and support planning discussions with individuals, relatives, and other care partners to ensure the right care is person-centred, planned, proactive, and coordinated, in line with the principles of ‘Right support, right care, right culture.’

However, we received positive feedback from a professional regarding a one-off observation during a care review meeting, who told us, “The registered manager showed professionalism, empathy, respect and appeared honest and reliable.”

All the staff we requested feedback from stated that they had worked closely with health and social care partners, as well as families, to ensure coordinated care and that any changes in the people’s health or support were addressed promptly.

The provider did not focus on continuous learning 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.

The service needed to improve its systems to ensure learning always occurred and quality concerns were addressed. Although audits at the service were taking place, the monthly audit tool had been completed incorrectly by the registered manager. Several questions were answered with ‘Yes’ when, in fact, this wasn’t the case. For example, ‘Are risk assessments in place for every identified risk?’ ‘Is a Do Not Attempt Resuscitation DNACPR in place?’ ‘Is there evidence of a Lasting Power of Attorney (LPA)?’ Following our review of records, it was clear these questions had not been answered correctly. The audit records did not accurately reflect the actual situation at the service.

An analysis of the service's latest client satisfaction survey was provided. This confirmed that 5 people had contributed to the exercise. However, upon requesting the actual questionnaires, we received 11 questionnaires. This was queried with the registered manager, who confirmed that there appeared to be some repetition. Updated records were submitted to the CQC. However, the new evidence clearly indicated that 11 people had contributed to this exercise, despite being advised that only a smaller number were, in fact, receiving care. The registered manager had not identified these anomalies during their auditing processes, and we therefore could not be confident in the evaluation process or the analysis provided.

The provider implemented a ‘whole service action plan’ following warning notices served against their registration at the last assessment. However, this plan failed to address all our previous concerns.