Caremark Tunbridge Wells, Tonbridge and Malling

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.

This service scored 54 (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 demonstrate a clear, consistent and embedded culture of high-quality, person-centred care. While leaders described a vision for improvement, this was not yet consistently understood or reflected in practice across the service.

Leaders described wanting to build a culture focused on learning, support and improvement, and staff often spoke positively about the leadership team’s approachability and willingness to help. Management also described working with other services and using shared learning to strengthen practice.

However, this intended culture was not consistently reflected in the experience of people using the service. The disconnect between leaders’ stated vision and the repeated concerns raised by people and relatives indicated the culture was still developing and not yet embedded strongly enough in operational practice.

The provider did not always demonstrate consistent and effective leadership. Whilst leaders were visible and engaged, leadership arrangements were unstable and did not always provide sufficient oversight or drive sustained improvement.

Leaders were actively involved in day-to-day operations, care review processes, incident follow-up and staff support. Staff often described managers as approachable and said they could contact them for guidance. There was evidence leaders understood frontline pressures because they involved themselves directly in operations.

However, leadership stability had been affected by turnover, including registered manager changes and periods without a registered manager in post. This weakened continuity in governance and limited the provider’s ability to embed improvements at pace. The service therefore benefited from visible leaders, but not always from stable, fully effective leadership arrangements.

Staff were generally able to raise concerns and felt supported to do so; however, organisational systems did not always ensure that concerns raised by people and relatives were acted upon effectively.

Staff interviews consistently suggested carers felt able to speak up to managers, report incidents and ask for support. Internal systems existed for reporting issues and managers described open communication expectations.

In contrast, some people and relatives did not experience the same level of openness or responsiveness. There were repeated reports of not receiving callbacks, not feeling heard and not having concerns resolved effectively. This disparity meant the provider supported speaking up internally better than it demonstrated listening and responsiveness externally.

The provider generally promoted fairness and support within the workforce, although formal evidence of equality oversight was less developed than other areas.

Staff described feeling respected and supported as individuals. Management had examples of adjusting work patterns, considering personal circumstances and trying to support staff wellbeing in practical ways. Staff comments suggested they felt treated reasonably and that managers were approachable when issues arose.

This indicated a generally fair and supportive culture within the workforce. However, evidence of formal monitoring or structured equality oversight was limited within the governance information reviewed. Workforce equality was therefore experienced positively in practice, but less strongly evidenced through formal systems.

The provider did not have effective governance systems in place to ensure safe, high-quality and sustainable care. Although systems had been introduced, they were not consistently embedded or effective in driving improvement.

Governance arrangements were in place but were still developing and had failed to identify shortfalls in practice. Care plans and risk assessments were not consistently complete or up to date, repeated issues persisted in the experience of people using the service, and some regulatory processes, such as understanding of notification requirements, referrals to external agencies and accuracy of public-facing information, had not always been robust. These factors indicated governance systems did not yet provide sufficiently reliable assurance.

The provider had created audit tools, incident logs, compliance trackers, review systems and management oversight processes intended to improve quality and reduce risk. Leaders were able to describe the purpose of these systems and provide examples of using them to identify shortfalls.

People and their relatives told us that carers were doing the best they could. One person said, my carers are lovely, but I’m sorry the office is rubbish for communicating. Another said, I have made complaints to the office and no one gets back to you or is even there to answer the phone.”

The provider generally worked with partners and other services to support people’s care, although coordination was not always consistent.

Managers and staff described routine liaison with local authorities, GPs, district nurses, pharmacies, emergency services and family members. There were practical examples of staff escalating concerns quickly to health professionals and managers working with external agencies when care needs changed or risks increased.

The provider also described using peer support from other services within the franchised network to share learning and improve practice. This showed good intent and some effective partnership working, although the consistency of coordination with all partners was affected at times by wider organisational weaknesses.

The provider did not always demonstrate effective learning, improvement and innovation. Although leaders identified areas for improvement and introduced changes, these were not yet sustainably embedded.

The service was clearly engaged in improvement activity. This included refresher training, audit development, care plan review projects, better tracking systems and attempts to improve oversight and communication. Leaders were able to explain what they had changed and why.

However, these changes were relatively new and had not yet translated into consistently improved experiences or outcomes. Similar issues continued to be raised by people and relatives, showing that improvement work had not yet produced a stable and demonstrable shift in service quality. The provider therefore showed commitment to improvement, but not yet consistent evidence of sustained impact.