Elite Care 24/7

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• 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 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst the provider promoted a supportive and inclusive culture and demonstrated a commitment to providing compassionate care, weaknesses in governance and oversight limited their ability to identify and respond to concerns effectively.

The lack of effective external oversight and challenge further reduced transparency and accountability within the service. As a result, we could not be assured the provider had fostered a culture that was consistently open, transparent and focused on continuous learning and improvement.

The registered manager described a commitment to providing compassionate, community-based care and spoke openly about their desire to learn and continuously improve the service. They explained that, due to the nature of domiciliary care, it was not always possible to bring all staff together for formal meetings. To address this, they met with smaller groups of staff and shared regular updates through other communication methods.

Staff told us the provider organised celebratory events which enabled colleagues to come together and recognise achievements. We also saw evidence of initiatives such as 'Carer of the Month', which acknowledged staff contributions and promoted a positive workplace culture.

Staff spoke positively about the registered manager and the wider management team. They described leaders as approachable and supportive and provided examples of additional support offered to staff who were new to care work and overseas workers adapting to cultural differences.

Staff told us they were usually provided with consistent calls, which enabled them to develop positive and trusting relationships with people and gain a good understanding of their needs and preferences.

The provider had policies relating to complaints, equality and diversity. Staff received training in these areas and most told us they felt comfortable raising concerns with leaders if required.

Relatives told us they had opportunities to provide feedback through satisfaction calls and felt able to raise concerns should the need arise.
 

The registered manager demonstrated compassionate and inclusive leadership. People and staff spoke positively about them and described them as approachable, supportive and available when needed.

However, governance shortfalls identified during the inspection indicated leaders did not always have effective oversight of the service or demonstrate full awareness of current regulatory requirements.

People and staff told us they liked and respected the registered manager. They described them as helpful and responsive when support or guidance was required.

The registered manager demonstrated positive interpersonal qualities and spoke about supporting staff development and progression. They gave examples of encouraging staff to undertake additional training and develop their skills to move into more senior roles within the service.

However, we identified gaps in governance systems and oversight arrangements. These meant that some issues, including shortcomings in care planning and record reviews, had not been identified and addressed in a timely manner. As a result, opportunities to drive improvement and ensure records consistently reflected people's needs and risks had been missed.
 

The provider fostered a positive culture where people and staff felt able to speak up and were confident their views would be listened to.

Staff told us they were aware of the whistleblowing policy and felt confident they would be listened to if they raised concerns. They described the registered manager as approachable and responsive.

We saw evidence that where people had raised concerns or complaints about the service, the registered manager had responded appropriately and in a timely manner.

Safeguarding concerns had not always been reported appropriately, including referrals to external agencies when required. This demonstrated that not all staff understood their responsibilities to raise and escalate concerns about people's safety and wellbeing. The registered manager acknowledged this during the assessment and took immediate action to complete any retrospective notifications.

However, although concerns and feedback were addressed when raised, the provider could not always demonstrate how information from complaints, concerns and feedback was collated and analysed to identify wider themes, learning opportunities and service improvements.
 

The provider valued diversity within its workforce and worked to promote an inclusive and supportive culture. Leaders recognised the importance of equality, diversity and inclusion and sought to ensure staff were treated fairly and with respect.

The registered manager spoke openly about the challenges of recruiting a workforce that reflected the diversity of the people using the service. They told us they were committed to attracting people from different backgrounds and creating opportunities for a diverse range of staff. The registered manager said, "We are always trying to attract different people to work with us and will continue to do so."

Staff received equality and diversity training and were able to explain what this meant to them. They demonstrated an understanding of treating people as individuals and respecting differences.

Staff spoke positively about their experiences of working for the provider. One staff member told us, "They are a good company to work for. I feel part of a team, which I didn't in my old job. That's why I recommended my friend to come and work here too." Another said, "The manager was very supportive after I had my family, and I am able to work hours which are better for me."

The provider had systems in place to support staff wellbeing and inclusion. Staff told us they could approach members of the management team by telephone or visit the office if they needed advice or support. Staff also received regular supervision and spot checks, which provided opportunities to discuss their development, wellbeing and any concerns they may have had.
 

The provider did not always have effective governance systems, clear oversight arrangements or robust processes to assess, monitor and improve the quality and safety of the service.

Leaders did not always act on the best available information relating to risk, performance and outcomes.

The provider carried out audits of areas including visit times and duration, medication records and daily care notes. However, these processes were not always effective. We found examples where incidents recorded by staff in daily notes had not been formally recognised as incidents or escalated for management review. As a result, opportunities to identify trends, investigate concerns and reduce the risk of recurrence may have been missed.

We also found some medication records did not clearly document the reasons why medicines had been declined. This meant the provider could not always demonstrate that medication discrepancies had been fully reviewed and appropriate action taken to mitigate potential risks.

The registered manager told us a new quality lead had recently been appointed to strengthen oversight and support the transition to an electronic quality assurance system. We reviewed the newly implemented audit processes and saw evidence that improvements were being introduced.

However, further development of these systems was required. For example, audit records did not always clearly demonstrate which records had been sampled, the level of risk identified, the impact on people using the service, actions taken, or how improvements had been sustained.

Governance systems had not identified the concerns found during this inspection, including shortcomings in risk assessments, care planning documentation, mental capacity assessments and medication records. This indicated that quality assurance processes were not consistently effective in identifying and addressing issues.

We discussed our findings with the registered manager, who was receptive to feedback and took immediate action to begin addressing the concerns identified during the inspection.
 

The provider did not always demonstrate effective partnership working to ensure people experienced coordinated and seamless care. Information sharing, collaborative working and the recording of multi-agency involvement were not always consistent.

The provider worked with a range of external professionals, including district nurses and occupational therapists, to support people’s health and wellbeing. We saw examples where care call times had been adjusted to accommodate visits from other healthcare professionals, helping to ensure people could access the support they needed.

We found some evidence of partnership working for people with more complex needs. However, this was not always timely, clearly documented or regularly reviewed to ensure all relevant agencies remained informed and involved. As a result, the provider could not always demonstrate how collaborative working contributed to achieving positive outcomes for people.

We discussed these findings with the registered manager, who recognised the need to strengthen partnership working arrangements and the recording of multi-agency involvement. They described the immediate actions they would take to improve communication and collaboration with external professionals to support better outcomes for people using the service.
 

The provider had not established effective governance systems to ensure the service was consistently monitored, risks were identified and acted upon, and regulatory requirements were met.

Whilst the provider recognised that systems and processes to support learning, improvement and innovation required further development, they had failed to make sufficient and sustained improvements since the last inspection.

The provider shared their intention to improve the service and had invested in new electronic systems to strengthen oversight and quality assurance arrangements.

However, these changes were at an early stage of implementation and had not yet become fully embedded in practice. As a result, there was insufficient evidence to demonstrate the improvements had been effective in delivering sustained positive outcomes for people or addressing the concerns identified during the inspection.

The registered manager was receptive to feedback and acted promptly in response to concerns identified during the inspection. This demonstrated a willingness to learn and improve, although further work was needed to ensure improvements were embedded and sustained over time.