Surrey Hills Home Help Services 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 Good.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant although leaders demonstrated passion and commitment to delivering good quality, person-centred care, governance systems and audit recording were not always consistently documented or robust, which impacted the provider’s ability to evidence effective oversight and quality assurance.

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

This service scored 62 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

When we asked the registered manager how they would like their service to be known in the area, they told us, “I would like us to be known as innovative, proactive, dementia specialist care agency. I think we already have that in Tandridge. We’re known for delivering good care to people who may be challenging or have previous failed care packages. I’m not saying we’re perfect. But our care delivery is good and its recognised.” It was evident this was felt amongst relatives. One relative had written to the service saying, “Without your support — particularly in locating and safely returning my mother when she leaves her property — I would genuinely feel lost. Your team’s knowledge of dementia and your ability to manage such challenging situations calmly and effectively is truly invaluable. Both myself and social services recognise your service as vital in my mother’s life. Your willingness to go above and beyond, often in difficult circumstances, does not go unnoticed and is deeply appreciated.” One relative told us their GP had recommended them as a service provider when they enquired about a care package for their family member. Another relative added, “They understand dementia and how to support her. They really understand person centred care.”

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.

The registered manager had a deep passion to provide people with holistic care and had spent their career innovating methods to promote this. They had created a local dementia-based day centre in Oxted, which was run by a separate staffing group. They told us, “It’s based on arts and crafts and activities that are meaningful to people rather than your usual bingos and floor boules. We’ve recently started no contact boxing for those with Parkinson’s as studies have shown huge improvements in their health and wellbeing. Others have been crocheting bonnets for the local post-natal ward at the hospital so they’re connecting with their community.”

The registered manager had arranged for her staff and relatives of people to attend a session from a dementia tour bus. This national program offers an opportunity for relatives, staff and care professionals to experience the world of the person living with dementia and understand how changes to their practice and the environment can improve their lives. The registered manager also ran sessions for staff and care professionals in which they wore age simulation suits. These were designed to simulate different illnesses such as a stiff back, COPD (chronic obstructive pulmonary disease) and eye diseases such as glaucoma. The registered manager told us, “I put 2 social workers in the suits once and they became emotional and told us they finally really understood the experiences of people.”

The registered manager was passionate in upskilling the staff around her. They were encouraging senior staff members to complete a higher level qualification in care and had supported them to achieve their current qualifications. Staff confirmed they felt supported by the registered manager, with 1 staff member saying, “The management are supportive They listen, provide guidance when needed and help ensure that we deliver - good care.” Another staff member told us, “[The registered manager] is very knowledgeable and approachable and very good at communicating with us. If we have any issues or queries we can easily request a meeting with her or give her a call.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. One staff member told us, “I am aware of the whistle blowing procedure. I'm aware through training policies and guidance from management that explains how to report concerns safely.” The registered manager informed us, “All staff know they can speak up. I always say come to me with any issues and if you’re not happy with how I respond I tell them they can contact CQC, social services or even the police if needed.”

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

The registered manager was sensitive to staff’s protected characteristics. They let new staff guide them on how they would like to be introduced to their colleagues and promoted a safe space where their wellbeing was at the forefront and supported. This included ensuring staff did not receive hurtful comments when supporting people and taking appropriate and sensitive action if this had occurred.

The provider had clear responsibilities, roles, and systems of accountability, but their governance systems were not robust nor routinely documented.Whilst care delivery was of good quality and, in some cases, exceptional, we identified shortfalls in documentation and governance arrangements which required strengthening.

For example, care plans and risk assessments were not consistently thorough or up to date, and the level of detail varied between people’s records. One person’s care plan included helpful information about environmental risk factors within the home, such as the location of the stopcock and fuse box. However, other care plans did not include comparable information. When this was raised, the registered manager told us they would review records to ensure they were up to date.

The provider’s quality assurance systems were not consistently completed and did not provide effective assurance. For example, the care plan audit had not identified that staff were not following one person’s care plan guidance in relation to recording what the person was wearing each day to reduce the risk of self‑neglect, despite that audit being scored as “always compliant.” This showed auditing processes were not effective in identifying and addressing gaps in practice.

Governance oversight of recruitment checks was also not sufficiently reliable. The provider’s staff file audit identified missing references for two staff members and recorded that another staff member did not have a health questionnaire on file; however, there was no evidence that action had been taken to rectify the missing documentation. In addition, when we reviewed recruitment files as part of our assessment, we found gaps in records, including missing references and other key documents. While several files contained the required information, these inconsistencies meant the provider could not demonstrate a complete and accurate oversight of pre‑employment checks and recruitment records.

Staff performance concerns were not consistently addressed in a way that demonstrated effective management oversight. For example, we saw one staff member was allocated additional hours during a meeting intended to address concerns about attendance and care delivery. Where staff raised concerns about another colleague not fulfilling their duties, we saw action had been taken to consider the staff member’s wellbeing; however, there was limited evidence of action taken to address the impact of the concerns on work performance. As a result, the performance concerns were not fully resolved through the provider’s governance and management arrangements.

Furthermore, the registered manager’s service improvement plan did not include information as to what had caused the action to be added to the plan, who was responsible for resolving the actions and what date theses should be completed by. The registered manager was open and transparent about this, telling us, “To be honest my care delivery is my priority. Care delivery is paramount for me. Up until January I was in the field the majority of the time too so there wasn’t the time to be on top of governance. But with recruiting 4 new carers and training up a staff member to take over the role can step back, I will have time for this going forward and it will be my focus.” Following our assessment they added, “We are always reviewing or looking at ways to improve our services as well as office management. I appreciate that it has been chaotic which has highlighted to us that the office needs to be streamlined.” The registered manager had already started to implement these changes during our assessment activity.

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.

Local external partners thought highly of the service. One external professional had messaged the service to provide feedback on their gratitude for the support given to people and to share that they were highly thought of. Another external professional told us, “There have been numerous cases we have worked on jointly and complex cases where staff have adopted particular strategies to support the more complex clients. They have arranged care packages quickly and responsively to more complex and challenging clients where other agencies would not accept. Care has been successful with this agency, and they have an approach of supporting the patient to manage their care where needed rather than a quick ‘we will do’ attitude.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

People and relatives were encouraged to share their feedback of the service through regular telephone conversations. The registered manager told us, “We do take feedback very seriously. There’s room for improvement of course. I do think we should do specific reviews, but we do ask for feedback during their reviews. Our clients feel comfortable to raise something that isn’t quite right and that’s important.”

Staff were also able to give feedback and request changes to their rotas to improve their work-life balance. For example, 1 staff member had been able to change her shifts to evening and bed care visits as this suited their personal needs better. The registered manager told us, “It’s a very open-door culture here so staff will tell us if they’re not happy and we’ll address it.”