Look Ahead Domiciliary Care (Hertfordshire)

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 inspection we rated this key question good. At this inspection the rating has changed to 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 service was in breach of legal regulation in relation to poor governance systems. This meant systems were not robust enough to demonstrate the service was consistently managed well.

This service scored 61 (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. They did not understand the challenges and the needs of people and their communities. We observed staff interactions to be caring, however we found further improvements needed to be made to instil a culture of care in which staff truly promoted people's individuality, protected their rights and enabled them to develop and flourish.

The provider had taken steps to gather insight from staff relating to the culture of the organisation.

The provider did not always have leaders that had the skills to recognise where improvements were required to the culture of the support being provided. People’s human rights were not always embraced and, in some cases, did not always focus on how to enable people to live their best life and be a part of their community.

Staff felt they were able to speak up about concerns they had, and they were listened to and felt action was taken. One staff member said, “I 100% feel listened to. We do reflective practice everyone has a voice. I get feedback good or bad. We speak about lessons learnt.”

Relatives and people did not always have a forum where they could openly discuss concerns they may have. Relatives stated in the past there was a forum where the provider held meetings for people and relatives to be heard. At the time of the inspection the management team had stopped these meetings. The management team were considering starting these again.

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. Staff said they felt the leaders and the provider fair and listened to them.

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 had shown an inability to effectively action in relation to concerns raised by partner agencies and did not take the opportunity to learn lessons in order to improve the service.

The provider lacked oversight of certain aspects of the care and care records being completed for people using the service. As part of the inspection, we had identified areas of improvement, which had not been found as part of their governance systems. For example, developing robust risk assessments, encouraging people to shape their own support and improve staff training and skills.

The management team completed regular audits; however, these were inconsistent between each service in the audits completed and the quality of information captured. This meant the provider’s systems for monitoring quality were not robust or effective. Where improvements had been identified, there was not always clear action plans or evidence to show actions were embedded in the service.

The provider had started to capture lessons learnt and shared these with management. However, we found examples where lessons learnt, and actions had been identified but not yet shared with the rest of the staff team. This meant staff were not equipped with the knowledge to change their support practice for the better.

Relatives felt that communication between the provider and themselves could improve. Relatives said they used to have the opportunity to meet with the management team to offer feedback but this had stopped and this is something that they would like reinstated.

The provider understood their duty to collaborate and work in partnership, with the hope that services worked well for people. They shared information and learning with partners and collaborated for improvement. Feedback from professionals showed that the provider was willing to make changes to improve the service and they had been engaged in conversations.

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

In some circumstances people were not treated with dignity and respect and were restricted by staff. This continued to show the staff team lacked the understanding of the guidance of right support, right care, right culture and there was an imbalance in respect for people.