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 requires improvement. At this inspection the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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. The provider had demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service. The culture was focused on facilitating mutual trust between leaders and staff as well as learning and improvement. Leaders continued to have discussion with staff through meetings, supervisions and day to day observations where they ensured staff understood the values and direction the provider set out. Staff and managers gave positive feedback about this initiative.

A staff member shared, “Since the management changes, the service has become more stable and positive – people are happier and more confident in their roles.” Another staff member said, “We all feel part of the same team, working towards the same goals.”

Leaders had set a clear strategic direction to improve quality, outcomes and consistency across learning disability and autism services, including the realignment of registered locations to ensure leadership was closer to people using services. This work demonstrated a positive culture of learning and improvement. However, at the time of the inspection, governance arrangements were not yet fully embedded. We identified 3 services were operating under a registered manager who was not aware the services fell within their registration, which only became apparent following receipt of a notification. We found that all services were management well and no risk to people services, however, this highlighted the need for continued oversight and clearer communication to ensure registration arrangements were fully understood, embedded and effectively managed, and to maintain staff clarity and continuity of care for people using services

The provider had 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 did so with integrity, openness and honesty. A staff member said, “Leaders are approachable, visible, and supportive – they provide guidance and regular supervision.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. People and staff were regularly asked for feedback, which was used to shape the service. The provider encouraged people to have their voice and to share their views about how to make change either within the service or to enrich the lives of individuals. A person said, “[Manager] is amazing, any problems, they are on it.”

The staff understood what to do if they needed to speak to someone about their concerns. The provider had a whistle blowing procedure in place. A staff member said, “There is a culture of openness, transparency, and trust.”

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 felt valued in their roles. The leadership team took a proactive approach to supporting staff. They ensured staff were able to work safely and considered each person’s whole self, including their wellbeing, when making decisions. For example, Leaders support staff with adapting working patterns. Leaders demonstrated a shared commitment to delivering person centred care.

The provider had clear responsibilities, roles, and systems of accountability in place to support good governance. These systems were used effectively to manage and deliver good quality, sustainable care and support. Since the last inspection there has been focus of fostering an environment of reflection, learning and change. This included review of their systems and ensuring that the information they gathered was meaningful. Leaders acted on the best available information relating to risk, performance, and outcomes, and shared this appropriately and securely when required. Governance processes identified where improvements were needed, supported by in depth information of people’s day to day experiences that enabled greater oversight and timely improvements and reflections where needed. The management team completed regular audits, spot checks, and competency assessments, with clear actions arising from these and evidence that they had been followed through. Lessons learned were captured and shared with staff to support ongoing improvement.

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. We reviewed detailed analyses of people’s care and care journeys, which are shared to support effective partnership working. Quarterly service reports provide an overview of active support, workforce and safeguarding arrangements, service improvements, feedback, challenges, and agreed priorities and next steps to inform continuous improvement in care.

The provider has established strong links with the local community and partner agencies. Professionals shared that the management team were responsive to requests.

The provider promoted a culture of continuous learning and improvement. Systems were in place to identify lessons learnt, and these were used proactively to strengthen practice. Since the last inspection, leaders had encouraged innovation and supported staff to explore creative ways of improving people’s experiences, outcomes and quality of life. The provider had recently engaged in a supportive process with the local authority, which resulted in the development of a multidisciplinary team around the service to provide guidance and support to drive improvements. Leaders welcomed this input and demonstrated an open and positive approach to learning and continuous improvement. The management team reviewed incidents, feedback and audit findings to identify themes and trends and shared learning with staff to promote safe and effective practice. Leaders remained committed to ongoing development across the organisation and to working collaboratively within the wider local system.