Regional Care Peterborough

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 management and leadership was inconsistent. Leaders did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance, which was related to record keeping and quality assurance.

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.

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.

Care staff told us that the provider supported them to provide high-quality, person-centred care with good teamwork and communication helping to ensure positive outcomes for individuals. Another member of care staff told us, “I have previously recommended Regional Care to others. We are taught to offer care and support as we would want our own families to be cared for.” A third member of staff told us, “They [Regional Care Peterborough] consistently show compassion and make every effort to meet the needs of both their care staff and the clients they support."

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

The registered manager and senior staff failed to consistently demonstrate the necessary knowledge and skills to lead the service effectively. Oversight, systems, and processes were not used appropriately or consistently, resulting in gaps that meant people were not always assured of receiving safe, high-quality care. Governance arrangements were weak, with ineffective monitoring and a lack of proactive management of key areas, including documentation. Although the registered manager acknowledged these shortcomings during the inspection and expressed an intention to invest in improvements, this response highlights that robust management and governance systems were not already in place, raising concerns about their ability to maintain effective oversight and ensure sustained compliance.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Documents also showed a clear whistleblowing policy was in place, supporting transparency and enabling staff to speak up without fear.

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 provider had effective procedures in place to promote equality, diversity and inclusion within the workforce and to prevent discrimination. Staff told us they felt their individual needs were respected and supported. Staff told us they were treated fairly and had no concerns about how they were supported or managed. One staff member told us, “We celebrate several events through the year and the office support people of other cultures and backgrounds such as the recent Ramadan Eid, participating in the Peterborough Pride last year and other events like national women’s day, just to mention the more recent ones.”

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 failed to operate systems effectively to identify shortfalls and regulatory compliance. For example, the provider had failed to identify care plans and risk assessments were not always accurate or person-centred. Additionally, the provider had failed to ensure they had accurate oversight of accidents and incidents. This meant the provider could not be assured they were consistently delivering safe, high-quality care. To ensure we can perform our regulatory functions, providers are required to share relevant information with us. However, during this inspection, the provider failed to consistently respond to our requests for information, and we did not receive all the information we requested. The registered manager had failed to identify that audits were not effective and not always relevant to the service being provided. For example, the infection control audits had been completed to show that there were some people with antibiotic resistant infections and that single use equipment was being used more than once. When we asked for further information about these issues the registered manager confirmed it was not the case even though they had consistently been answered as such on monthly audits from November 2025 to February 2026. Audits had not always been fully completed or signed off by the registered manager. Audits of daily notes had not identified that notes had been copied word for word from previous entries. The provider responded to our feedback about the governance of the service and stated. “We will take this as a learning curve and use it to the best of our ability to tune things around moving forwards. We will take good note and appropriate actions in all the area where we have done poorly…. We will strongly and rapidly improve on them and ensure all new system that have been put in place are well embedded.” At our previous inspection in 2023, we identified breaches, including a breach of regulation in relation to good governance. At this inspection we found the provider had failed to act and make sufficient improvements. This meant systems for checking care quality and safety remained inconsistent and ineffective.

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.

The provider told us they worked with professionals such as the GP and district nurses. Staff told us they worked with healthcare professionals, relatives and the management supported staff in accessing these partnerships when needed. One member of care staff told us, “I also receive appropriate support from healthcare professionals such as doctors, nurses, specialists, social workers and mental health/crisis teams when needed.”

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.

The issues we found regarding reviews and audits meant the provider’s quality assurance systems and processes were not always effective. This meant the provider had not always identified learning to improve the service. The way the provider operated their audits required improvement to make them effective.