Coast Community Care

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 this assessment 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 governance at the service.

This service scored 50 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. The service had a business continuity plan that covered all services managed by the provider. Although this document was comprehensive it was in need of review as some of the key contact details were out of date. The registered manager told us that the service intended to expand but that this had to be achieved in conjunction with recruiting more staff and providing appropriate training. It was acknowledged that the current gaps in training required improvement. The service did support some people with complex needs and in many cases this was successfully achieved and people received positive care and support. People’s care needs needed to be at the centre of any expansion plans.

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. There had been changes to the management structure of the service in the months prior to this assessment. The registered manager was registered for two services and held a higher position of ‘Commercial and Services Director.’ The service was overseen daily by a manager who was in the process of registering to take over from the current registered manager. These changes needed time to settle in and a period of management stability at the service was needed. Staff however did tell us that managers were supportive, approachable, and available when they needed support or advice. Comments from staff included, “Managers support us, they are very supportive” and “Managers support my wellbeing. They address concerns straight away.” Another added, “Managers are supportive, especially those in the office.”

People did not always feel they could speak up and that their voice would be heard. The registered manager had introduced a ‘council meeting’ for all services sitting under this provider. The object of the meeting was to provide an opportunity to staff from across services to raise concerns and suggestions relating to service improvements, to provide staff with a voice. However, it was noted that for the last two meetings, one meeting had only one staff representative present and the other had none. It was unclear how staff from the service were able to take part in these meetings. Staff were nevertheless encouraged to attend staff meetings and raise concerns but had fewer opportunities through supervision meetings due to an irregular meeting schedule. All of these issues were raised with the registered manager and a more accessible and timely structure was being developed.

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. Different cultures, faiths and backgrounds were represented within the staffing team. Difference was respected and celebrated and no one told us they felt excluded. The staff team represented well the people being supported and in some cases requests had been made from people to have carers from their own culture. Where possible these requests had been fulfilled. Important festivals were highlighted and celebrated, one recent such day was Philippine Independence Day. Similarly, religious high days were also recognised for example, Christmas and Eid. Equality and diversity policies were in place and were regularly reviewed.

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. Auditing processes were not effective. The registered manager told us about the service auditing process. Auditing was carried out at a local level by managers and senior staff working in the office and then results were sent to the service directors, including the registered manager. Recent re-structuring of the service management appeared to have de-stabilised these processes and a number of gaps were identified and issues that had not been followed up on. There were gaps in staff training, some were incomplete or out of date and other important modules had been missed, for example, epilepsy training. Significant numbers of staff (12) were shown as in urgent need of refresher training in autism awareness and diabetes. Medicines training was also incomplete. There were inconsistencies in staff supervision meetings with one staff member telling us they had received just 2 meetings in a year of employment. Care plans and risk assessment reviews were incomplete and similarly, the auditing processes had not apparently identified this. Effective methods for capturing feedback from people, relatives and staff were all lacking and this had not been identified by auditing or any quality control checks by the registered manager. All of these issues were highlighted to the registered manager and wider management team and were acknowledged. We received reassurances that work would be done to rectify these concerns. Time would be needed however to fully embed an effective auditing process where both good practice and gaps were identified and acted on.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. There were some inconsistencies in people’s experience of the service working well with other professionals with some reporting waiting for several months for medicines reviews. Although some of these issues related to partner agencies and professionals there was nothing documented relating to the steps the service had taken to communicate with other professionals to highlight concerns. Staff did however tell us that they worked well with some partners for example, community nurse, to compliment the support people received.

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 systems and processes in place were not effective at capturing best practice or learning from when things went wrong and this resulted in a lack of continuous learning and improvement. The registered manager had begun to consider more effective ways of capturing feedback from staff but this needed to capture all staff to be meaningful. We noted that care visit timings, punctuality and staff travelling time were all working well but the information available to staff within care plans and risk assessment was lacking.