Oswestry Also known as Approved Care and Support

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 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 regulation 17 in relation to governance at the service. There were ineffective systems in place to monitor and ensure staff competency regarding medicine administration and oversight of care records. The provider also failed to ensure notifications were submitted in line with the legal requirement to do so.

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.

The provider demonstrated clear values and aims within the service, and it was evident the management team was passionate about delivering high quality, caring community care. Staff we spoke with shared these values. An open-door policy at the office allowed staff to drop in to discuss concerns or share ideas, this was complemented by regular communication through emails, messages, focus group meetings, and formal one to one supervision. We were told these meetings had been effective in reinforcing the provider’s vision, values, and aims. Staff reported confidence any concerns raised would be addressed promptly and appropriately by the management team.

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.

The registered managers and operations manager demonstrated a strong commitment to providing high-quality care. Staff and people who use the service told us the management team were capable and inclusive leaders.

Staff described the management team as approachable and said they were confident any concerns raised would be followed up promptly. They explained regular supervision sessions and group focus meetings were in place, and they felt comfortable approaching managers outside of these formal arrangements. Staff highlighted the open-door policy as a positive aspect of the culture.

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

The provider fostered a positive culture where people felt they could speak up and have their voices heard. Staff had access to a whistleblowing policy, and all staff spoken with told us the registered managers were approachable, and they could share concerns openly. We observed a suggestion box in the office, allowing staff to submit ideas or concerns anonymously if they preferred not to raise them directly.

The registered manager told us they encouraged openness and honesty, reiterating that if they were unaware of issues, they could not make improvements. This demonstrated the registered manager empowered staff to speak up.

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 they were treated equally and without discrimination at work. Staff training included equality and diversity. Staff described the team and managers as supportive. A relative also told us, “They employ diverse carers.”

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.

We found there were not sufficient processes in place to monitor staff medicine competencies following training for medicine administration. This was highlighted by the medicine error identified during our inspection. This demonstrated systems in place were not sufficient to highlight any gaps in staff learning needs around medicines. The provider informed us training has been sourced and scheduled for required staff members.

In addition, we reviewed 8 care plans, we found 6 did not contain the required risk assessments or health specific care plans. This indicated systems and processes in place are not effective in identifying and addressing gaps in care planning and risk management. The absence of effective care plans and risk assessments increased the risk to people as there was no assurance care was being delivered in line with people’s needs.

We found notifications which the provider is legally required to submit to CQC relating to certain incidents had not been submitted to us as required. The provider informed us they had experienced difficulties accessing the portal to submit these notifications but had not taken action to address this. This was a missed opportunity to share information in a timely manner. Notifications have been submitted retrospectively.

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 found staff worked in partnership with other professionals when needed to ensure people received appropriate care and support. Staff told us they contacted other professionals as needed.

We saw evidence of the provider working with social workers to act in the best interests of a person who did not have capacity to consent to care. The provider also supported people to access help with environmental risks, including making referrals to the fire service for fire risk assessments where 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.

We found recurring themes highlighted in the previous inspection in 2020 regarding health-specific care plans and risk assessments. This indicates learning from past findings had not been fully embedded into practice and that effective systems had not been implemented to ensure these were consistently in place.

We found the provider had made some improvements since the last inspection. Staff files were up to date and fully completed, highlighting safe recruitment practices. We also saw evidence of regular supervisions being held with staff alongside 4 monthly focus group meetings where discussions regarding lessons learnt from complaints and concerns were held. For example, staff staying for the duration of the call, professionalism of staff and infection prevention measures were discussed and addressed with the team.

We found during our inspection registered managers were responsive to feedback and they were reactive in taking steps to address concerns flagged. For example, sending notifications in retrospectively, reviewing care records whilst we were onsite and sourcing training for autism awareness and medicine competency. This demonstrated the provider acted upon feedback to improve the quality and safety of care provided.