Care Staff Services Ltd

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 inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in breach of legal regulation in relation to governance .

This service scored 29 (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.
The registered managers told us they used spot checks and monthly service user feedback calls to monitor care quality and staff performance. However, both registered managers confirmed they had not completed spot checks. People and relatives told us feedback calls had stopped. The registered managers told us staff meetings took place once a month, and due to the large volume of staff some were not able to attend in person. The managers told us supervisions were used to ensure staff had read the meeting minutes. However, the supervision forms we reviewed contained lacked evidence of this. Staff meeting minutes did not refer to the visions, values and strategic goals of the service, which meant there was a lack of shared direction between managers and staff. Although the registered manager explained what vision they had for the service and what values they expected staff to show when supporting people, our evidence gathered provided limited assurance on how this was monitored and discussed with staff.
 

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.
Management team or managers were not visible to people. People told us, “I am not in touch with the management”, and “I met the manager 4-5 years ago”.
Staff feedback indicated leaders did not embed a positive and open culture, meaning there was a lack of inclusivity and integrity. Leader did not lead by example, modelling inclusive behaviours across the staff team.
The registered managers also told us they were no longer receiving support from their leaders, which meant they were not always supported to access appropriate support and development for their roles. The leadership structure was unclear. There was significant confusion and delay in determining the status of the nominated individual and how this affected oversight and decision-making.
The registered manager’s office did not indicate staff were able to openly come in to speak to management and access the building. For example, we found signage stating, “Carers and visitors are not allowed without permission”. This did not demonstrate inclusivity and openness present in the service.
 

People did not feel they could speak up and that their voice would be heard .
Staff repeatedly expressed fears of being dismissed when raising concerns. Throughout our assessment we were contacted by a high volume of whistleblowers who were told not to speak to or share concerns with CQC Inspectors. This demonstrated a closed and unsafe culture, where staff could not confidently report concerns without feeling their voices would be unheard.
 

The provider did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them.
We were not assured the working environment was inclusive, and staff’s wellbeing was considered consistently. For example, staff meeting minutes did not demonstrate staff wellbeing was discussed. Furthermore, the purpose of the meetings did not capture opportunities for staff to include items or issues on the agenda to discuss as a wider group. The provider also did not evidence staff received training to support with skills in equality and diversity. This did not ensure the service had a positive culture which did not always support better outcomes for people.
 

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 did not evidence they have established systems and processes to quickly identify, monitor and manage people using the service with high level of risk. This did not demonstrate effective oversight of people’s needs and requirements. For example, we requested a list of people with their specific conditions such as diabetes, epilepsy, catheter use, or dementia. The registered manager was initially unable to provide this, necessitating a colleague to compile the list over 4.5 hours. This did not demonstrate people most at risk could be quickly identified and safeguarded to ensure equitable care delivery.
People’s care plans and risk assessments were stored ineffectively on the software used by the provider. Essential information including medical details were not clearly displayed. This made it difficult for staff to access key information, increasing risk of errors and unsafe care. Although the registered manager stated the care plans were also printed and put in people’s homes; there was no assurance that these were consistently updated or accessed, particularly in emergency situations . Furthermore, people we spoke to told us they did not have a copy of their care plans.
During our inspection we found people’s records were amended . For example, the quantity of medicine administered to a person on the previous day. This demonstrated a lack of oversight and governance of systems and processes. This also meant inadequate investigations could be completed due to amendments made before identifying discrepancies.
We found concerns how the service’s "on-call" and "monitoring team" operated, with vague responsibilities and an apparent reliance on international administrative support to monitor care. This raised concerns regarding the effectiveness, accountability, and immediacy of care oversight, particularly when critical clinical incidents were missed or responded to late.
Quality audits and action plans were designed to focus on learning and improvement. But these did not identify the deficiencies we found during our assessment, such as a number of breaches of regulations indicating people’s care and safety were at risk.
 

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.
People’s care plans were not always up to date, detailed and accurate, therefore it was unclear whether partnership working was always fully supporting safe care. Staff did not support people to access the community when possible. The registered manager told us they communicated well with district nurses and social workers. However, evidence we collected did not demonstrate the provider understood their duty to collaborate and work in partnership with other services to ensure continuity in people’s care and to achieve the best outcome for people using the service.
 

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.
We found serious and sustained failures in the service's governance, oversight, and leadership that did not ensure safe, effective, or well-led care. The systems in place did not support the effective assessment, monitoring, and mitigation of risk to people’s health, safety, and welfare. This did not support a culture of openness and learning within the service.
We found there were ineffective systems and processes in place to review incidents and accidents with the focus to improve people’s outcomes. This meant people were at continued risk of reoccurring incidents of harm. For example, where physical or chemical restraint was used the management team failed to review these episodes to ensure the safest and least restrictive techniques had been used. There was no evidence of learning for staff from these episodes. Records demonstrated staff had not been involved in reflecting after incidents and had not considered what could be done to avoid the need for its use in similar circumstances. This meant the registered manager/provider failed to monitor and manage the use of restrictive practice which placed people at risk.
The lack of feedback opportunities from people using the service, and opportunities for anonymous staff feedback meant this information had not been used to make improvements across the service. This meant people were being placed at risk of receiving a poor quality of life due to a lack of continuous learning and improvement.