Care and Support Service Sandford Station

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 remained 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.

Company values were discussed as part of staff induction and annual refresher training. The management team promoted these values within staff supervisions and held staff meetings regularly. This gave staff the opportunity to raise ideas they had to make improvements to the service people received. The staff team worked towards supporting people in line with company values, they promoted people’s independence and supported people to live their lives according to their wishes.

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.

There was not currently a registered manager in post. A domiciliary care manager was currently overseeing the service, with a care and support lead, senior carers were also employed. A senior manager told us a new manager had now been recruited, and they would be applying to be the registered manager when they joined the service.

The management team were aware of and worked in line with the duty of candour. They were open and honest with people when things went wrong and aimed to learn from these events to prevent them occurring again. They were supported by senior managers and were included in development opportunities within the organisation. For example, the manager was part of the provider’s equality and diversity working group, which worked on ensuring the provider’s systems were inclusive for people and staff.

People and relatives told us managers were approachable, and they could speak to them when they wished to. Comments included, “I have spoken to the manager. It is easy to contact them” and “Yes I can talk to the manager, they are approachable.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. However not all staff felt they could speak up and that their voice would be heard.

Staff were given opportunities to raise concerns and provide their feedback, this included in team meetings and supervisions. Safeguarding and whistleblowing policies were available to staff, and staff had been reminded of their responsibilities in relation to safeguarding and whistleblowing in a recent team meeting.

Most staff told us they felt comfortable to raise concerns. However, some staff raised to us they were apprehensive to raise concerns as they felt staff had not always been treated equally, specifically in relation to medicine errors. We raised this with the manager.

The manager told us there had been several medicine errors which they had needed to investigate, and there had been a lot of necessary work completed to reduce medicine errors.

They planned to have further discussions with staff to ensure they are comfortable to raise any concerns they have.

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.

Management discussed any additional support staff needed with them in supervisions. Flexible working arrangements were available to staff, including where staff required flexibility in working hours due to their personal circumstances. Where staff required reasonable adjustments to support them in their role these had been risk assessed and implemented. Staff shared various examples of how they had been supported when they had requested flexibility in their working arrangements.

The provider offered ways for staff to speak with higher management and raise any ideas, questions or concerns they had. For example, regular provider employee forum meetings were held and a representative from the service attended these meetings.

Staff meetings could be joined remotely to provide more opportunities for staff to attend and share their views.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The management team completed a wide range of audits to monitor the quality and support the running of the service. Audits reviewed a range of areas such as medicines, falls, and care plans. Any identified actions were completed immediately or transferred to the service action plan to be worked on. The provider’s quality team also completed monthly audits covering multiple areas and provided guidance to the management team on how further improvements to their service could be made.

The manager understood their responsibilities, including the requirement to notify CQC and other relevant agencies of significant events. The service had displayed its CQC assessment rating on their website and at the service as required. The provider had a business continuity plan, to guide staff in emergency circumstances. People’s records were stored securely.

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 service encouraged partnership working and advocated on behalf of people to ensure they received effective health care. Staff told us they report any changes in people’s presentations to their seniors or managers, who then make any referrals to external partners as required.

A health professional told us, “This close working relationship is of real benefit to their residents and reflects a well-led service, the management team are approachable, responsive, and clearly committed to working in partnership with primary care.”

People had multiple opportunities to be a part of the village community and social groups, and there was wider information available to people should they wish to access other social activities and places within the community. Some people were supported by staff to access social events and day trips as they wished.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The management team encouraged staff members to develop by supporting them with opportunities to further their skills and training, for example completing health and social care qualifications and mental health first aider training.

Organisational data was shared with the staff team around accidents, incidents and lessons learnt to share learning. The provider was in the process of researching and trialling new technologies which could assist with reducing falls for people.

Governance processes supported ongoing monitoring, provider audits demonstrated a focus on learning and improvement, and an action plan was in place to address identified areas for improvement.

The provider responded positively to feedback provided throughout the assessment.