LANH

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 good governance.

This service scored 61 (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 had built a positive culture within the service, for example staff told us, “If you want to expand your knowledge and do more training, they really support you.”

The provider had not always ensured that leaders had the skills, knowledge, experience and credibility to lead effectively. Leaders at the service had gaps in their knowledge in relation to national guidance, for example, the principles of the Mental Capacity Act 2005 had not always been implemented for everybody when determining a person’s capacity. Leaders at the service were also not fully aware of the Care Quality Commission (Registration) Regulations 2009: Regulation 18 as they had failed to and were not aware they needed to notify CQC of police incidents. Once this was brought to the attention of the provider, they immediately started to submit notifications to CQC that were notifiable.

The manager had applied to be registered with the CQC and had completed qualifications in order to support their knowledge and development. The manager told us they were involved in a number of forums to ensure they were kept up to date with relevant changes in health and social care. A staff member told us of the leadership of LANH, “they are very professional people.”

Whilst there we identified shortfalls in the knowledge for leaders at the service Staff we spoke with were complimentary about the leadership team at all levels.One staff member told us, “They want us to be good carers.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. There is a culture of speaking up where staff actively raise concerns and those who do (including external whistleblowers) are supported, without fear of detriment. When concerns are raised, leaders investigate sensitively and confidentially, and lessons are shared and acted on. Staff told us they felt very supported by the provider and they understood how to whistle blow or raise concerns, one staff member told us, “Think there’s a positive culture where can discuss issues, if have any worries can openly ask these. If we raise concerns a meeting is quickly convened.”

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.

All the staff we spoke with were positive about working with LANH. Comments included, “I love working with LANH,” and “They are supportive.” The manager and provider had a system in place to ensure that new staff were well supported when they started working with LANH. Some staff had come from overseas and told us LANH had supported them to settle in the UK. One staff member told us, “When you are going through a lot emotionally they are really supportive.”

The manager and provider had implemented different systems to ensure staff were well supported, including giving staff access to a employee support system. Staff told us that leaders often called them to ‘check in’ and make sure they were ok. Staff told us that during a particularly difficult time, the leaders at LANH provided exceptional support to them. Staff told us, “They have offered me counselling. It gives me comfort to feel like I’m in a safe space surrounded by family. It makes me feel like I will be ok because they are there for me.”

The provider did not always have clear and effectives responsibilities, roles, systems of accountability and good governance. The provider had not ensured that their auditing identified the issues we found during the inspection. For example, risk relating to people’s health needs were not always well managed, such as, risks assessments and guidance for staff relating to blood thinning medicines had not been implemented. Other risks relating to people being at risk of self-neglect and constipation had also not been well managed.

The provider had systems in place for the oversight of incidents, accidents and safeguarding, however these were not always effective to ensure all possible actions could have been taken. For example, systems to check on the wellbeing of people were not always robust and improvements for some people were needed.

Care plans were not always accurate and reflective of people’s current care needs. For example, assessment tools such as Waterlow were not always updated when people’s need changed. People also had information that was out of date, such as significant injuries, that was no longer relevant.

The provider had not ensured that effective processes were in place regarding people’s capacity. We found that care plans were not always detailed to ensure it was clear if people had capacity, and if they did not, details in relation to who was supporting the person to make decisions was not consistent.

The provider had not ensure robust systems to assure the notification to CQC of notifiable incidents. The provider had not notified CQC of police incidents and safeguarding alerts. We made the provider aware of this failing and following the inspection they submitted notifications for new incidents that had occurred.

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. For example, safeguarding referrals had not always been made in relation to people self-neglecting.

However, the provider also demonstrated examples of good practice with other partners. For example, the provider worked in partnership with other stakeholders, including organisations who supplied equipment for people. When people needed equipment, the provider worked with multiple organisations during challenging periods when information between those organisations was not always transferred, and ensured people received the equipment they needed in a timely manner.

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. The provider worked within the local system to share learning and good practice. For example, when there were water shortages in local areas, the provider alerted the local authority and other stakeholders to ensure people received joined up care.