Crescent Office

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.

Most people were positive about the support they received. However, some said improvements were needed, particularly about the skills of staff and call timings. The registered managers and all the staff we spoke with demonstrated a commitment to providing person-centred, high-quality care. However, there was no evidence the service’s shared vision, values or goals were shared with staff, and people did not always receive person-centred care or have their risks managed well.

Not all leaders understood the context in which the provider delivered care, treatment and support. 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.

The service was not always well-led. Processes for monitoring the service and driving improvement were not always effective. We identified areas of concern and breaches of regulations that were not identified by the provider.

Two registered managers ran the service. One had more experience and was mentoring the other. Some people and staff told us they were not confident this arrangement was working and felt 1 registered manager did not have the appropriate skills. Other people, relatives and staff were positive about the leadership and described the registered managers as “good managers”, “approachable” and “supportive.”

People did not always feel they could speak up and that their voice would be heard.

Staff had access to whistleblowing information and guidance and told us they knew how to speak up if they had concerns or something went wrong. Some staff told us the registered managers listened, supported them and took action. However, others told us they had raised concerns several times, but no action was taken.

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 received training in equality and diversity and staff told us they were treated fairly without discrimination.

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’s monitoring and governance processes were not robust. The provider did not have effective oversight of the service and were not aware of the issues we found on this inspection. For example, we identified concerns with care plans, medicines management and consent, but there were no audits to assess and improve the quality of these areas.

The systems to assess, monitor and mitigate risks to people were not effective. This placed people at risk of harm. Records related to people were not always maintained to be accurate and up to date.

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, with the local authority if there were concerns about people’s mental capacity.

As outlined in the ‘How staff, teams and services work together’ section of the report, carerecords did not demonstrate collaborative working with external professionals. However, staff contacted health care professionals external to the service if they had concerns.

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.

When accidents or incidents occurred, staff arranged for people to get help from partner agencies such as paramedics. However, records did not demonstrate that learning was captured or used to improve the quality of care, nor was there evidence of analysis of accidents, incidents, or concerns to identify patterns or trends that could inform service improvements.

The provider met with people to review their care package, and most were positive about this. Some changes had taken place after these such as staff arrangements and call timings. However, when people raised complaints and concerns, this did not always prompt the provider to take action to make the necessary improvement for people. For example, a relative told us they had complained to a registered manager about staffing arrangements several times but, this had not been satisfactorily resolved at the time of the inspection.