Northamptonshire Domiciliary Care Agency

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• 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 Inadequate and in breach of regulation in relation to good governance.

Although we found sufficient improvements had been made at this assessment to change the rating to Requires Improvement we found the service continued to be in breach of good governance.

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.

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 clear vision and set of values centred on being passionate, inclusive, brave, positive and kind.

Staff we spoke with were aware of the provider’s values and described how these influenced the way they supported people. The provider had delivered a range of initiatives, including personal support roadshows and culture workshops, to help communicate its values, expected behaviours and strategic priorities across the organisation.

The registered manager demonstrated a clear vision for the service and spoke positively about the improvements that had been made and the actions being taken to further strengthen practice.

Feedback from staff suggested the culture and direction of the service had improved, with staff describing a more positive environment and greater support from leaders. A staff member told us, “We see manager now on a regular basis, we are no longer on our own.” Another staff member told us, “Things are so much better I feel proud to work for Mencap again.” This indicated the service was moving in a positive direction and that efforts to improve culture were having an impact.

However, feedback we received from families regarding the culture and direction of the service remained mixed although one relative told us, “There have been changes for the better since last CQC.”

We identified areas where practice required further development to achieve the vision, values and behaviours, including continuing to strengthen staff understanding of the principles of the real tenancy test, and ensuring restrictive practices were consistently reviewed and reduced wherever possible.

Although improvements had been made, further work was required to ensure these were consistently embedded and sustained over time.

There was a new manager who had registered with CQC at the time of our assessment. Staff consistently spoke positively about the registered manager and the support provided by the seconded area operations manager and regional manager.

Comments from staff included, “The registered manager is a breath of fresh air,” and, “The new management team are visible, approachable and show they care.” Staff also told us, “[Registered manager] is here a lot and so are the service manager and assistant service manager.” This feedback reflected increased visibility of leaders and a leadership team that staff found supportive and accessible.

The registered manager was supported by a team of service managers and assistant service managers, providing operational support across the service. Staff told us there had been noticeable improvements in the visibility of local leaders since our last assessment and described managers as approachable, helpful and responsive. We also received some positive feedback regarding engagement from senior leaders within the wider organisation.

Feedback from relatives about leaders and managers was more mixed. While there was evidence that leadership had improved, further work was required to ensure these improvements were consistently experienced by all stakeholders, and that leadership practice was fully embedded and sustained in service delivery.

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

Staff understood how to raise concerns and were familiar with the provider’s whistleblowing policy and reporting procedures. All staff we spoke with were able to explain how they would escalate concerns both within the service and through the provider’s formal processes. This demonstrated staff had access to mechanisms to speak up when they identified issues affecting people, colleagues or the service.

At our last assessment, staff told us they were not confident concerns would be acted upon if raised with the provider or local management team. During this assessment, feedback had improved. Staff told us they now felt able to speak up and were confident their concerns would be listened to and considered. One staff member told us, “Now you can say something is wrong and feel people will listen.”

Staff particularly highlighted the positive impact of the new registered manager in creating a more open culture. Staff described leaders as approachable and receptive to feedback and provided examples of concerns leading to action. One staff member told us, “[Registered manager] listens. It is because of [registered manager] that we have increased the staffing level.”

This feedback indicated there had been a positive shift in the culture of the service, where staff felt more empowered to raise concerns.

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.

The provider had a clear vision for belonging, equality, diversity and inclusion and promoted these principles through a range of staff network groups and organisational initiatives. There was a diverse workforce supporting people who used the service and leaders spoke positively about creating an inclusive culture where people and staff felt valued and respected.

The registered manager demonstrated a clear commitment to equality, diversity and inclusion and provided examples of how these principles were embedded in practice. For example, the registered manager described how a person had expressed an interest in working within the provider’s registered office and had been fully supported to do so. The registered manager told us that increasing the involvement of people with disabilities across all areas of the service was an important part of the culture they were developing.

Staff also provided examples of reasonable adjustments that had been made to support them in their employment, helping to ensure they could fulfil their roles effectively.

At our last assessment, staff told us there were limited opportunities for career progression and development, and some felt the move from support worker to service manager was too significant.

During this assessment, we found the provider had introduced the temporary role of assistant service manager. Staff told us this had created additional development opportunities and had also strengthened management oversight during a period of change and improvement.

The provider had systems and processes in place to support the oversight of quality and risk across the supported living services.

This included a governance dashboard, audits completed by the provider’s quality team, and regular audits undertaken by the local leadership team. We saw evidence of oversight visits carried out by the registered manager, demonstrating a structured approach to monitoring service performance and driving improvement.

We found there had been improvements in governance since our last assessment, and leaders were able to describe how information from audits and oversight activity was used to identify areas for development.

However, governance processes had not consistently identified all the concerns found during this assessment. For example, provider audits and monitoring had not identified issues relating to restrictive practices, bowel massage, expired paracetamol, and aspects of mental capacity assessments.

Although the governance of the service had strengthened, further work was required to ensure improvements were fully embedded and sustained over time. We were assured this would improve as the new local leadership team continued to embed new practices.

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 provider had developed and maintained a range of partnerships with local and national organisations to support people and drive service improvement. Leaders told us they had worked closely with local authorities and had successfully completed their contractual action plans. As a result, the service was able to accept new admissions, demonstrating improved confidence from commissioning partners in the quality of the service being provided.

The provider had also continued to strengthen relationships with other stakeholders and specialist organisations. For example, leaders described working with the Prader-Willi Syndrome Association to access specialist knowledge and guidance to support people with specific health needs. These partnerships helped the provider to develop staff knowledge and improve the support available to people using the service.

Feedback from partner organisations was positive about the progress that had been made. We received examples of local partners recognising the improvements that had taken place since our last assessment. For example, a professional told us, “I have seen improvement over the last 6 months, I am more confident in the manager.”

The provider demonstrated a focus on learning, improvement and innovation since our last assessment. Leaders shared learning reviews that had been completed following our previous assessment and provided service improvement plans that had been developed for each supported living service.

The provider had invested in workshops with staff to help them understand regulatory expectations and prepare for inspection activity. Staff demonstrated increased confidence when discussing the service and the improvements that had been made.

We found there had been positive progress in embedding learning and driving improvement across the service. Leaders were able to identify a number of actions that had been completed and described how learning had been shared across teams.

However, learning, improvement and innovation was not yet fully embedded or consistently effective in identifying and addressing all areas requiring improvement. For example, we found some repeat concerns during the assessment and not all actions had been identified through the provider’s own improvement processes.

The provider was receptive to our feedback, acknowledged the areas for improvement and demonstrated a clear understanding of the further work required. We were assured leaders remained committed to continuing the improvement journey and embedding changes in practice to support sustainable improvements across the service.