Archived: Curant Care Maidstone

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 requirement improvement. 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 at the service.

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 provider told us there were concerns at the service such as high levels of staff sickness. However, when we asked them how they planned to improve the culture there was not a clear plan to do so. Plans focused on recruitment and monitoring performance, and lacked the components needed to improve the underlying culture behind the levels of sickness.

There was a system in place to undertake spot checks on staff. However, complaints were not recorded and analysed for trends to support an understanding of the culture in practice.

There was a strong message from the staff team that communication needed to be improved. For example, staff told us that calls could be added at the last moment which made it difficult for them to plan their day.

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.

Whilst some people and staff were positive about the manager at the service we did find significant failures within the governance of the service. A review of the call schedule shared with us during the inspection showed in January the manager was scheduled for 140 care calls. This took them away from managing the service which inevitably impacted on service standards.

The manager was enthusiastic and had started as a care worker working their way up to the manager’s position. However, this was their first role as potential registered manager, and they did not have significant management experience. This coupled with working so many hours providing care meant they were not set up for success in their new role.

We identified CQC had not been notified about concerns when they needed to be. Notifications had not been submitted by the manager as required, we also found concerns relating to the managers understanding of handling people’s sensitive data securely.

People did not always feel they could speak up and that their voice would be heard. We did not find a culture where all staff felt they could actively raise concerns and be listened too and supported. Feedback from staff was mixed. One staff member told us they had raised concerns with the office regarding call times, “When you speak to the office, they are deaf to it. I will raise issues when I find them. I do report issues but feel like nothing gets resolved.” Other staff told us they did feel they could raise concerns. One told us, “I have proactively raised concerns about service users’ safety and person-centred care. Management has consistently listened and taken effective action to address these issues.” The manager told us they issued ‘broadcasts’ to staff to inform them of changes and areas where change was needed. However, one staff told us, “They put out broadcasts, but it doesn’t make any changes.”

During the inspection we did identify a number of concerns which had not been raised to management such as one person informing staff they had fallen and had hurt themselves. During the inspection we raised this with the manager who told us they had since taken action. However, the concern had not been raised by staff prior, and it needed to be.

The provider did not value diversity in their workforce. They did not work towards an inclusiveand fair culture by improving equality and equity for people who worked for them.

One carer told us, “Support is a bit hit and miss, depending on how well staffed the office is.” There was mixed feedback from staff over how well supported they would be when they did, or might in the future, have a medical need. Some staff told us they did feel well supported. However, others told us they did not feet supported or valued. One carer also told us, “I think they need to show more support to the carers. If it’s your day off they can hound you if they have sickness.” Whilst staff told us they felt supported by each other there was a mixed experience as to how well staff felt supported by and listened to by management.

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.

Quality assurance systems and audits needed to be reviewed and significantly improved to ensure they are effective and people are safe. For example, medication records were audited. However, we identified concerns with people’s medicines, gaps in medication records and service users not always receiving their medicines as prescribed. Care plans needed to be updated, and quality reviews had not led to these being up to date prior to the inspection.

The manager told us they regularly reviewed service users’ daily notes. However, we identified concerns relating to one service user falling and struggling with swallowing and neither of these incidents had been identified in the service users care plan. Staff had also not reported these as incidents.

There were audits of call times. However, we identified short care visits, late care visits and visits that were over 45 minutes early. The manager completed a selection of audits of the daily notes. However, these focused on record keeping and not analysing how many calls were late, short or missed.

The location has moved office. Whilst they informed CQC the provider had moved; they had not informed us that the location had moved. This meant the service was operating from a different location from where it was registered to operate from.

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 were being supported by partners such as the district nurse and staff were given this information, so they knew who to contact if needed. However, partnership working was at risk of not being effective due to poor care planning. For example, where people had constipation there was not escalation route for what to do if a person did not respond to medication. This meant there was an increased risk people would not be referred to the GP if this was needed or encouraged to contact them themselves.

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.

The provider has not sufficiently improved the service over the last 3 inspections. This is the third consecutive inspection we have found similar concerns in medicines management, risk management and governance. There had also been previous concerns around complaints not being recorded, incident management, staff deployment and failure to notify CQC. Following the previous inspections, we asked the provider to put together actions plans to improve. However, the service hasn’t improved and there remain concerns as the provider has failed to learn lessons and lead positive change.