A & T (Salisbury) Ltd

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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 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 provider was in breach of legal regulation in relation to the governance of the service.

This service scored 62 (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. Leaders told us they were very invested in the service. Their vision was to ensure the service remained very small, friendly and intimate. They did not want any expansion in the number of people supported or staff in case the consistency and standard of care provision currently provided was lost.

Leaders were very happy with the way the service was performing and enjoyed providing people’s support. They said they knew people well, including their preferences, which enabled a good standard of personalised support to be provided. Staff told us they enjoyed providing people’s support. There was a positive culture, based on providing people with the support they wanted. One staff member told us, “Clients aren’t just a name to them. [Leaders] are passionate about what they do.”

The provider 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.

Staff told us there was a “lovely” culture, and they felt safe and were well supported. They said leaders would respond immediately if needed and were always at the end of the phone. One staff member was positive about the qualities of leaders and said they were spoken to with respect.

Staff told us they were never expected to support people who were complex or challenging. They said this, alongside the values of leaders, promoted confidence and a feeling of safety. Leaders demonstrated strong values and were clearly compassionate about the overall service they provided.

The provider fostered a positive culture where staff felt they could speak up and their voice would be heard. The provider had a whistleblowing policy which was available at the service. Staff knew how to raise any concerns and felt sure these would be listened to. Staff told us they had no hesitation in speaking up or raising any concerns. They said they were confident they would be listened to, and their concern would be investigated and satisfactorily resolved.

Staff told us there were various systems to encourage openness including informal conversations, a phone application, supervision sessions and staff meetings. Leaders confirmed this and said they regularly spoke to staff. They were confident any concerns would be raised immediately, and an investigation would then follow.

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. This included additional support, flexibility and adjustments to enable staff to undertake their role, to the best of their ability. Leaders told us staff brought additional skills and experience from their other employment in health settings. Records showed staff had undertaken training in equality and diversity.

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.

Leaders told us they only spent about 20% of their time undertaking management responsibilities. The rest of their time was spent providing people’s support. This did not enable effective oversight and management of systems such as care planning, risk management, auditing and overall record keeping.

As a result, shortfalls had not been identified or addressed. This included those found at this inspection such as failure to identify and mitigate risks people faced, and the lack of detail and information within care planning about people’s needs and the support they required.

For example, some of the information within different sections of the care plan was conflicting, and not all records were dated and fully completed. The timing and duration of people’s support were also not detailed, which did not enable effective monitoring or any patters or trends to be identified. Checks to review the content of people’s daily records and medicine administration records, had been undertaken. However, these were not consistent which did not ensure shortfalls were identified or addressed in a timely manner. Records demonstrated spot checks had been undertaken to assess staff’s performance, but there had not been any assessment of leader’s practice.

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. Leaders worked closely with other professionals to ensure people’s needs were met. This included contacting people’s relatives or the GP if people were unwell or an occupational therapist if additional equipment was needed.

Leaders told us much of their contact with other professionals was with local pharmacies to ensure people had their medicines on time. A health and social care professional told us the service served the community well, and “wished all care agencies were like them.”

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.

Leaders told us they wanted to serve the public and were not interested in expanding or changing service provision. They said they had “set the bar for the standard they expected” and did not want to jeopardize this. However, whilst care provision met people’s needs, management systems and responsibilities had not been given adequate focus or development. This did not ensure leaders were up to date and adhering to the legal requirements of their registration.

Although records demonstrated staff had received training and formal supervision, goals or additional learning had not been identified. Records also demonstrated leaders had completed the mandatory training expected of staff, but no other learning related to their role had been undertaken. This did not ensure the ongoing development of the service or ensure it effectively met legal regulation.

Leaders told us they would meet to discuss how best to improve these areas whilst also continuing to provide people’s support.