Allot Healthcare Services York

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 requires 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 36 (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 and registered managers were unable to demonstrate a clear understanding of the service being delivered and there were significant discrepancies in key information about the service. During the inspection, the registered manager gave differing accounts regarding the number of people using the service, numbers of staff employed, use of bank staff and records held within organisational systems. For example, we identified 90 staff showing as active on the electronic system, 63 staff on recruitment records, 70 staff on the training matrix, 59 on a staff list and 44 staff initially reported to inspectors. Similar discrepancies existed in relation to the number of people supported. These inconsistencies limited the provider’s ability to demonstrate effective oversight of the service and therefore people’s safety.

The service had experienced significant operational difficulties following loss of access to its recruitment and compliance systems. Whilst the provider described plans to rebuild systems and transition to alternative electronic platforms, they were unable to demonstrate that effective contingency arrangements had been implemented in a timely manner. Records required to evidence safe recruitment, staff training, governance and quality assurance were incomplete, difficult to access or unavailable during the inspection.

Although staff generally described supportive relationships with colleagues and some said managers listened to concerns, this was not reflected by governance processes or outcomes for people using the service. Feedback from relatives highlighted poor communication, inconsistent care provision and concerns that issues raised were not effectively addressed.

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.

The registered manager was unable to provide important information regarding staffing, recruitment, training compliance, governance systems and oversight arrangements. They were unable to explain aspects of risk monitoring, call prioritisation or how services assured themselves staff were suitably trained and deployed. Significant records requested by inspectors were not available during the site visits despite being requested in advance. The provider was aware of a number of concerns within the service, including complaints regarding timekeeping, continuity of care and staffing difficulties. However, governance systems had not identified or responded effectively to wider concerns found during the inspection. Examples included inconsistencies in recruitment records, significant training gaps, incomplete audits, poor oversight of incidents and discrepancies between information held on different systems.

Some staff spoke positively about support from managers. Staff told us managers were approachable, completed spot checks, held team meetings and responded when concerns were raised. Staff also described receiving supervision, training opportunities and support from office-based staff. However, these positive experiences were not consistently reflected by the provider's records or governance arrangements.

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

The provider had systems intended to promote openness and encourage people to raise concerns, but these were not always effective in demonstrating that concerns resulted in learning and improvement. Staff told us they felt able to raise concerns with managers and knew how to escalate safeguarding concerns. Staff described contacting the office for advice and said concerns were generally responded to. Staff meeting records showed whistleblowing was discussed and staff were encouraged to speak up. However, governance records did not consistently demonstrate that concerns raised were followed through, monitored or acted upon. Staff meeting minutes recorded issues regarding continuity of care, difficulty contacting the office and electronic call monitoring response times. Whilst these issues were acknowledged, records did not consistently evidence actions taken or outcomes achieved. We also identified incidents, complaints and safeguarding concerns that were not always reflected in governance monitoring systems.

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

The provider had systems intended to support equality, diversity and inclusion within the workforce. Training records included equality, diversity and inclusion as a mandatory training subject. The workforce was diverse and staff from a range of backgrounds were employed across the service. Staff generally described a supportive working environment and said they felt able to approach managers for support. However, leaders could not consistently demonstrate effective oversight of workforce arrangements. Records relating to sponsored workers, working arrangements and deployment were not always accurate or clear. We identified discrepancies between recruitment records, staffing records and rota information. This reduced assurances that leaders consistently monitored employment arrangements and staffing deployment effectively. Due to these concerns, we shared this information with the relevant partner organisations to ensure the issues were followed up appropriately.

The provider's systems did not always provide clear evidence that all staff had completed required training or that workforce records were maintained consistently. Gaps in training records and incomplete recruitment documentation meant leaders could not demonstrate that development, supervision and support arrangements were consistently monitored across the workforce.

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.

Governance systems were ineffective and did not provide leaders with assurance regarding the quality, safety and sustainability of the service. Whilst the provider completed a range of audits, these had failed to identify significant concerns found during the inspection. We found examples of incidents, safeguarding concerns, injuries, care concerns and record-keeping issues that had not been captured, reviewed or escalated appropriately through governance systems. Several incidents identified in care records and paper documentation had not been recorded on incident logs or incorporated into management oversight processes.

The provider could not consistently demonstrate oversight of staff recruitment, training, competence or deployment. Significant discrepancies existed between training records, recruitment records, staffing records and electronic systems. The provider had lost access to key recruitment and compliance systems and had not implemented sufficiently robust alternative arrangements. As a result, the provider was unable to reliably demonstrate safe recruitment and ongoing workforce compliance.

Quality assurance processes were not consistently effective. Client surveys identified concerns regarding timekeeping, communication, staff consistency and competency, yet we found limited evidence demonstrating how learning from this feedback had been translated into measurable improvements. Audits frequently identified actions but did not consistently evidence completion, review or impact. As a result, people were placed at risk of receiving unsafe, inconsistent and poor-quality care because the provider could not be assured risks, incidents, staffing concerns and feedback were being effectively identified, monitored and acted upon.

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.

Partnership working was not always effective. Safeguarding concerns had been raised by external agencies regarding communication, continuity of care and people's safety. Information shared by the local authority identified discrepancies within service user records and concerns regarding oversight of commissioned care packages. Complaints and safeguarding notifications also highlighted occasions where information had not been shared effectively or where families had concerns about the reliability of care arrangements. The provider had engaged an external consultant to support improvement work and governance development. However, improvements were still being developed at the time of the inspection and their impact could not yet be demonstrated.

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 did not consistently learn from incidents, complaints, feedback and governance information to drive sustainable improvement. Although audits, complaints reviews and incident reviews were completed, we found multiple examples where concerns had not been fully captured within governance systems. Several incidents and safeguarding concerns had not been recorded within accident and incident monitoring records. This meant leaders could not demonstrate they had complete oversight of risks or were consistently learning from events.

The provider identified actions within complaint reviews, audits and quality assurance reports, particularly around timekeeping, continuity of care, medication management and communication. However, concerns relating to these areas continued to be reported by people, relatives, staff and partner organisations. This indicated learning was not always embedded or translated into sustained improvement.

Leaders had begun introducing new systems, working with external consultancy support and reviewing governance processes. However, these developments were largely reactive to concerns identified by external agencies and the inspection process. At the time of our inspection, improvements were incomplete and governance arrangements had not yet demonstrated their effectiveness in improving outcomes for people.