Paramount Options Ltd

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 57 (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.
The provider did not always ensure care was person centred and staff were provided with guidance to assist them in providing appropriate care. Breaches of regulation had been identified which could put people at risk.
There was mixed feedback from staff when asked if they felt supported by senior management. Some staff said they felt supported. Other staff members told us they felt supported when asking for guidance for their role, but they do not feel fully supported by senior management in relation to other areas of work. These staff said they felt there was poor communication and some staff felt they were not valued or respected.
People and relatives were happy with the care they received from the staff who visited them with their comments including, “Yes, I am definitely happy; they are good”, and “I am happy enough if it keeps going like this.” Health and social care professionals told us they felt staff were very skilled, professional, had a good relationship with their client and provided the care required.
The provider had a strategy and vision document which identified the vision and values for the service.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. 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.
We identified a breach of a number of legal regulations. We also identified, from an action plan the provider showed us in response to a local authority visit, that they had not taken appropriate action to resolve the identified issues.
At the time of the assessment the registered manager was unable to attend the on-site visit and resigned from the service shortly after the visit. The nominated individual planned to apply to register with the CQC as the registered manager for the service.
People told us they, in general, they felt the service was well run but 1 person raised concerns about the management of the service. Their comments included, “Yes, I do, my requirements are met”, “As far as I am concerned, I do think it is well managed, I have had no bad experiences” and “It is [well managed] but the care agency management of their staff is letting them down”.
Some staff told us they did not feel supported with some aspects of their role and senior staff did not always respect or value them.
Health and social care professionals commented that they felt the nominated individual was helpful, could answer questions and when documents were requested, information was provided in a timely manner.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.
Staff confirmed they felt confident and understood how to raise concerns about changes in a person’s care needs. The nominated individual understood their responsibility to ensure if something goes wrong, issues were responded to in an open and transparent manner.

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 policies and procedures related to recruitment which identified all the legislation related to workforce equality, diversity and inclusion. The nominated individual explained they contacted staff on Fridays to check if they had any commitments so their rota could be amended.
The nominated individual shared a leadership development document which identified areas of personal development for senior staff.

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 had some audits in place, but these were not always robust enough to identify where actions were required to make improvements. The provider also has a number of policies and procedures in relation to undertaking audits, but these were not always followed. The audits in relation to medicines management, care plans and safeguarding had not identified issues with recording of information. Risk management was not always effective as risk assessments were not always completed. This meant the provider could not ensure information was accurate, reflected current care needs and provided staff with guidance on how to support people appropriately.
The provider had procedures in place to ensure personal information of people they supported, and staff was stored in line with best practice and legislation.

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.
Staff worked with a range of organisations to support people with their care. The nominated individual explained staff engaged with GPs, district nurses, the local authority and other local services. Care plans indicated which health and social care services were involved in supporting people.

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.
The provider did not always complete quality assurance checks which were robust enough to identify possible areas of improvement. Following an incident, accident or safeguarding concern, areas for possible improvement to reduce future risks were not always identified. Care plans and risk assessments were not always updated and any lessons learned were not always shared with staff.
Staff completed training courses to help them keep up to date with best practice. The provider undertook an annual survey with service users to obtain their feedback on the care received.