Premier Care - Halton Branch

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
The service was in breach of legal regulation in relation to governance.
 

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 mostly had a shared vision, strategy and culture. We did see 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. Staff were able to describe the provider's values and most staff feedback indicated they felt part of a supportive team. Relatives told us they felt listened to when concerns were raised and that managers generally acted to address issues. A relative told us, "We'll be there with you on this journey, let's take it one step at a time," describing the support provided by managers during difficult periods.
However, issues identified through care record reviews and governance systems demonstrated that the provider's stated values and expectations were not consistently reflected in practice. Records did not always provide clear guidance for staff. These issues meant the provider could not always demonstrate that its culture and values were embedded consistently across the service.
 

The provider mostly demonstrated inclusive leadership and understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders mostly had the skills, knowledge, experience and credibility to lead effectively.
People and relatives largely spoke positively about managers and described them as approachable and responsive when concerns were raised. Staff feedback was also mostly positive, with several staff members describing managers as supportive, open and willing to act on concerns.
We found, however, leaders had not always identified or addressed weaknesses in care planning, risk assessments, daily notes, and record keeping. Although leaders had implemented improvement plans and undertaken audits, some -shortfalls identified previously continued to occur. This showed leaders were committed to improvement but had not always been effective in ensuring improvements were embedded and sustained.
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.
The provider had policies and procedures in place which promoted speaking up and protected staff from disadvantage when raising concerns. Most staff feedback was positive, with them telling us they felt able to discuss concerns with managers and office staff. People and relatives also described managers as responsive when concerns or complaints were raised. Records showed complaints and incidents were investigated, actions were taken and learning was identified to reduce the risk of recurrence. Overall, people, relatives and staff were able to raise concerns and there was evidence leaders listened and responded appropriately.
 

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.
Staff generally spoke positively about their experiences of working for the service and described supportive working relationships. Leaders recognised the importance of inclusive recruitment practices and had introduced measures to support diversity within the workforce. The provider also had systems to support staff wellbeing and to enable staff to raise concerns where they felt they had been treated unfairly. While some staff feedback suggested experiences of management support were not always consistent, there was no evidence of a closed culture or widespread concerns relating to discrimination or unequal treatment.
 

The provider did have clear responsibilities, roles, systems of accountability and good governance in some areas, however this required improvement to ensure they acted on the best information about risk, performance and outcomes.

While governance systems had identified some shortfalls, including contradictory information within care plans, they had not been sufficiently effective in ensuring concerns were addressed promptly. We found ongoing recording and documentation issues during the inspection, which had the potential to impact the safety and wellbeing of people with increased risks, including those related to pressure care, nutrition and hydration. Although the provider was taking steps to make improvements and had provided assurances that actions had commenced, governance arrangements had not yet achieved sustained improvement. Further work was needed to ensure robust oversight and effective quality assurance processes were embedded across the service.

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.

People and relatives described positive outcomes achieved through joint working, including improvements in skin integrity, rehabilitation following hospital discharge and support to remain living independently at home. The provider also demonstrated involvement in community initiatives and charitable fundraising activities, including support for Alzheimer's Society, Dementia UK and the British Heart Foundation. These activities promoted community engagement and inclusion for people using the service and staff.

The provide was mostly focused on continuous learning, innovation and improvement across the organisation and local system. They mostly encouraged creative ways of delivering equality of experience, outcome and quality of life for people.
Leaders had developed improvement plans in response to audit findings and had completed significant work to address concerns identified through internal quality assurance processes. Staff understood the importance of reporting incidents and there was evidence of learning being identified following accidents, safeguarding concerns, complaints and medication incidents.
However, the quality of learning recorded varied and did not always demonstrate clear root-cause analysis, action owners, timescales or evidence that improvements had been embedded. Several shortfalls identified through previous audits remained evident at the time of our assessment, particularly in relation to care planning, governance oversight and record keeping. While the provider demonstrated a commitment to improvement, learning was not always translated into sustainable change. Overall, systems supported learning and improvement, but opportunities remained to strengthen oversight and ensure improvements were maintained.