Choices Homecare (Rotherham North & Doncaster)

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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 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 good governance.

This service scored 50 (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. We received mixed feedback from people, relatives and staff about the care and culture. Some people told us their care was inconsistent. A relative said, “Recently a new carer did not know my relative so struggled. Sometimes [name] do not understand staff. [Name] does not feel comfortable with some of the new carers. The continuity is not great. It is better having carers that know their needs. I have addressed this to the company. They said they are down in staff. They are not as attentive. They [staff] do not arrive on time.”

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. The service had recent changes within the management team, and we received mixed feedback from staff about them feeling supported and listened to. A staff member said, “The new manager is approachable, very down to earth.” Whilst another staff member said, “Not enough staff, we are rushing between calls. We always have extras on, but it doesn't work. There is no communication at all. I haven't had any supervisions; I have a little bit of training.” The new manager had recognised some shortfalls within the service and had introduced a service development plan. However, this required implementing and embedding into practice. The senior leadership team had failed to recognise, or act on concerns we found during our assessment. We received mixed feedback from people and relatives about the service being well led. One person said, “They are absolutely brilliant.” Whilst another person said, “I am thinking about changing care companies.”

People did not always feel they could speak up and that their voice would be heard. Staff meetings were not always undertaken and some staff told us these were required more often to enable effective communication. The manager had recently introduced staff meetings and plans were in place for regular meetings. Whistleblowing procedures were in place and staff felt able to raise concerns, some staff said they did not feel listened to and described poor communication. This indicated weaknesses in staff engagement and culture.

The provider had not consistently demonstrated a commitment to fostering an inclusive and fair culture for its workforce. Although staff were offered opportunities to provide feedback, these had not been undertaken recently and existing feedback had not led to effective improvement. Staff surveys showed ongoing concerns about communication and recognition. Feedback from staff was mixed about feeling included or listened to. No staff told us they had experienced discrimination.

The provider did not always 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. Whilst auditing systems were in place these required strengthening to ensure they were robust and recognised concerns we found during our assessment. We found some gaps in monthly audits and current systems in place audited a snapshot of people's records. Audits had either failed to recognise or had not actioned concerns we found in relation to care records, medicines management, accident and incident monitoring, staff supervisions, staff training, and staff allocations and call times.

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. We received mixed feedback from partners who worked with the service. The local authority had completed a contract monitoring visit and told us there were some improvements required. A professional told us the management team had failed to complete information they required within the allocated time frame and the management changes had impacted the service negatively. A professional told us, “Improvements are required to meet contractual obligations.”

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 service had a period of time without a registered manager. However, a new manager had recently been employed and had recognised some of the concerns we identified. They put a service development plan in place, which they were working through to address the issues. There were clear timescales for completion, however actions required embedding.