Hales Group Limited - Norfolk

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.

This service scored 25 (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. Poor oversight and governance did not assure us that there was a shared vision, strategy or positive culture within this service. Staff reported working in isolation with little opportunity to meet, to share idea, to embed good practice or to gain support when they faced difficulties. Some staff told us management were unavailable and could be rude and unsupportive. For example, 1 member of staff said, “On call-its atrocious. I rang them at 6am and I didn't get a response back until 6.35am. Evening on call is very poor.” Staff told us there was divisions within the team and they chose who they felt they could go to. Staff also told us they did not get regular supervisions or appraisals. Staff spoke about being confronted and not supported in their role. Several staff told us they could have long travel times to work, with little or no travel time between visits and this made their days long. Staff told us this is affecting their well-being and family life.

Staff who had left the organisation told us the reasons for them leaving is because they felt undervalued and unable to continue in such a demanding role. Communication across the organisation was poor and we were unable to see how information of importance was effectively communicated due to fragmentation in the teams. A reliance on electronic communication required staff opening their apps and reading important information which we could see they did not always do. People using the service and their families felt their views were not heard and the service was not based around their needs. The management team had become recently aware of the challenges within the culture of the service and were starting to address some of the issues. We have assurances following the assessment and an action and service improvement plan was put in place. The new manager told us they would be making an application to register with the CQC, as required. The provider also agreed not to take on any people’s care until they were able to effectively deliver a safe service for people they already supported. However, since these assurances were provided, we have received continued concerns about the delivery of care. The service is continuing to investigate these concerns.

The provider did not have a proactive and positive culture of safety based on openness and honesty. Staff did not listen to concerns about safety and did not always investigate and report safety events. Lessons were not learnt to continually identify and embed good practice.

Daily risk meetings and handover minutes from 1 on call person to another were viewed but did not always show what actions had been taken to manage risk or who should follow things up. Lessons learnt from incidents were not robust as communication across the staff team was poor and management staff were stretched. Provider audits identified actions but did not always show how these actions had been followed up particularly when staff needed support and retraining. We identified that medicine audits were carried out on a small representative sample which did not enable the provider to identify themes or patterns or look at records in line with call scheduling to determine levels of risk such as time critical medicines. For example, medication audits completed in January 2025 covered medications administered in August, September, October and November 2024 . This was not in line with the service’s own policy which outlined medication audits were to be completed monthly. This meant errors were not identified in a timely manner.

Auditing and quality assurances that were in place were ineffective in driving improvement or reducing risk within the service to ensure the safety of people.

Staff reported working without support and sometimes made multiple attempts to escalate concerns or report changes to people’s needs with no clear response from management or improvement noted.

People and staff did not feel they could speak up and that their voice would be heard. Systems in place to seek and act on feedback were not fully embedded which would enable people and staff to formally be consulted about the service they received and improvements they would like made.

Relatives, staff and people using the service expressed concern about communication and how the provider acted on their feedback. They said when they did raise concerns these were not always addressed or resolved or agreed actions maintained. Staff felt not everyone in the management team were relatable and they preferred to communicate with some staff rather than others and did not feel all staff acted in a professional manner. Areas of the business such as staff appraisal, supervision and spot checks were not completed regularly or thoroughly meaning concerns were not being addressed in a timely, systematic way.

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

There were clear challenges and divisions within the work force and a lack of trust amongst staff and leaders. Staff expressed feeling unfairly treated and not having a good work life balance. We noted that staff working long hours could comprise their health and safety, as well as placing people at risk of receiving poor quality care from tired staff more prone to errors. The electronic monitoring systems did not enable management to effectively monitor staff to ensure their wellbeing. A staff member told us, “I never really work with the same person. It’s whoever they put me with. Everyone and anyone. It's not consistent. Some staff communicate and others not so much.”

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.

Prior to our assessment we identified areas of risk for this provider and received information of concern from the local authority. During our assessment we identified 5 breaches of regulation and found the provider did not have a robust system of governance or an effective management team. Work force planning was particularly poor with care calls being missed, running late or not being delivered within the agreed times. Staff reported being overloaded and rushing between calls whilst people using the service felt their needs were not being met and they were not consulted about their care. Care staff told us they were tired, 1 said, “It is the managers responsibility to cover and not mine and they need to prioritise my wellbeing as I feel my day is too long they need to decline some visits and ask them to be covered.” 

We found records systems to be poor and care plans and risk assessments did not reflect people’s needs accurately. Risks of avoidable harm were increased by poor planning and ineffective dissemination of information across the organisation. For example, we noted medicines not being administered consistently in line with the prescribers’ instructions. We found call times impacted on people’s care and left people either with calls delivered close together or people waiting a long time for their call. This meant that people did not get their personal care, medicines, meals or assistance up and to bed and an appropriate time. On call arrangements were ineffective as additional care hours needed to be covered taking office staff away from their core duties. We found handover records from the on call ineffective as actions and follow up were not always recorded and daily handovers were not always occurring and meant dissemination of information was poor. Timely action had not been taken to address and reduce the risks to people particularly when complaints had been received, we were unable to see effective actions to ensure peoples safety and continuity of care.

The provider did not understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

Whilst we received some positive feedback from health professionals, the information supplied by stakeholders was mostly negative and did not reflect a service where people received joined up care. Whilst care plans and risk assessments were in place, some people and relatives were unable to recall being asked to contribute to the development of the care plan. Staff reported changes to people’s needs were escalated but it remained difficult to get through to anyone or be told what actions had been taken. A staff member told us, “We are asking for reassessments on certain clients and this isn't getting done.” Without robust information governance and effective audits, it was difficult to see how the provider could work collaboratively with other partners in health and social care. Examples of this included call data and the provider being unaware of calls simultaneously being logged into at the same time or cut extensively which would impact on people’s care. The provider could not judge if the person was receiving the right amount of care for their needs if call cutting was a daily feature of that person’s care. In addition, staff told us that there were lots of miscommunications including information about hospital discharges and staff not always being advised who was in hospital or if they had been discharged and not always having the right information to deliver the care safely such as medication administration sheets. This could result in missed or incorrect care.

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 always actively contribute to safe, effective practice and research. The service’s history showed there was a lack of continuous learning, innovation and improvement across the organisation with repeated requires improvement CQC ratings. We found similar themes being raised repeatedly, particularly around people’s care experience and call scheduling. The provider did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. At the time of our assessment, the manager told us they were working towards addressing immediate concerns, but this would take some time to implement. Whilst addressing concerns the provider was also looking to grow the business without being able to deliver an effective service to people who were already receiving a regulated activity. This did not reflect a learning culture.