Expectation Care Limited

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 54 (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.
There was a lack of evidence to show there was a focus on learning and improvement. The provider had not independently identified and acted in relation to the concerns we found during our assessment.
However, staff felt there was there a culture of collaboration, where they were listened to and communicated with.

Following our feedback the service identified their own learning and development needs and made plans to address these.
 

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 lead with integrity, openness and honesty.
When leaders were alerted to examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff, they did not evidence that they had addressed this. For example, when staff shared concerns during meetings and supervisions about the people they supported. Meeting minutes contained out of date and inaccurate information recorded in error.

However, meetings did address values, work ethics and respect with staff and managers shared feedback from people.
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.
People and staff told us that leaders were open to feedback, and staff felt supported to speak up.
Staff told us management were responsive and supportive and readily available if they reached out.
Staff told us they had regular supervisions and meetings where they could speak up and raise any concerns.
However, as previously stated there was a lack of clear evidence that complaints were responded to, appropriate referrals were made and lessons learnt were shared with staff.
 

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.
Leaders promoted people’s equal rights and ensured there was no workforce inequalities.
The provider had signed up with a service to provide confidential counselling for all staff. In meetings staff were thanked for all their hard work and asked if there were any questions for managers.
Workers recruited from overseas told us they felt valued and supported.
 

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.
Audits and spot checks were unclear and not effective. Audits did not identify the concerns we identified in meeting minutes, incident forms, daily records, medication administration records and care plans. When concerns were identified in audits, no further information, actions or follow up was recorded relating to these findings.
Staff had not been assessed as competent in the care they carried out for people for example when administering complex medication.
Some documentation was incomplete, inaccurate or had not been updated for a period over 12 months. For example, information recorded on meeting minutes did not match records held and included discussions held over 12 months before.
Some incidents and actions discussed with the registered manager had not been recorded.
However, the provider was committed to making improvements and was introducing new systems and processes.
 

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.
For example, appropriate referrals had not always been made to external health and social care professionals where this was required for people. Better collaboration was required with health and social care in relation to safeguarding concerns, training for staff and ensuring people had the right equipment in place.
However, staff supported people to integrate within their community by supporting them to local places and providing flexible care so people could attend groups.

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.
Following a safeguarding enquiry the provider completed an action plan detailing how they were going to make improvements to the care provided. However, we could not see evidence that these actions had been started or completed or were planned. This included weekly care audits, staff performance management and training completion.
However, the provider was committed to embedding better systems.
The registered manager also shared their plans to take the initiative to improve their practice by joining a learning and development management support group and attend workshops.