Amber Home Carers Surrey

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 the 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.

The values and shared direction of the service were not clearly defined. Whilst staff told us they were committed to their roles, they were unable to share the values of the organisation or how this was promoted through their work. The registered manager told us they aimed to ensure consistency and quality of care for people throughout the service. However, we found these principles were not embedded into practice. Whilst people told us they received periodic calls from the management team, people’s views were not collated to ensure they influenced the direction of the service.

Staff told us they felt they were able to work as a team and were respected by the registered manager and office support staff. They spoke about the people they supported in a respectful way and told us they wanted to develop in their roles.

Following the inspection the provider told us they had implemented additional systems to further embed the values of the service and ensure staff were aware of the aims of the organisation.

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 and experience to lead effectively.

There was a lack of role clarity and support for the registered manager within the management team. The Nominated Individual had been unavoidably absent from the service for several months. During this period, there had been a lack of support, supervision and oversight of the service. The registered manager had been employed by Amber Carers Ltd for a number of years although had only recently taken responsibility for the management of the domiciliary care side of the service. The provider had not implemented any additional processes to provide structured support, managerial oversight and supervision to help them develop in their role. This had resulted in systems to monitor the service and to address concerns not being fully embedded.

The registered manager showed an eagerness to review shortfalls discussed during the inspection and gave assurances these would be addressed. They were clear they wished to continue to develop in their role and to support skills development within the staff team.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The service had a whistleblowing policy in place for staff to refer to if they required guidance on speaking up. Staff told us they would not hesitate in reporting any concerns or issues to the registered manager and felt their views would be listened to.

Regular staff meetings were held where staff could discuss the support they provided. Minutes reflected people’s individual needs were discussed and guidance shared in areas such as people’s mobility and changes to call times. Staff were able to raise their views, and these were taken into account when reaching decisions.

The provider did not always value diversity in their workforce. They did not always strive towards an inclusive and fair culture by promoting equality and equity for their employees. Staff told us they felt they were treated equally and that the management listened to requests for personal support. One staff member told us, “They are very good to work for and are interested in the welfare of the staff. They have helped me, and I have learnt a lot.”

Despite the positive feedback from staff, we found the provider had not implemented effective systems to provide staff with additional support, despite identifying this as a need. The provider informed us that they had identified gaps in staff knowledge when supporting individuals due to their cultural experiences with care services. However, they had not implemented effective training or mentoring to support staff with these specific needs, putting both staff and the people they were supporting at risk of harm.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Quality assurance systems were not always effective in identifying shortfalls in the service and the support people received. Audit systems to review people’s care plans, risk assessments and daily care notes were not completed on a regular basis. This meant the concerns we identified in relation to the lack of guidance, consistency and monitoring had not been identified. The monitoring of the timings of care calls was not robust and whilst some improvements had been noted, further work was required to ensure people consistently received their support at the correct time and in line with their needs. Audits had not identified shortfalls in the timeliness of completing recruitment checks.

The provider and registered manager had not always complied with their regulatory responsibilities. Registered providers must inform CQC of specific incidents so that we can monitor risk and protect people. However, the provider had not notified CQC of the prolonged absence of the Nominated Individual. Whilst the registered manager had made efforts to inform CQC of significant events, they had not always used the correct process which had led to delays in this information being received and processed.

Concerns regarding the governance of the service were mitigated to a degree due to the registered manager’s knowledge of people’s needs and their staff team. However, a more systematic approach to management oversight was needed to minimise the risks to people’s safety and ensure the quality of the service could be sustained.

Following the assessment the provider informed us changes to governance systems and the monitoring of the service were being implemented.

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.

The local authority had raised concerns regarding how rotas were established and how staff were utilised across the provider’s domiciliary care service and their supported living service. They had requested clarification regarding how staff hours were split between the two sides of the service. Whilst the provider had made efforts to comply with this request, the local authority felt additional work was needed to ensure complete transparency.

In other areas we found the service worked well with partner agencies and had developed positive relationships. In addition to local health and social care professionals, the service worked with food banks, the local council environmental health service and voluntary groups to help supplement the support people received.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. Whilst individual complaints, accidents and incidents were reviewed and acted upon, there was no central monitoring process in place to identify trends and themes. In addition, where concerns had been identified through spot checks and the analysis of staff call times these were not always addressed and acted upon to minimise the risk of them happening again.

The lack of robust quality assurance processes meant the service had not developed action plans to address shortfalls in the service and assess the effectiveness of measures taken when issues had been identified. The registered manager demonstrated a willingness to implement strategies to learn, embed improvements into practice and drive positive change.