KMX Nursing Agency

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 good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 had a shared vision, strategy and culture. 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. The management team ensured staff understood the challenges of people they supported. Following incidents staff were included in de-brief sessions to discuss what went wrong and what could be done differently. Staff attended group meetings to discuss the service and provide suggestions. Focussed meetings were held with people’s care staff team; we reviewed minutes which documented a person’s individual circumstances including conditions of their DoLS authorisation and how staff were to support them. A staff member spoke about meetings and told us, “We are routinely encouraged to share ideas in team meetings, reflective practice, bite size trainings where our leaders are open to suggestions and staff opinions to improve patient care. Staff are supported with updating trainings, and are provided with reflection time, enabling us to be more adaptable to new and better ways of practice.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The management team included 2 registered managers and a clinical lead, all of whom were registered nurses including in mental health. They were supported by an office team and team leaders. Although the service does not provide nursing or clinical care the registered manager told us having a clinical lead provided a link between professionals and staff to help to quickly identify concerns, escalate them and ensure staff understood instructions. Staff and relatives spoke positively of the registered managers, their comments included, “I do keep in touch with the bosses regularly, [registered manager] is supposed to come here at some stage and see [person].” And, “I feel the leadership team is knowledgeable and experienced. They understand care work from the ground up and provide strong guidance. They are approachable, well-organised, and always open todiscussing concerns. It gives staff confidence in their decisions and direction.” Professionals all gave positive feedback about the management team. One said, “Yes, the service is well-led, with [registered manager] providing warm and responsive leadership. The team takes a person-centred approach and genuinely seems to care about the individuals they support. Their responsiveness to our service’s needs has been consistently appreciated.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff and people were given opportunities to speak up, the registered managers had an open door policy and sometimes worked alongside staff and people. Staff received regular supervisions which enabled them to speak up in confidence. There was a freedom to speak up guardian and a policy for staff to follow if they were not comfortable to speak with the registered managers. A staff member said, “Where no satisfactory action is taken I would escalate by way of whistleblowing.”

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. The workforce included a diverse range of backgrounds; their cultures were respected by the management team. Staff’s protected characteristics were considered when scheduling rotas, for example, where staff had childcare responsibilities or wished to have time off to visit family. A staff member told us about challenges they faced in their home life and said, “This flexibility has had a positive impact on my wellbeing, and I appreciate the understanding and consideration shown by management. The working pattern suits me well, and any adjustments I’ve requested have been met with support, even though in the beginning it wasn’t easy.” The registered manager told us when staff arrived from overseas they would match them with a buddy to help them adjust to life in the UK. If needed, staff were offered additional language courses to help them learn and adapt. The management team engaged with occupational health for staff who required reasonable adjustments.

The provider mostly had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. Routine audits were completed for areas, such as, medicine management, these were effective and identified where improvements were needed. The management team told us they read through people’s support plans and updated them when required. However, we highlighted 2 occasions where associated documents were not aligned with care records, there was no formal auditing tool for this to be internally identified. We discussed this with the management team who advised they will adapt a care planning auditing tool and undertake continual reviews of all records. The management team used spot checks to ensure the service delivery was of a good standard. Spot checks examined care delivery, documentation, staff understanding and was an opportunity to receive direct feedback from people. The management team understood their responsibilities under the duty of candour to be open and transparent when things went wrong. The registered manager told us, “We don’t sweep anything under the carpet.”

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. The management team provided multiple examples of where they had worked in collaboration to provide positive outcomes for people. These included liaising with psychiatrists, GPs, the learning disability nursing team and occupational therapists. Professionals provided positive feedback about working with the service. Some comments included, “KMX has always conducted themselves with respect towards both service users and professionals. They value transparency and treat everyone with dignity and care.” And, “KMX has been able to deliver a good service to my client by meeting their overall needs and detecting issues or concerns that require escalation to other professionals within the multidisciplinary team (MDT). KMX managers offer supervision and reflection to staff following incidents of challenging behaviour and they always ensure that support workers are aware of the actions agreed in MDT meetings.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research. The registered manager told us how learning and improving was also identified through feedback or incidents. They implemented a new handover system which allowed ‘real time communication’ for a person whose needs changed frequently, this allowed staff to safely respond to their changing needs. The management team identified themes of complaints was in respect of staff time keeping, they responded to this by changing their monitoring system. A member of the management team told us, “The staff use an app that tracks their geographic travels. We can tell immediately on the system whether an employee is late or leaves early. We have made major advances in this area.” A staff member said, “One key area that I have improved on after clients feedback is my time keeping. I have become more aware of the need to be punctual for client calls as my lateness can impact the client and family plans such as leaving the house for work which would not happen until I can take over the support of the client.”We received positive feedback from people’s relatives about the timekeeping of staff.