Northumberland Mid & North Domiciliary Care 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 outstanding. 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 86 (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 an exceptionally strong and well-embedded culture that placed people, their rights and their aspirations at the heart of everything they did. Leaders, managers and staff shared a clear vision based on inclusion, equality, dignity, choice and independence. This culture was consistently evident throughout the assessment and was reflected in the experiences of people, the feedback from professionals and the actions of staff at every level of the organisation.
The person-centred values described throughout this report were embedded across the service. Staff shared a common commitment to enabling people to live meaningful lives and achieve outcomes that mattered to them. Healthcare professionals consistently recognised this approach, with one describing the service as having, "a culture of enabling." This was evident in the way staff balanced safety and independence, supporting people to take positive risks, develop new skills, maintain relationships and remain active within their communities.
There was a culture of openness, learning and continuous improvement. Managers and staff regularly reflected on accidents, incidents and safety concerns to identify learning and improve practice. Lessons learnt were shared across the provider's wider services to support positive outcomes for more people. Electronic care records facilitated effective communication between staff and managers, helping to ensure information was shared promptly and people received consistent and coordinated support.
Staff worked proactively with health and social care professionals to maintain safe systems of care and ensure continuity of support. Professionals spoke highly of the service, and we saw evidence of effective partnership working to meet people's changing needs. Staff also advocated strongly on behalf of people, including working with housing providers to ensure people lived in environments that met their needs and supported their wellbeing.
Staff were proud of the support they provided and understood the difference they made to people's lives. One staff member said, "We must be getting something right, or the staff team wouldn't stay. We must be getting it right for the people we support." This reflected the stable, committed workforce and the positive culture we found throughout the service.
The provider had created a culture where people were listened to, staff were empowered, learning was embraced and everyone worked towards the shared goal of helping people live safe, fulfilling and independent lives. This strong and consistent culture underpinned the positive outcomes experienced by people using the service.
 

The provider had exceptionally 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 always did so with integrity, openness and honesty.
The registered manager and service managers demonstrated compassionate, confident and highly effective leadership. They had created a positive culture where people, staff and professionals felt valued, listened to and empowered. Leaders were constantly visible within the services, celebrated achievements with people and staff, and ensured the provider's values of choice, independence and inclusion were embedded throughout the service.
There was a strong culture of openness, learning and continuous improvement. Managers regularly reviewed incidents and shared learning across the organisation, while effective communication systems ensured people received safe, consistent and responsive support. Staff were empowered to make decisions in people's best interests whilst receiving strong oversight and support from the management team.
Leaders maintained a strong presence across the service and were genuinely connected to the people they supported. Service managers regularly visited people, including undertaking unannounced visits, to seek feedback, observe care and ensure support continued to reflect people's wishes and needs. People looked forward to these visits and spoke openly with managers, demonstrating the trusting relationships that had been developed. By listening carefully to people and acting on what they heard, leaders ensured people's experiences directly influenced how the service operated.
Staff spoke highly of the leadership they received. One staff member said, "I've always felt supported by my manager, she knows her job inside out and this helps me during challenging times, or if something new arises. [The service manager] is aware of my [disability] and always helps me when needed." A healthcare professional told us, "[The service manager] is very accessible, responsive, and proactive when issues arise."
The strength of leadership was reflected in the positive, enabling culture found throughout the service, where staff were motivated to achieve the best possible outcomes for people.

The provider was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.
The provider had created a strong and open culture where people, relatives and staff were actively encouraged to share feedback, raise concerns and influence how the service was delivered. Staff consistently told us they felt listened to, valued and confident that any issues they raised would be acted upon. This culture of openness was supported by visible and approachable leaders who maintained regular contact with both people and staff.
One staff member told us, "My service manager is very supportive. She answers the phone if I need to contact her and she is also very hands on. She will help to cover a service if needed and it's very easy to work alongside her. She knows all her staff very well, as well as [person] and we have a good working relationship. I feel I could speak to her about any issues or concerns and would not hesitate to contact her at first opportunity."
The provider not only gathered feedback but demonstrated how it was used to improve outcomes. Following a staff survey with an excellent response rate, staff raised concerns about differences in pay rates across local authority areas. Leaders listened and took meaningful action, aligning pay to the higher rate to ensure fairness and consistency across the workforce. This demonstrated staff were confident their voices would lead to positive change.
People were equally empowered to speak up and influence decisions affecting their lives. As described elsewhere in this report, people were involved in care reviews, recruitment processes and meetings relating to their support. Leaders maintained regular contact with people through planned and unannounced visits, providing further opportunities for people to share their views and experiences. Feedback from people, relatives and professionals was consistently positive and reinforced the provider's person-centred and enabling culture.
The provider also demonstrated a commitment to learning from concerns, incidents and complaints. Managers regularly reviewed accidents, incidents and feedback, sharing learning across the organisation to improve practice and prevent recurrence. This created a culture where speaking up was valued, feedback was acted upon and continuous improvement was everyone's responsibility.
 

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.
The service had supported staff to work more effectively through several reasonable adjustments when they may have otherwise been unable to. For example, a staff member has severe dyslexia and the manager had agreed a process to ensure they could still make suitable daily notes, and supported them with reading information when required.
A staff member said, “I have never been discriminated against at work. I feel safe to carry out my role well. I [have a number of protected characteristics] and my manager is supporting me to make any reasonable adjustments to support me in my role.”
 

The provider 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.
Regular reviews of records, accidents, incidents and feedback from people and staff were in place to ensure the service was providing good quality care. The registered manager shared lessons learnt with staff and with other services belonging to the provider. The electronic care planning system supported managers with a real-time overview of people’s care each day. Meaning they could monitor people more closely and react earlier to potential problems.
Effective audits were in place to monitor various aspects of the service including medicines, care records and staff performance.
 

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.
Healthcare professionals said staff worked with them well, listening to advice and implementing it correctly. People were supported to be part of their communities.
A healthcare professional said, “Staff have been confident in working with myself as a visiting professional; they have readily asked questions and shared their perspectives and observations and have advocated for the person in terms of their known preferences, needs and independence. They have been very open to considering other options and have actively sought feedback on their support. They have been keen to share how they are meeting the person’s needs – and to check that they are doing as much as possible.”
 

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 spoke in detail about continuous improvements being made at the service, based on feedback from people, relatives and staff. The management team had advocated for people to have improvements to their homes to improve their quality of life.