Because We Care Northampton

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 continued breach of legal regulation in relation to governance at the service. 

This service scored 36 (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. Although the provider’s statement of purpose outlined aims such as supporting individual choice, personal decision-making, and recognising the need for personal fulfilment, these aims were not effectively embedded in practice. There was a poor understanding and inconsistent application of the Mental Capacity Act 2005, and planning around people’s goals and aspirations was not always considered, as highlighted earlier in the report. Furthermore, there was limited evidence of regular or effective engagement with staff to ensure they understood or upheld the service’s purpose and values.

Leadership at the service was ineffective in ensuring compliance with regulatory responsibilities. The provider and registered manager failed to meet their obligations and did not offer sufficient support to the director, who had been acting as the manager, to ensure these duties were fulfilled. There was no established or effective system in place to assess, monitor, or improve the quality and safety of the service, resulting in significant gaps in oversight. While policies and procedures were in place, they were not consistently followed by leaders. Staff said, “[Registered manager] used to have involvement. I don’t hear from her,” and “[Registered manager] has taken a back seat. She doesn’t get involved in much anymore.” In response to the shortfalls identified during this inspection, the provider engaged an external consultancy company to provide immediate support, highlighting the lack of leadership capability in making the improvements required.

Staff told us they felt confident to speak up, however, they did not always feel listened to. Although a group messaging system was available, staff had limited opportunities to share ideas and feedback in a meaningful way. The provider did not facilitate regular team meetings, and staff did not receive consistent supervision, which further limited structured opportunities for open dialogue. While leaders were open to feedback during the inspection, there was little evidence of a proactive approach to fostering a culture where staff felt their voices were heard and acted upon.

The provider did not always value and work towards an inclusive and fair culture by improving equality and equity for people who worked for them. For example, staff were being paid on different days based on their individual circumstances, which demonstrated a lack of fairness and did not promote equality across the workforce. A staff member questioned, “Why does [staff member] get paid 2 days before me?”

The provider did not have clear responsibilities, roles, systems of accountability and good governance. There was no established process to audit daily logs, which meant important changes in people’s needs and risks were not identified or acted upon. Care plans were reviewed annually but failed to ensure they accurately reflected people’s needs, preferences and risks. In addition, there was no system in place to investigate missing signatures on MAR to ensure people received their medicines as prescribed. An investigation carried out by the acting manager at the request of the inspector found that a person had missed doses of medicines and that staff required further training, which had not been previously identified or acted upon. Where audits or investigations were carried out by the acting manager, prompted by the inspection, Artificial Intelligence (AI) had been used to generate auditing templates and reports. This practice raised concerns about reliability and data privacy, as the use of confidential care records with AI had not been risk-assessed. This lack of robust governance and failure to implement sustainable systems did not ensure people received ensure safe, high-quality care and increased risk of harm.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. However, they did not always share information and learning with partners or collaborate for improvement. Where partners had identified areas for improvement which had been shared with the provider, these were not acted upon to ensure that improvements were implemented and sustained. For example, the local authority conducted a visit at the service in 2022 and highlighted improvements needed including updating care plans and gaps in compliance. Our findings at this inspection showed action had not been taken to effectively address and sustain these identified areas for improvement. This limited the effectiveness of partnership working and hindered opportunities for shared learning and continuous improvement.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. Processes were not in place to ensure that learning happened when things go wrong. The provider had not taken effective action to address the concerns raised at the previous inspection, showing a lack of commitment to continuous improvement. Leaders had not engaged with local forums or groups to share ideas and learning.