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 Inadequate. At this assessment the rating has remained 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. Whilst the culture of the service was person-centred, the provider did not prioritise safe and high-quality care. There was no evidence of regular or effective engagement with staff to ensure they understood or upheld the service’s purpose and values. The provider was unable to monitor staff practice against their values as these were unclear. Staff reported mixed experiences of support and engagement with the provider, with limited opportunities to contribute to service development or quality improvement.

Leadership at the service remained ineffective in ensuring compliance with regulatory responsibilities. As found at the last inspection, systems in place to assess, monitor, or improve the quality and safety of the service remained ineffective, resulting in significant gaps in oversight. While policies and procedures were in place, they were not consistently followed by leaders. The provider has been unable to proactively identify the shortfalls found at the last inspection and this inspection and continues to be reliant upon external consultants and CQC inspections to identify areas for improvement.

As found at the last inspection, staff told us they felt confident to raise concerns, but they did not always feel their views were acknowledged or listened to. Although a group messaging platform existed, staff had few meaningful opportunities to share ideas or offer feedback. The provider did not hold regular team meetings, and supervision was inconsistent, further reducing chances for open communication. While leaders were receptive to feedback during the inspection, there was limited evidence of a proactive approach to creating a culture where staff felt listened to and their input acted upon. A staff member said, “Sometimes [the provider] needs to be a bit more honest with us. Give us (staff) more information.”

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. Staff continued to report they did not always feel they were treated as equals. A conflict of interest existed between the provider and some staff which influenced how other staff experienced fairness and inclusion. Some staff reported feeling that this relationship affected decision making and created an inequitable working environment.

As found at the last inspection, the provider did not have clear responsibilities, roles, systems of accountability and good governance. The provider continued to lack effective leadership and failed to implement robust systems to assess, monitor and improve the quality and safety of the service. Required improvements found at the previous inspection were still outstanding, leaving people at continued risk of harm. Care planning systems remained inconsistent, with care plans and risk assessments frequently out of date, lacking essential detail, and failing to reflect significant changes in needs despite external reviews identifying required improvements. Medication governance was unsafe, with no evidence of regular or effective MAR audits, persistent recording errors and missing ‘as and when’ (PRN) medicine protocols. There were multiple examples of discrepancies between a hospital discharge summary and MAR charts that the provider had failed to identify. Oversight of record keeping was insufficient, with repeated missed care entries, including those allocated to the provider themselves, and no evidence that learning from audits had been implemented or embedded. Collectively, these failings demonstrate a persistent absence of effective governance and managerial oversight, resulting in sustained and widespread risks to people’s health, safety and wellbeing.

There was limited evidence to show the service had established connections and professional relationships with external organisations or the wider community. As a small home care agency, informal contact took place with health and social care professionals when required. The provider did not have regular involvement in local community initiatives or collaborative working that supported people’s wellbeing beyond their immediate care needs. Opportunities to strengthen links with local networks had not yet been fully explored.

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