Complete Home Care Sussex Ltd

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 inspection we rated this key question good. At this assessment the rating has remained 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 provider’s strategy had a strong focus on providing person centred care and staff demonstrated a clear understanding of this. People and their families described a reliable service with staff who knew them well and understood their needs. A person told us, “They are very good. I was thinking of going into a care home but having the carers helped me to stay at home.” A relative said, “The set up is very good. They (care staff) write in the book and update on the phones. New carers know what they are doing, they have notes. It just flows, consistency is what we get all the time.” Staff told us they were able to work flexibly to ensure people’s needs and preferences were met.

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.

Staff told us the managers were approachable and supportive. One staff member said, “I feel very well supported in my role. I have three monthly support checks and supervisions.” Another staff member told us, “The managers deal with everything, I never have a problem because they are keeping things up to date which means we always know what’s going on.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they were able to raise any concerns openly and they felt confident their views would be considered and acted upon. One staff member said, “We can absolutely speak up, our views are encouraged.” They described how they had concerns about a manual handling procedure and asked a manger to review the way care was being provided. They told us, “I called the office to explain. They always support our judgement and came out to assess the situation.” Another staff member explained how they had identified some potential risks, they said, “When I told the manager they acted straight away and came out to do a risk assessment.”

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.

Staff spoke positively about the supportive culture and described feeling respected and supported in their roles.

One staff member gave an example of having adjustments made when they had suffered a back injury. They told us, “When I came back to work, they arranged light duties and that helped a lot.” Another staff member said, “I had health issues, the managers were all supportive and understanding.”

A manager described how they had dealt with an incident of racial abuse, they said, “We have a policy of zero tolerance to any form of racial abuse towards our staff.” They explained the actions they had taken to support the staff member and to ensure there were no further incidents.

The provider used effective and proactive ways to engage with and involve staff, including having small group meetings to support staff to be included and to encourage engagement. One staff member said, “It’s easier to speak up when there’s a smaller group.”

The provider did not always have clear systems of accountability or good governance.

Some management systems were not robust. There was a heavy reliance on verbal communication which meant there was a risk that some information could be lost or not acted upon. Managers took immediate actions to introduce a new system for communication so the provider could be assured all information was acted upon and recorded.

Systems did not always support good governance and oversight of quality. For example, incidents were recorded individually and dealt with when they happened. This did not provide oversight of incidents and there was a lack of analysis to identify patterns or trends.

Some audits were not effective in identifying shortfalls. Medicine Administration Record (MAR) charts were completed on the provider’s electronic monitoring system and an audit report was analysed a week after the medication was administered. This meant there was a potential delay in identifying any discrepancies with these records. A staff member responsible for analysing the audit said care staff would inform the office staff of any medicine issues when they happened. However, we noted that this had not happened for one person. The manager took immediate action to introduce a more regular MAR chart audit so the provider could be assured that shortfalls or discrepancies would be identified quickly.

Staff understood their roles and responsibilities. Managers monitored the quality of the service and staff performance with regular support visits.

There were contingency plans in place for emergencies. This included a system to identify people for whom the service was critical. This meant the provider could be assured staff would know which visits to prioritise in an emergency situation.

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.

Staff described positive working relationships with other agencies. One staff member described how joint visits had been arranged with district nurses for some people and with hospice staff for people receiving end of life care at home. Another staff member explained how they supported a person with physiotherapy following instructions from the physiotherapist when the person came home from hospital. Records confirmed how staff were trained with an occupational therapist when equipment was put in place for a person with mobility needs.

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.

The provider was committed to continuous learning and supported staff with professional development. One staff member said, “I am starting a level 3 qualification, the company have paid and I get 8 hours to do the work.”

People and their relatives spoke highly of the staff and described them as skilled and professional in their approach. One relative said, “They are very professional, they give advice and share their expertise always.”