Gray Healthcare

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

The clients we spoke to told us that their overall experience of the service and the managers employed to look after them and their staff team was positive. One client told us that the manager for his care often visited him, and they were a positive factor.

Staff told us that managers did visit them whilst on duty with their clients, some felt it could happen more often, but generally all comments were positive regarding managers.

Staff told us that a lot of the locality managers had been support workers in recent years, and that this promotion from within was encouraged at the service.

Commissioners we spoke to did not raise any issues relating to the standard of management, other than to be positive.

Data supplied by the service showed that in the month of December 2024 there had been 31 visits to service homes by community support managers, as well as 12 spot check visits by senior managers.

There were team meeting records for each client, with a set agenda including safeguarding (including a collaborative reading of the safeguarding plan for the client ensuring all present knew the plan), team focus (what further training or wellbeing was required), and client improvements (achievements, highlights, areas for discussion).

We saw evidence of audits being completed and presented regularly in meetings, with full discussion of salient points and actions taken to ensure that any shortfall was dealt with.

Clients we spoke to were positive about their ability and right to air opinions or grievances they may have with the service.

The freedom to speak up guardian at the service was the head of human resources (as outlined in section 5.2 of the whistleblowing policy), although some staff were not sure who it was (the policy had only recently been updated with the specific role information), and there were policies and procedures that gave staff avenues to make their voices heard.

The service issued an employee handbook, a bound publication that outlined a comprehensive package of terms and conditions of service that included all aspects of the expectations of the service and also what the employee could expect.

Commissioners we spoke to raised no concerns regarding governance, management, and sustainability, although they did raise concerns about the turnover of locality managers for their clients.

Audits were in place to monitor records, and these were discussed in regular meetings that involved staff at all levels, ensuring that information was widely disseminated.

There was a comprehensive clinical procedures policy that had been updated in October 2024, outlining the requirements for each role in the recording and action of clinical procedures. Responsibilities for each role were explained in detail.

The service had an assessment and care planning schedule that definitively laid out the care plan, health and safety and operational assessments minimal review requirements, who would conduct the review and where on the computer system could the results be found. Care records that we reviewed showed that auditing was taking place regularly.

In view of the diverse client group that were supported by the service, there was a comprehensive autism and learning disability policy. The policy outlined the training and application of good practice when supporting clients with autistic or learning disabilities.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service started a Value Awards Ceremony in 2022, aimed at celebrating the efforts of those staff who met and went beyond the core values of the service: inspire, collaborate, unique, innovate and honesty and transparency. All staff within the service were able to both nominate and be nominated for the awards.

The service had a diversity, equity and inclusion policy and procedure in place, updated in December 2024. This was guided by the Equality Act 2010, amongst other legislation, and considered diversity of staffing and skillsets within the service that was best suited to the needs of the clients served. The policy also outlined the actions to be taken should there be any considered violations or infractions of the policy.

The registered manager told us that the visions and values were maintained by robust governance and that team briefs, staff surveys, outcome reports, team meetings and other avenues existed to ensure that the values of the service were monitored and preserved.

We saw minutes of team meetings, a standard agenda included consideration of team building and supporting each other. The service had also introduced a comprehensive training package aimed at building trust and accountability in teams, aimed so “Leaders consider the importance of coaching and feedback, both positive and constructive in creating a culture of learning and continuous improvement”.

The clients we spoke to told us that their overall experience of the service and the managers employed to look after them and their staff team was positive. One client told us that the manager for his care often visited him, and that they were a positive factor. Another patient told us that if they had a problem, they knew they could go their manager for help but then stated that this never happened as they had no problems to report.

A carer told us that they felt the manager for their relative’s care was very positive, as were the rest of the team. The manager had a “can do” attitude and listened and acted accordingly.

Staff told us that managers did visit them whilst on duty with their clients, some felt it could happen more often, but generally all comments were positive regarding managers.

Staff told us that a lot of the locality managers had been support workers in recent years, and that this promotion from within was encouraged at the service.

Staff told us managers were approachable and listened to concerns and ideas related to the care of their clients. Staff told us this reflected the management opportunities for staff within the service.

We were told that there were staff surveys, one to one meetings, team meetings, an open-door policy to speak to managers, all ways in which staff could raise concerns with leaders at the service. The registered manager showed that on three occasions in December he had personally visited three people they support in one area, not just to check that clients were happy, but also to listen to staff and take on board their feelings and opinions.

Due to the nature of the service, and the wide geographical spread of the locations where clients were situated, we did not observe active involvement of clients in their homes during the assessment and interaction with team and team leaders, but comments from clients about their care teams and managers was very positive. Our interaction with the service team at the office base was very positive, team leaders and management were clearly knowledgeable about the service and were very keen to ensure that their clients received the best care possible.

Staff told us that they had visits from leaders and management, one staff member suggested that such visits could be more frequent. None of the staff interviewed had anything negative to say about their leaders and managers.

Data supplied by the service showed that in the month of December 2024 there had been 31 visits to service homes by community support managers, as well as 12 spot check visits by managers. There had also been four senior management team visits and four other visits, along with several quality assurance visits.

Staff meetings were held on a bi-monthly basis, the meeting having a set agenda, but staff were encouraged to add any other business that they wanted to discuss. Team meetings with community support managers were held on a weekly basis and were chaired by the regional head of operations or the head of operations. Meetings were planned over a 12-month period so members knew in advance when the meetings were being held and could plan schedules, accordingly, ensuring high levels of compliance.

We reviewed the minutes for the bi-monthly meeting that took place in November 2024, noting that the agenda items related to ensuring the effective running of matters relating to client and staff safety. The minutes included embedded documents making easy access to information pertinent to staff needs, including directing staff to the lone worker policy to ensure safety.

We reviewed minutes of the community support manager meetings, the most recent reviewed being for 30 January 2025. The agenda appeared quite fluid, allowing for matters of most concern to be considered and actioned. This showed that the community support managers were considerate of their team and clients. The minutes included embedded documents allowing an overview of the most recent meeting findings and actions.

There were team meeting records for each client, with a set agenda including safeguarding (including a collaborative reading of the safeguarding plan for the client ensuring all present knew the plan), team focus (what further training or well being was required), and client improvements (achievements, highlights, areas for discussion). In all, 25 areas relating to the client were discussed, a comprehensive review of the package of care and how to maintain the safe environment for both staff and client.

Feedback forms were available to staff regarding training, allowing staff to give opinions on the worth and competence of training and instruction. We looked at data from 191 forms that had been returned and summarised relating to staff consideration of training and it was noted that a very high percentage of comments were favourable and complimentary.

We saw clear evidence of audits being completed and presented regularly in meetings, with full discussion of salient points and actions taken to ensure that any shortfall was dealt with.

We reviewed outcomes regarding capable, compassionate and inclusive leaders. It was clear from the comments of clients, staff and management that the service had full confidence in the leaders at all levels within the service. Processes were in place to audit opinions and consider viewpoints of both clients and staff, and we saw evidence that these were considered and actioned.

Clients we spoke to were positive about their ability and right to air opinions or grievances they may have with the service. We saw evidence that clients, carers and commissioners were forthright in meetings, and that actions were taken to alleviate any problems that were raised. Clients told us they knew who to raise issues with, not just locally but also at the service main office, if necessary. A carer told us of an incident involving a staff member who was not appreciated by her relative and felt that the staff member’s presence could cause a problem. The carer told the community support manager of their fears and those of the client, and the staff member was moved the next day.

The freedom to speak up guardian at the service was the head of human resources (as outlined in section 5.2 of the whistleblowing policy), although some staff were not sure who it was (the policy had only recently been updated with the specific role information), and there were policies and procedures that gave staff avenues to make their voices heard. There was a whistleblowing policy, staff knew how to access it, it was available on the service intranet page as part of the service, as well as an “app” on work telephones. One staff member described the service as having a “very open culture” and felt that they could approach their manager or senior manager with any problem they had.

Staff were aware of the visions and values of the service, and a manager told us that they felt that these were applied appropriately and fairly to all clients. The manager stated the service believed in taking the approach of trying to foster and maintain the independence of each client and felt that this was considered throughout the service.

A manager told us that there was a “Have your Say” email address available to staff that allowed for whistleblowing should it be felt necessary to take such action. Another manager told us that they felt the service environment was culturally positive, and that staff were actively requested to make any problems known.

The service had a specific freedom to speak up guardian, and it was clear that there were a number of avenues and policies in place that gave staff and clients the opportunity to raise issues, either publicly or privately, or anonymously.

The service issued an employee handbook, a bound publication that outlined a comprehensive package of terms and conditions of service that included all aspects of the expectations of the service and also what the employee could expect. This included pay information, holiday entitlement, pregnancy and maternity rights, paternity leave, social media responsibilities, general rules and disciplinary procedures. It also included the grievance procedure and how to complain and public interest disclosure (whistleblowing). The whistleblowing procedures described were comprehensive and assuring, including the legal right to approach an outside statutory authority if they felt the matter too serious for in-house management.

The service had easy-read complaints guidance and forms for clients raise issues without fear of reprisal. Conversely, staff had the whistleblowing policy that was last reviewed in September 2024 and that comprehensively set out the steps to be taken by staff if they felt there was something wrong: the policy stipulated the duty of care of staff to raise awareness of issues that might be affecting clients or staff. The policy identified the difference between raising concerns and whistleblowing and outlined the steps to be taken to ensure that a fair outcome would be achieved. There was assurance that there should be no fear of reprisal for raising issues.

An audit graph of the period of 1 January 2024 to 31 December 2024 showed that there had been only 11 complaints in that period, and that all had been successfully resolved.

We assessed the outcomes of the service on the ability of staff and clients to freely speak up as positive. All people interviewed knew where to access policies or knew how to make a complaint or raise an issue. Policies and documents provided by the service clearly showed that staff and clients were advised to raise issues of concern as the service felt there was a duty of care to both employees and clients to ensure that opinions expressed were heard and acted upon. The limited number of complaints in the year prior to assessment showed that issues raised were dealt with effectively, as well as being an indicator of a good service.

The service maintained an equality, diversity and inclusion policy, updated in December 2024. The policy showed that considerations were given to all when applying this policy.

Application forms for a career at the service included a diversity section for completion by the candidate. This included ethnicity, gender, age, and any disability. The figures for completion were tabulated in an audit, showing completion rates of this survey from January 2024 to February 2025. The survey was not a requirement to be filled in, and a high percentage of people chose not to complete the survey.

The training compliance rate for the service in diversity, equity and inclusion stood at 94% at the time of the assessment. The service did have equity and diversity champions.

Staff we spoke to did not raise any issues with regard to diversity, equity and inclusion.

Experience of governance, management and sustainability was not a topic raised directly with clients and carers who benefited from the service. We were told by a carer that they had a weekly meeting with the locality manager and a member of the integrated care board, this was seen as a really positive occurrence that allowed for ideas and information to be exchanged and keep carers informed of progress, as well as to discuss any issues that may have arisen. The carer felt that the manager was doing a really good job and was a positive influence on their relative and the relationship between the family, the integrated care board and the service.

The registered manager told us that there were key performance indicators that were maintained and used to drive improvement and quality initiatives. These indicators were compiled in a report. When asked about systems to ensure care plans and risk management plans were updated regularly, we were told that due to the governance process these were reviewed regularly to ensure quality and that they were being updated, just prior to the assessment a full review of all plans relating to client care had been completed.

The registered manager informed us that handovers between shifts and team were also regularly checked, and that any communication deficits were noted through the reporting system. Staff were informed of any important changes or information during team, where there was a set agenda that ensured all salient points were raised. We were told that computer system and processes allowed oversight of daily operations and other systems.

Commissioners we spoke to raised no concerns regarding governance, management, and sustainability, although they did raise concerns about the turnover of locality managers for their clients. One commissioner suggested that the service might concentrate more on providing better and more effective care for clients than on governance: this was not a criticism of the care received by the client, it was a compliment about the level and standard of care received.

Due to the nature of the service, and the wide geographical spread of the locations where clients were situated, we did not observe clients and staff in home premises, however comments from the clients we spoke to showed a positive reaction to the management of their care. The clients felt involved and had good relationships with their community support managers.

The service used an effective computer system to record all records and client details that could be accessed by relevant staff if necessary. Audits were in place to monitor records, and these were discussed in regular meetings that involved staff at all levels, ensuring that information was widely disseminated.

The service had a governance manual that included all aspects of governance systems and audits, as well as operational flow charts and management structures. The audit and continuous improvement process was outlined in the manual, clearly showing frequency of audits and meetings, as well as who carried out relevant tasks: weekly audits included property visits, community support manager meetings, and incident/safeguarding reviews. Monthly audits and meetings included case note audits, infection prevention and control audits, and also review meetings of the audit results. Other reviews and meetings that were bi-annual or yearly were also included in the timetable.

The manual also outlined the process flow maps and terms of reference for each group, ensuring that there could be little or no dispute over the direction group.

There was a comprehensive clinical procedures policy that had been updated in October 2024, outlining the requirements for each role in the recording and action of clinical procedures. Responsibilities for each role were explained in detail.

There was a good governance and procedure policy, updated in December 2024, that provided guidance and support on the measures and requirements in place at the service. The policy was closely aligned with the regulations of the Heath and Social Care Act, and followed each regulation with a comprehensive review of how it applied to the service. The roles of the nominated individual and the registered manager were explained and their importance in the regulatory process.

The service had an assessment and care planning schedule that definitively laid out the care plan, health and safety and operational assessments minimal review requirements, who would conduct the review and where on the computer system could the results be found. Care records that we reviewed showed that auditing was taking place regularly.

The service maintained an equality, diversity and inclusion policy, updated in December 2024. The policy showed that considerations were given to all when applying this policy.

In view of the diverse client group that were supported by the service, there was a comprehensive autism and learning disability policy. The policy outlined the training and application of good practice when supporting clients with autistic or learning disabilities. Care records showed that consideration was given to these characteristics and that actions were properly implemented. The service was supported by a local autism well being project in Liverpool.

The information we accessed concerning performance indicators and audit documents indicated that the service had a comprehensive governance structure in place. This was reflected in comments from staff, clients and commissioners, albeit a commissioner did suggest that governance was secondary to client care: this was seen not as a criticism but as an opinion about priority. The outcomes indicated that governance is well embedded at the service, and that due diligence was practiced ensuring the safety of clients and staff.

Multi-disciplinary team meetings were held regularly, with a monthly team meeting to bring together any findings or information that was pertinent to the client and progress of their care. Whilst these meetings did not directly involve the client, information from clients was used in the meetings to draw attention to any shortfalls or indeed positive experiences.

Staff from integrated care boards attended these meetings, and the minutes showed that a high level of discussion was held that would have an impact on the care of the client.

The service maintained an agreed and relevant terms of reference for work with integrated care boards and other partners involved in the care of a client.

The service worked closely with local commissioners and integrated care boards. The service actively worked in various forums to work collaboratively with partners. We saw in meeting minutes that an evidence-based approach was used to ensure that information was clearly shared to the benefit of the client. In transition planning we saw collaboration at the beginning of a client journey, and in transition to moving clients on in the community as part of the service mobilisation process.

Contractual obligations meant the service had to ensure that feedback was available and provided regularly to partners. The service also issued a clinical commissioner report which provided a full summary of the client journey.

We saw commissioner reports that were comprehensive, and included a clinical summary, assessment and observations, current focused interventions, outcomes achieved, analysis of any incidents (with full breakdown of figures) and recommendations.

Transition meeting minutes were seen to be comprehensive and inclusive. Representatives of involved organisations were present at the meetings and their input considered and implemented where applicable.

Staff at the service were involved in an external learning initiative about systems approach to patient safety incidents as part of continuing professional development. We saw that medication training was also in place, with distance learning courses alongside mandatory training for staff.

Training was encouraged from induction to the service: we saw the employee handbook and documentation relating to the training of staff, including specialist training where required. E-learning was completed on a specific platform used by the service, so it was easy to monitor and maintain. During induction, if a staff member had not completed 100% of their training, there was an alternative method of checking if competency was high enough to be signed off as competent, these were known as Staff Knowledge Questions.

The service also considered the mandatory training needs of the integrated care boards who commissioned their work, to ensure that the requirements of the board and the clients were met. The service had a training inductions guideline policy in place, but training did not stop at induction, with regular updated e-learning and face to face training from external companies.

There was a full training policy and procedure that had been updated in July 2024 that outlined all training needs and how it was managed and maintained. Professional development was stressed for all staff, with high levels of trauma-informed care training that was delivered by an affiliated organisation.