Local Homecare

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 remained requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 50 (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 always demonstrate a clear and shared vision or strategy that reflected values of transparency, equity, equality, human rights, diversity, inclusion, and meaningful engagement. As a result, there was limited evidence that the service fully understood or responded to the challenges faced by people and the needs of the communities it served. This lack of strategic clarity impacted the consistency and quality of care delivery.

Although the registered manager was actively working to implement improvements, further progress was needed to ensure that feedback from people and their relatives was not only heard but acted upon in a way that led to measurable improvements in the service. New systems and processes had been introduced, and managerial oversight was beginning to take shape. However, not all gaps in care and documentation had been identified and addressed. Further improvements were required to ensure these processes became fully embedded and sustained.

During the inspection, feedback was provided to the registered manager regarding specific issues identified, and they responded promptly to address these concerns. This demonstrated a willingness to improve but also highlighted the need for a more robust and inclusive leadership approach that consistently prioritises the voices of those using the service and ensures that care is delivered in line with best practice and regulatory expectations.

Not all leaders demonstrated a full understanding of the context in which care, treatment, and support were delivered. There were instances where leadership did not reflect the values and culture of the workforce or the organisation, and some leaders lacked the necessary skills, knowledge, experience, and credibility to lead effectively. The management team did not have sufficient clinical oversight to ensure that people were supported safely, particularly in relation to administration of medicines.

People and their relatives reported that they were aware of recent management changes and knew who the new manager was. The registered manager maintained regular communication with people and families, and did so with openness, honesty, and integrity. Systems were in place to guide staff on the expectations of their roles and conduct. However, due to limited information within care planning documentation, staff were not always clear about their responsibilities or the specific tasks required to meet people’s needs.

Despite these challenges, staff spoke positively about the support they received from the registered manager. Feedback included, “They look after me, they are supporting me,” and “The manager is really nice and easy to talk to, he's so easy going, I can't say anything bad about him, the same for the care coordinators.” These comments reflected a supportive working environment, although further development of leadership capacity and clinical oversight was needed to ensure safe and effective care delivery.

The provider did not consistently ensure people could speak up and that their voice would be heard. Staff reported feeling comfortable raising concerns with the registered manager, with one staff member stating, “I would report any concerns immediately, so the manager could take the necessary actions to keep the person safe.” This reflected a positive internal culture of openness and accountability.

Feedback from people and their relatives was mixed. While all felt they could speak up, not everyone believed their concerns were consistently listened to or acted upon. One person commented, “It just seems really organised. It is structured. I can always talk to someone if I need to.” However, another expressed frustration, saying, “It’s just not well led, new staff are not given the information they need before supporting me, I have to tell them.” These contrasting views highlighted inconsistencies in how feedback was received and responded to across the service.

The registered manager held regular team meetings, providing staff with opportunities to raise concerns and contribute suggestions for improvement. They demonstrated a commitment to transparency and accountability, particularly in their approach to managing incidents, in line with the duty of candour.

The provider demonstrated a commitment to valuing diversity within its workforce and worked towards fostering an inclusive and fair culture. Efforts were made to improve equality and equity for staff, ensuring that people felt respected and supported in their roles. Staff reported feeling valued by the provider and believed they were treated fairly in the workplace. Policies and procedures were in place to promote workforce equality, diversity, and inclusion, including specific measures to support staff with protected characteristics under the Equality Act 2010. These policies aimed to ensure equal opportunity and equitable treatment throughout recruitment and employment practices, contributing to a more inclusive organisational culture.

The provider failed to implement robust systems of accountability and governance, resulting in inadequate oversight of the quality and safety of the service. There was a lack of effective mechanisms to monitor and address deficiencies in key areas such as assessment, care planning, risk management, medicines administration, and overall governance. The registered manager demonstrated gaps in knowledge relating to health and social care regulations and best practice guidance, which adversely affected the quality and safety of service delivery. Although care plan audits were carried out, they did not identify critical shortfalls, leaving staff without sufficient information or guidance to meet people’ needs safely. Care plans were incomplete and lacked essential risk assessments, placing people at risk of harm. Systems intended to review and monitor care were ineffective, and the management of medicines did not align with best practice standards. While audits and stock checks were conducted, they failed to detect discrepancies, and medicine records were poorly maintained with no corrective action taken. There was insufficient oversight of staff training. Lack of training meant staff did not always have the necessary skills or knowledge to deliver safe care, placing people at risk of harm. Despite these concerns, staff expressed positive views about recent changes under the current registered manager, with one staff member noting that issues are now addressed promptly.

The provider did not consistently demonstrate an understanding of their duty to collaborate and work in partnership to ensure services operated seamlessly for people. There were instances where information and learning were not shared effectively with partner agencies, and opportunities for collaborative improvement were missed. Although shared care arrangements were observed with another agency, the absence of clearly defined responsibilities created a risk of tasks being overlooked or unnecessarily duplicated. The management team had started to work with people and relatives to make improvements to the overall standard of care provided.

The provider and registered manager failed to maintain oversight, learn lessons, and make changes to improve the service. The provider has failed to achieve the rating of good for the third consecutive assessment which demonstrates a failure to learn and significantly improve. However, the registered manager has shown a strong commitment to addressing the shortfalls identified by CQC and developing the service to meet the needs and wishes of the people it supports.