Creative Support - Bedford Services

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 Outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 100 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

People using the service were supported to be involved in and part of the shared direction of the organisation. The provider held ‘Creative Voices’ events which were held nationally and all people using services were invited to attend. Creative Voices provided opportunities for people to review policies, processes and to include people in any future planning and corporate strategies. Events also provided opportunities for people to meet new friends and share their insights and experiences of accessing support services.

Staff were very motivated and proud of the service. There was a very strong focus by managers on inclusion, equality and diversity issues. This was evident in discussions with management and staff, and they had an excellent understanding of the provider’s values and the vision of the organisation. One staff member told us, “I know what the values are, welcoming, empowering, compassionate, aspirational, respectful and effective. We learn about these in our induction, and they are reinforced during training and meetings.”

The registered manager and the provider had an excellent understanding of CQC’s guidance ‘Right Support, Right Care, Right Culture’ which detailed the service requirements for people with a learning disability and autistic people that incorporated the guidance. The provider had a clear strategic vision that was shared with staff. Creative Support held a quarterly registered managers conference and training, and information was explored about the providers shared vision and ethos of giving people the Right Support, Right Care, Right Culture. The care coordinators and senior staff then held their own team meetings in the individual services to feedback information to all staff to share the providers vision for the future.

The provider had embedded 6 fundamental values in all roles within the organisation and all staff were expected to work with these values at the core of everything they did. These were discussed at staff meetings and staff supervisions. We found these values had been embedded into staff practice and demonstrated the provider's commitment to ensuring a focus on best practice. There were regular updates for staff through staff through meetings, 1-1 meetings, emails and newsletters. Staff completed mandatory training sessions to understand the vision, values, and strategic goals, and how their roles contributed to achieving them.

The provider had exceptionally 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 always did so with integrity, openness and honesty.

People and relatives were very complimentary about the management team. One person told us, “[Name of manager] has really helped me. All the managers are really good. They helped me reconnect with family I hadn’t seen for years. Now I have family.” A relative commented, “The management team have made a lot of improvements and [family member] is living their best life. I couldn’t fault them. They deserve an award.”

One of the providers 6 core values was compassion which was described to be at the heart of the service. The management and staff team demonstrated a deep sense of empathy, kindness, and understanding and part of the value for compassion read, ‘We offer compassionate, relationship-based support which is flexible and reliable.’ The senior operations manager and the registered manager spoke passionately about people they supported and were keen to share and celebrate people’s achievements. For example, we were informed of 1 person who had always wanted to go on a boat cruise independently and commented, “It’s one of my greatest goals.” We saw this had recently been achieved and the persons feedback read, “I enjoyed everything about the holiday, trying new food, meeting people from various works of life and having my independence to make choices of what I want.”

The provider was committed to continually motivating the staff team and recognising their dedication to their role. For example, every 2 months there was a ’WeCare’ awards where staff are nominated by any person who felt a staff member had gone over and above their roles. There was specific recognition for efforts relating to Dignity in Care.

The registered manager and the management team lead the service with passion, integrity and fairness. One staff member commented, “The managers are very good role models. They know everybody in every service and all the clients know who the managers are.” We saw this was the case when we visited services with the managers and observed people greeting them warmly, engaging in conversations and laughing together.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The management team promoted an open and transparent culture. They encouraged staff to raise issues and concerns so these could be known and addressed.

Staff were confident they could always speak to senior managers when they needed to and felt listened to and supported. One staff member said, “We have a lot of training, and I know I could speak up and disclose any safeguarding concerns I had. I know the managers would deal with it properly and I know they would support me through the whole process.”

Staff completed training called ‘My Clients, My Responsibility’ which was in relation to safeguarding and whistle-blowing and provided staff with detailed information about raising concerns and associated accountability.

The provider also has a scheme called Code RED. Its aim was to promote an open culture of individual responsibility and escalation followed by quick action. Contact details were provided for staff if they wanted to raise concerns. The provider had appropriate policies and procedures in place to support and promote staff raising issues. The registered manager investigated concerns in a sensitive and timely manner. They identified and acted on lessons from these to continue to improve the service. The management team encouraged feedback on a frequent basis from the staff team.

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them. Staff told us they felt valued and included. One staff member said, “This is the fairest and most inclusive company I have ever worked for. They understand how important my religion is to me.” Another commented. “The managers are very approachable, flexible and supportive.”

The provider embraced and valued staff differences, such as those related to gender, race, ethnicity, age, disability and professional backgrounds. For example, staff were supported to observe diverse holidays where possible and embraced various cultural perspectives and traditions. The provider has also set up an equality, diversity and inclusion network to prioritise the voices of minority ethnic colleagues.

The provider had numerous initiatives to support staff with inclusion and equality in the workforce. For example, there were equality, diversity and inclusion groups and leads. We saw a LGBTQ and equality policy and a supporting staff through gender transition policy. The provider completed a race pay and gender pay gap analysis ensuring that all staff received fair pay. Anti racism and cultural awareness training was provided for managers. There were promotions of various events such as local and national pride, black history month and supporting staff through Ramadan and a celebration of Diwali. In recognising the value of a diverse work force the provider supported staff to ensure their cultural needs were met by approving longer than usual holidays to allow them to visit family in their home countries.

There were various policies in place to support and value staff. For example, there was a Black Lives Matter policy to take action against racial inequality and there was a halo code to provide a safe and open workplace for staff to wear their hair in protective or cultural styles. In addition, there was a menopause policy to support staff by allowing additional rest breaks, reduction of hours and changes to clothing.

We saw evidence that the provider created opportunities outside of their contractual obligations to support people's well-being. For example, they organised parties and events for people they supported and celebrated staff birthdays and achievements. The provider was committed to continually motivating the staff team and recognising their commitment to their role. For example, when the provider received positive feedback about staff this was always shared to celebrate staff commitment. There were the ‘WeCare awards where staff were nominated for commitment to their role ensuring good practice was recognised and staff were valued.

Feedback from staff was listened to and acted on. For example, staff fed back that the sleep-in bed was uncomfortable. The provider ordered a new bed for the staff which was more comfortable promoting improved rest when sleeping at work.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support.Staff told us the service maintained very high care standards and that people were very well looked after. One staff member told us, “I believe we provide the best care we can and provide people with new opportunities all the time. We are always thinking what can we do to make our clients lives better.”

People were encouraged to be involved in governance practices where they were able. For example, we saw that 1 person was the fire warden for the building and staff supported them to test the fire alarm on a weekly basis. Another person was supported with checking the epilepsy sensor to ensure it was working each day. On the day of our visit 1 person had a clipboard with pictures put in a sequence of what was expected of visitors, such as showing ID, signing into the visitor’s book and showing visitors around the service. Once each task has been completed, they ticked their list on the clipboard. We saw that they enjoyed taking the lead in this role.

The management team were highly committed to improving the service they provided and had introduced a number of initiatives to help make improvements. These included introducing champions within the care team for a variety of relevant subjects such as medication, finance, health and safety and activities provision. The senior operations manager attended the quality assurance medication work shop each month. This was an opportunity to discuss good practice, consider where there were any challenges in services and how processes could be further developed to reduce medication errors and learn from errors in the past.

The provider had successfully embedded a very robust auditing system to monitor the quality of the service. This included regular internal audits in areas such as accidents and incidents, risk management plans, staff training, staff supervision, reviews of people's care plans and recruitment records. Actions plans were put in place to address any areas that needed further improvements. For example, following a robust review of accidents and incidents we saw that the provider had created a vehicle observation of practice to ensure staff were competent with all vehicles in use, created further photographic guides for staff guidance and had introduced written daily equipment checks for all moving and positioning equipment.

Best practice was shared throughout the team, identifying what had worked well for each person, or what had not worked well. Risk assessments addressed people's diverse needs and risk management plans were proportionate and centred around the needs of the person.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement. The management and staff team had built good working relationships with health professionals and supported people to see them if they needed this support. A relative said, “The staff support [family member] to attend hospital and clinic appointments. My [family member] gets nervous when they go to their appointments. The staff are very good at supporting them and reducing their anxieties.”

The registered manager told us that multi-disciplinary meetings were organised if there were any concerns about a person’s care or well-being. People experienced positive outcomes because staff understood their needs and worked collaboratively with other organisations. The management team has built strong partnership working with health and social care professionals. This included attending care forums, learning disability partnership boards, and local council meetings, regular meetings with health care professionals and social care governance meetings to network and learn ideas. Registered managers were encouraged to attend the Bedford Borough Registered Manager Network where all managers could share best practice.

Feedback from partners indicated the staff and leaders at the service actively engaged with external health services to promote the wellbeing of the people using the service. One social care professional who had worked at the service told us, “The manager has built up very good relationships with health professionals. If there are any concerns about a person’s well-being multi-disciplinary meetings are held swiftly and I saw they all worked collaboratively in the persons best interests.”

The staff worked in partnership with other professionals to ensure people received holistic and joined up support which met their needs. They supported people to access a range of services and had effective systems of communication with healthcare teams. There were clear avenues of communication with other health professionals such as the occupational therapist, dietitian, and epilepsy experts. All staff training was in line with the recommendations of Skills for Care and records conformed these were all up to date. Following a robust review of accidents and incidents staff training had been updated to ensure safer working practices and this had included working collaboratively with other health and social care professionals to ensure best practice recommendations were implemented and embedded into staff practice.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Staff told us learning from concerns and incidents was a key contributor to continuous improvement and meant the service continued to change and adapt the support provided and reduce the risk of further re-occurrence. For example, one staff member told us, “Across the organisation there were a couple of incidents where things went wrong, and actions were taken to address them and learn lessons. Improvements were put in place, and this was shared with all staff in the organisation.”

There were robust processes in place to ensure that learning happened when things went wrong, and best practice guidance was sought and shared. For example, across several services across the organisation there had been 3 accidents within a short space of time. The provider completed a robust review to look at the incidents and a wider review of the way staff managed moving and positioning within Creative Support. Following this robust review there were service wide recommendations that included some bed rails in service which should be removed. As a result, a central log of all bed rails in Creative Support was implemented and a new bed rails risk assessment put in place. The provider created a vehicle observation of practice to ensure staff were competent with all vehicles in use in the services, created further photographic guides to ensure staff were clear about the correct procedures to follow, reviewed all paperwork and made changes and enhancements to procedures, and managers attended further training in relation to moving and positioning.

Also, a result of the review the provider established a moving and positioning working group which continued to meet monthly to ensure all of the actions above, were embedded corporately. A moving and positioning conference was due to be held in 2025 to ensure the actions above were embedded company wide. The impact of this comprehensive review had included people having their needs met by better trained staff, better storage of equipment ensured that people’s space was maximised and safe, prompt action was taken to ensure equipment was suitable and that when changes were are needed, they are made in a timely way to meet changing needs, risks to people were managed safely reducing risk and the review of bed rails has meant that the least restrictive options are in place in people’s homes. In addition, the review and subsequent actions had embedded a culture of learning, evidence-based practice and transparency.