Care Outlook (West Wickham)

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• 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 requires improvement. At this inspection the rating has changed to requires improvement. This meant people were not safe and were at risk of avoidable harm.

We found the provider to be in breach of 1 legal regulation relating to good governance.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team did not always demonstrate a culture of learning and improvement or show how this was being embedded into the service to ensure people received safe, high-quality care. The provider carried out surveys and engaged in regular conversations with people, relatives and staff. However, it was not always clear how their feedback was being used to improve the service provided.

Leaders did not always have strategic oversight or awareness of their responsibility to comply with regulatory standards in order to deliver safe care for those who used the service. We identified breaches of regulations which placed people at risk of avoidable harm.

We received mixed feedback about the management team or managers not always being visible to people. One person we spoke with told us, “I don’t know the manager.” Another person said, “I tried to contact the manager to give feedback, but nobody answered.” A third person said, “A few problems. Manager who goes missing.” A relative told us, “The problem I have is I can’t contact the manager I have tried quite a few times.” Another relative said, “Manager? Only knew one.”

Whereas other people said, “I can approach the manager, no problem” and “I have contact with the manager.” Other people said, “A few months ago a manager from the office had to come out…” and “The manager phones and comes out to visit me.

Staff told us they knew how to speak up if they had concerns or something went wrong. There service had a whistleblowing procedure in place which guided staff on how to raise concerns they had.

Staff told us they felt supported by the manager. One staff member told us, “I have a very good manager.” Another staff member said, “[Manager] is good and acts on any concerns I have.” A third staff member said, “I like [manager], they are supportive.”

Although there was no staff member that needed support at the time of this inspection, the provider told us they considered the diverse needs of their workforce and would offer support if required.

The provider and manager did not have an adequate understanding of their role and lacked effective oversight of the service. The manager was not aware of the issues we found at this inspection and did not provide evidence to demonstrate how the service was well led. The lack of systems to monitor the quality of the service and provide effective managerial oversight did not allow for lessons to be learnt. There was no evidence actions was taken to drive improvements in the service. This placed people at risk of harm.

The provider’s monitoring and governance processes were not sufficiently robust. The provider’s systems to identify and manage risks were not always effective, as they had not always identified the risks people faced while receiving care and had not always put effective risk management plans in place to address mitigate risks. People’s care plans did not include all relevant information about their specific health conditions and how they impacted them as individuals and updates to people’s care needs were not always recorded. Learning from accidents and incidents had not been disseminated to all staff.

The systems to ensure people always received their medicines safely were not always effective, as we identified shortfalls with the way the provider was managing people’s medicines, which placed people at risk of unsafe care.

The provider carried out a number of audits. However, these audits which covered care plans, medicines management and daily notes had failed to identify and resolve the concerns we found at this inspection.

The manager provided us with a ‘Quality Monitoring’ report which covered, ECM analysis, quality of care delivery, medication management, safeguarding and communication. However, the report was not dated and all ‘Actions’ were marked as ‘In-progress’, with no completion dates. Where the report identified concerns, we found at this inspection they had not been rectified. For example, the report stated, ‘there are carers who aren’t logging into the visits at the correct times and fail to stay for the full duration.’

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information with partners and collaborated for improvement. This included doctors, district nurses.

The provider did not always focus on continuous learning and improvement across the service. The provider did not have effective systems and processes in place to evidence that they were learning from accident and incidents.

Regular care staff meetings were held, however, the opportunity to learn from accidents and incidents and share good practice in relation to individuals had been missed.