Midlands Care Direct

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.

This is the first assessment for this newly registered service. This key question has been rated as 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 governance.

This service scored 61 (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 vision and values were shared by the staff team and reflected in the care and support provided. Staff demonstrated a commitment to promoting the person's independence, choice, dignity and wellbeing, ensuring support was delivered in a person-centred and respectful manner.

For example, staff consistently spoke about the importance of enabling the person to make their own decisions and maintain control over their life. They recognised the person's right to take informed risks and described how they balanced this with their responsibility to promote safety and wellbeing. Staff understood the importance of supporting the person's individual goals, preferences and aspirations, and provided support in ways that encouraged independence rather than creating dependence.

The person's feedback was consistent with the provider's stated values. They told us they were treated with kindness and respect, were listened to, and were supported to live their life in the way they chose.

Records and discussions with staff demonstrated a shared commitment to delivering care that was personalised, inclusive and focused on achieving positive outcomes for the person.

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. However, some areas of leadership development were identified.

The registered manager had not fulfilled their registration regulatory responsibilities of reporting all notifiable incidents as required. From reviewing the person’s care records, we identified example’s when police incidents had not been reported to CQC as required. This is important information that assists CQC in monitoring services. Following the inspection, the registered manger submitted this information. The registered manager had limited understanding of the Mental Capacity Act 2005 and required additional refresher training to improve their knowledge and practice.

The registered manager was supported by an administrator and received additional support from an external consultant. They told us they were in the process of further developing the service and had plans to appoint a registered manager. They explained this would enable them to step back from the day-to-day operational management of the service and focus on strategic oversight, governance, quality assurance and service development which they recognised needed strengthening.

Staff were consistently positive about the registered manager’s supportive approach. A staff member said, “The registered manager is very good, they are responsive and provide guidance, support and feedback, they are very knowledgeable and experienced. Any lessons learned are shared with staff.”

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

Policies and procedures, including Freedom to Speak Up, Whistleblowing and Safeguarding, supported staff to raise concerns and promote people's safety and wellbeing.

Staff told us they had access to these policies and felt confident raising concerns when required. They were also confident that any issues raised would be acted upon appropriately.

The registered manager encouraged staff involvement and engagement, including opportunities to lead discussions during team meetings and contribute ideas for service improvement. Staff described the registered manager as approachable and supportive, helping to create an open and inclusive culture.

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 told us they felt valued and supported in their roles. The provider aimed to create a positive working environment where differences were respected, and staff were encouraged to contribute their views and experiences. This helped to promote an inclusive culture and support positive outcomes for both staff and the person using the service.

Staff confirmed the registered manager was fair and treated them equally and they had not experienced any form of discrimination.

The registered manager told us and staff confirmed, reasonable adjustments were made to support staff in their role.

The provider had an equality and diversity policy that reflected the Equality Act 2010. This protected both staff and people using the service against any form of discrimination.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider's governance systems, processes and procedures for assessing risk and monitoring the quality and safety of the service were not fully effective. They had failed to identify a number of the shortfalls found during this inspection, which meant opportunities to drive improvement and reduce risks had been missed. The registered manager acknowledged the shortfalls identified and took some immediate action to begin addressing them.

Monitoring systems had failed to identify that statutory notifications had not always been submitted when required. As a result, the registered manager had not consistently met their regulatory responsibilities.

The provider did not have sufficiently robust or embedded systems to monitor the quality-of-care delivery and demonstrate how the person had been consulted and involved in decisions about their care and support. There was an over-reliance on informal discussions and practice. This meant the provider could not consistently evidence how the person's views, wishes and feedback had informed the planning, delivery and review of their care and support.

Audits and checks had also failed to identify that some risk assessments and care plans lacked sufficient detail and guidance for staff. In addition, governance processes had not identified the shortfalls relating to medicines optimisation and the application of the Mental Capacity Act 2005, as detailed in the Safe and Effective key questions of this report.

These issues demonstrated that governance arrangements were not always effective in identifying concerns, driving improvement and ensuring the service was consistently operating in line with regulatory requirements and best practice.

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.

The registered manager told us, and records confirmed, that staff worked collaboratively with the person's multidisciplinary team. This included liaising with health and social care professionals, emergency services and other agencies when required to support the person's health, safety and wellbeing.

Records demonstrated that information was shared appropriately and that staff sought advice and guidance from partner organisations when concerns arose or additional support was needed. This helped to ensure care was coordinated, responsive and focused on achieving the best possible outcomes for the person.

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. However, opportunities for learning and improvement had not always been effectively identified through the provider's governance and quality assurance processes. As identified during this inspection, auditing and oversight systems had failed to recognise a number of shortfalls relating to record keeping, care planning, medicines optimisation, the application of the Mental Capacity Act 2005 and regulatory reporting requirements.

The registered manager was receptive to feedback, acknowledged where improvements were required and took immediate action to address concerns identified during the inspection. This demonstrated a willingness to learn and improve. However, further work was needed to ensure quality assurance systems were sufficiently robust to identify issues promptly, drive continuous improvement and sustain positive outcomes for the person.