ECHO Supported Living Services Limited

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 good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 86 (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 ontransparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities. The provider shared their values with us, describing them as empowering people to have opportunities and develop their strengths by working in partnership with the person, being open and honest and caring. Their vision included embracing positive behaviour support ethos to make systems work for people, and ensuring every person had access to a home of their own in the community, with reduced hospital admissions or repeat placement breakdowns, improved quality of life and reduced restrictions. The registered manager told us, “Our most recent closed culture survey demonstrated 100% of staff feel lessons are learnt and shared effectively. This reflects a psychologically safe environment where staff feel confident to report concerns, reflect on practice and contribute to service improvement.” The feedback from all stakeholders was exceptional. Partners told us the provider worked with them to ensure people were supported to live in suitable environments which met their needs when they began using the service and were able to support people when their needs changed. Relatives told us people using the service now had stable placements, which enabled people to live independently in their own homes. Others commented how their loved ones were in hospital for a long time as nobody could meet their needs and this provider had built a home for them. A relative told us, “We are really happy at the moment, [person’s name] is the safest they have ever been.” Another relative told us, “[Person’s name] is doing really well, it’s the best place they have had.”

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. Relatives spoke positively of the providers leadership, describing good communication and feeling listened to and involved. A relative told us, “I have high expectations of them, they meet them.” Another relative told us, “One good thing is the scheme manager makes sure information is passed on well, they are really on top of that and if something goes wrong, the level of detailed information I get is good.” The registered manager told us they had a senior management team in place to ensure management support was available in each scheme, adjusting the level of support depending on the complexity of people’s needs and the number of people supported in each scheme, with the registered manager having oversight. Staff told us they were happy with the management support, commenting it was a nice place to work, very supportive and a good positive atmosphere. A staff member said, “This is the best company to work for, all the management team are good, we have access to lots of training.” Another staff member told us, “I think it is a nice place to work, it’s so supportive here, we are more than a number, we have engagement, they will find solutions, a really good and positive atmosphere. We have a good rapport with people.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The registered manager told us they had systems in place to ensure staff had the opportunity to raise any concerns. They told us they had put speak up champions in place and they met with them regularly to allow any concerns to be raised. Staff were aware of the role of the champions, and we saw this had been discussed in team meetings. Staff also told us they felt confident in raising any safeguarding concerns with their management team. We saw where incidents had occurred these had been shared with the appropriate body.

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. The registered manager told us there were policies and procedures in place to support workforce equality, diversity and inclusion. The registered manager told us they ensured staff had support to meet their individual cultural and religious needs and could give us examples of what support was in place. Staff confirmed they felt the provider operated in an inclusive way. A staff member said, “We are united and there is inclusion here and unity.”

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. The registered manager told us they used a service development plan to have oversight of the service, and this ensured any actions required following feedback, audits and checks on the quality of the care people received were monitored. We saw audits were in place which checked on all aspects of peoples care and support. For example, medicines, positive behaviour support, mental capacity assessments, cleaning, daily living tasks and activities. The service development plan included the areas for improvement; the actions required to achieve this and enabled them to be monitored to ensure completion. For example, where a medicines count was identified as incorrect, competency assessments were required and the service development plan showed these had been completed. The service development plan also monitored the completion of individual actions required for updating peoples risk assessments and support plans following an incident or safeguarding outcome. Furthermore, the plan also monitored positive outcomes people had experienced. For example, a person had previously had a bad experience during an outing. Following lessons learned and structured work the outing had taken place again and due to the preparation, this was now reported as a success.

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 registered manager told us before opening a supported living service they worked with local commissioners to make sure the provision will meet local need, they liaised with local health care providers to ensure appropriate access to services for the people who would reside in the service and get to know all local partners. Partners confirmed the provider worked well with them and ensured they understood local provision and could access this for people they supported. One health professional told us, “The provider are very well respected within our area and display a very caring ethos in their services.” Without exception the provider worked with relevant community nurses, intensive support teams and continuing health care teams to establish peoples support plans. We saw numerous positive comments from other professionals which included one professional saying the provider was “exceptional” and that their responsiveness and dedication to meeting an individual’s needs was highly valued. Another comment included, “The care provided since discharge has been seamless and of a consistently high standard.” The provider developed specific support plans designed to improve outcomes. For example, proactive strategies and partnership working had led to reduced medication use for some individuals. In another example, people were supported to share their experiences with partners to support other people with similar experiences on their journey. The provider had been asked by local commissioners to share their work on restrictions support planning following best interests’ meetings. The work was viewed as a great asset in reducing additional questions and delays in the court of protection process when people were being discharged from hospital. Local commissioners facilitated a workshop for other providers to learn from this practice.The provider identified potential for health inequalities when requests for reasonable adjustments were not considered by a health professional. The provider worked in partnership with the professional to make sure reasonable adjustments were made and access to health services was maintained.

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. Without exception everyone we spoke with told us the provider encouraged learning and innovation. A health care professional told us, “The management team are very proactive in identifying learning from incidents and take accountability. They are always an active participant in meetings and willing to discuss and adopt new ways of working.” Feedback from stakeholder was consistently used to drive improvements. Peoples individual feedback was used to tailor their support for example around individual environments and staff relationships. Without exception the feedback from visiting health professionals was described as outstanding in all areas. Family and friends similarly gave overwhelming positive feedback with 96% of respondents rating all areas as good or outstanding. Despite the positive results, where comments had been made about areas which could be improved this had led to actions around strengthening communications using a WhatsApp group to keep families informed, improving appointment updates and doing more for social connection. The feedback we received from relatives suggests these actions had been taken and were successful in driving improvements in these areas. The registered manager told us learning and improvement from feedback was a strength of the service. The learning culture was underpinned by a robust governance system. All incidents were proactively analysed for risks and trends and shared with all staff through established forums. There were service development plans used to formally track actions, accountability and timescales with progress monitored to ensure sustainability and continuous improvement. Root Cause Analysis was in place to consider wider contributory factors when incidents occurred. Staff told us they had immediate debriefing following incidents and the registered manager confirmed this was done with additional reflective practice and team discussions. The registered manager told us they proactively seek to prevent incidents through early identification of risk and proactive intervention, rather than responding after events occur. The provider had a system in place to examine the service for closed culture risk factors and took action to reduce them. A report had been completed which identified inherent risks, the mechanisms in place to reduce them and any actions which were needed to further reduce the risks. Everyone we spoke with was aware of the importance of this work in the service. The provider was also instrumental in sharing learning and best practice with other agencies and providers.