Archived: East Anglia Domiciliary Care Branch

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 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 inadequate. At this assessment the rating has remained the same. This mean there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.The provider was previously in breach of legal regulations in relation to the governance of the service. Improvements were not found at this assessment, and the provider remained in breach of these regulations.

This service scored 32 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. The provider’s statement of purpose set out their aims and objectives. This stated an aim was to enable people to make choices in all aspects of their life. However, there was poor understanding and implementation of the Mental Capacity Act 2005 to ensure choices were made in people’s best interests where they lacked capacity. Another aim was to ensure people’s wishes were fulfilled and maximise their independence and wellbeing. But goal setting and independence planning was poor as identified earlier in our report. The provider did not always understand the challenges and the needs of people.

At the time of the assessment there was no registered manager in post. However, the new manager was in the process of applying to become registered with us. There had been several changes within the local management of the service since we had last assessed with a new locality manager and service leads, some of whom were new to a leadership role. Staffing continued to change during our assessment with a new quality manager, coach and further changes to the service leads. This meant the new structure was not embedded and had led to further changes of staffing for people and uncertainty this brought for them. Leaders did not always have the skills, knowledge and experience to lead effectively. Although the start of improvements had been seen in some homes in other areas this was not so clear with gaps in staff’s knowledge and experience needing to be addressed.

The provider had failed to ensure there was a robust system which was promoted to staff, people who used the service and relatives about how to raise concerns and support to be able to do this. The process in place was not followed by staff and leaders to ensure the concerns and complaints were identified as such and could be addressed. This led to low reporting of complaints and a lack of oversight and monitoring.

We found the provider had failed to ensure they had oversight of the staff working in each home. We identified staff who did not have the required training to meet people’s needs. There was lack of a robust system to identify which agency workers worked in each home, whether they had the rights skills and training and were inducted. We identified shifts when agency staff worked on their own and shifts where there were not staff who had the required training to meet people’s needs. This meant people were put at risk of not receiving care and support to meet their needs or promote equality or equity for them.

The provider’s system in place failed to provide accurate information needed to give oversight to manage the service. Not all audits were being completed. When they were, not all of them were identifying issues and concerns we had during this assessment. Audits were not picking up issues in relation to safety, staff training, consent, assessments of people’s mental capacity, medicines, staff recruitment, gaps in care records and risk assessments. When actions were identified, there was a lack of oversight to ensure these were managed and completed. The gaps and inaccurate records were of particular concern due to the high agency staff use, which had been decreasing as new staff were employed, who all relied on care records and guidance. Staffing was not being appropriately managed to ensure there was sufficient, suitably qualified staff. The incident and accident system was not being implemented robustly. There were gaps in forms being signed off and not all incidents were included on the incident dashboard. This meant themes and trends were not being identified to ensure lessons were learnt to support improvements in people’s care. The complaints system had failed to identify complaints. Policies and procedures were past their review dates, which meant staff could be referring to out of date guidance.

We found examples when referrals had not been made to health care professionals when they should have been, for such things as monitoring of people’s bowel movements, which put their health at risk. We received overall positive feedback from health care professionals who worked with staff regularly, who said staff were knowledgeable about people and seemed to know people well in terms of their individual needs. One GP said he previously had concerns about the home, however with a change of staff and service lead there had been improvements to the care and support provided to people.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. Lessons learnt from incidents, complaints and feedback were not routinely identified, discussed and shared. The provider did not encourage creative ways of delivering equality of experience, outcomes and quality of life for people. They did not actively contribute to safe, effective practice and research. The model of care was not aligned with current best practice guidance right support, right care, right culture. People were not enabled to always enjoy a full life or identify what goals and ambitions they had.