Sugarman Health and Wellbeing - Watford

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 changed to 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 good governance.

This service scored 57 (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 not ensured there were positive working relationships between colleagues and support from managers. Staff feedback suggested there was a disconnect between the office team and the community team. The service provided care in various counties, meaning community staff did not really visit the office and described issues with communication when trying to report concerns or seek support. This differed to feedback from the registered manager who found the provider supportive; they described improvement between other locations due to use of online communication systems and told us, “When things get difficult, everyone mucks in. We pride ourselves on being responsive as a team.” Following our inspection, the registered manager told us they had identified the issue between teams and had planned open days to encourage care staff to join them for a day.

The provider had not ensured there was effective oversight of the service. Care was provided over a vast geographical area with care staff managed by 1 of 3 nurses. People’s care was categorised at level 1-3 dependent on level of need. The nurses managed the 16 level 3 care packages, the rest were managed by care coordinators with oversight from the nurses. This included staff supervisions and competencies and audits of people’s care records with out of hours support provided by care coordinators. We found room for improvement in those we reviewed, and feedback received, and documentation reviewed suggested some staff felt stretched.

The registered manager felt remote oversight was manageable. They told us they were confident in the policies, people and structure of the organisation and said if something happened there tended to be someone in the area who could respond. However, our findings suggest the processes were not always effective and staff did not always feel supported by the office team.

The provider’s processes to enable staff to speak up were not clear. Their whistle-blowing policy stated for staff to report concerns to the registered manager, or if the concerns were about them to the provider. There were no names or contact details and feedback from staff suggested they did not know who to approach. When asked if they knew who to raise concerns with, responses included, “Someone in the office who I'm not yet sure of.” and “Yes, but not always comfortable to do so.” And “We do not know who we actually email if we have a problem as whenever there is one nobody wants to take responsibility.”Therefore, we were not assured staff felt able to speak up or be listened to. Following our inspection, we saw a ‘take 5’ document which included a whistle-blowing email box for staff as well as informing them to raise concerns with their line manager, on call person or the registered manager.

The provider had policies to support fair treatment of staff. Staff did not raise any concerns related to equitable treatment.

The provider’s processes to monitor the safety and quality of the service were not always effective. Staff completed audits of people’s daily logs, medicines and monitoring charts. We did not see evidence of care plans and risk assessment audits; this meant we were not assured any gaps were identified and addressed. The medicines audits we reviewed did not identify all issues clearly with actions to address them. Where actions were identified, it was unclear what oversight there was of these; it stated on them they were shared with care staff via email.

The provider had an event tracker where all incidents, safeguarding concerns and complaints were collated by month including how many of each type there had been. There was not enough detail here for any meaningful analysis. This meant we were not assured all themes from incidents would be identified. The registered manager told us a theme was staff sleeping during shifts. This had been addressed but continued to be an issue. Staff acknowledged it could be difficult to stay awake as there was not much to do overnight and they could not recall night spot checks completed. However, the registered manager told us they were implementing electronic monitoring and planned to have hourly tasks for night staff to time stamp which should help with this.

The provider’s matrix to monitor compliance with mandatory training only included care staff; we saw no evidence of office staff training, some of whom provided on-call support to staff in the community. The matrix did not include the 2-day clinical training, which appeared to be a one-off with no evidence seen of refreshers. There was no monitoring of staff competency assessments; whilst the system only allowed staff who had been assessed as competent to provide care, there was no evidence of regular assessment of competency.

The provider shared information and learning with partners and collaborated for improvement.

The registered manager told us they created ‘client focus plans’ for care packages with ongoing concerns. We reviewed an example and found actions included meeting with other professionals for support. A professional told us, “Sugarmans have always appeared to be very cooperative and responsive in replying to emails and attending meetings.”

The provider had a strategy to improve the quality of care, and the service provided. The priorities were to keep people safe, to engage with people who used the service and improve staff recruitment and retention.

The provider had some processes to support with learning and improvement. We saw a meeting held in February 2025 included a learning session on completing medication records as well as information about diabetes. However, the medicines records we reviewed suggested this had not been effective.

The provider did not have a call monitoring system. This meant staff were not able to log in and out of visits and therefore no alerts could be generated if they did not attend. Whilst this risk was mitigated because most people either had staff or a relative with them or were able to contact the office themselves if staff did not arrive, there were plans to implement electronic monitoring following a pilot. This would also help address the issue of incidents whereby staff had slept during shifts.