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 requires improvement. At this assessment the rating has remained 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 provider was previously in breach of the legal regulation in relation to good governance. Whilst some improvements were found at this assessment, these were not all fully embedded, and the provider remained in breach of this regulation.

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.

Staff and leaders did not always demonstrate a listening culture to promote trust and understanding between them and people using the service. People and their relatives did not always feel listened to. A relative said, “Our office contacts are great at the minute - but I don’t always receive the rotas … again this has been mentioned and while it gets rectified it’s not a constant communication.” We were also told by a relative, “We have the opportunityto raise any concerns we may have; these tend to be around poor communication from the office and problemsaround administration.” Another relative said, “Contact with office staff is good, but I do feel some members do need to brush up on their communication skills.”

The provider had worked to improve communication throughout the service. Since our last inspection ‘morning meetings’ had been implemented which were attended by the office team and the nurses; these helped ensure information was shared. The registered manager told us, “I’m hopeful staff would feel better than before. There are a lot of conversations and trying to find best way; morning meetings work well. The new system can be overwhelming, but they have worked well and see the benefit from them.”

Most staff who gave feedback were positive. A staff member told us, “They seem a lot more put together now and have a better day to day running of things.” Another member of staff said, “Communication between carers and the Sugarman team is very good. They regularly contact me, check that I am okay, and confirm availability before shifts, which I really appreciate.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support.

Managers were knowledgeable about the issues and the priorities for the service. They had engaged well with CQC since the last inspection and were keen to improve the service. The new system was being implemented in stages to allow for initial issues to be resolved. The medicines administration record (EMAR) was done first, followed by daily logs. They had seen an improvement in EMAR recording.

Staff had not always checked daily logs and therefore had not identified some of the gaps in records we found. A staff member told us, “We all need to check notes every day, but not 1 of us is doing it because we do not have time.” We fed this back to the provider, and they were aware this was an issue. The registered manager said, “It is a challenge which we are having planning meetings about for the next year. We are looking at having a central person whose role would be to monitor logs/alerts etc.”

People did not always feel they could speak up and that their voice would be heard.

The provider’s whilstle-blowing policy did not include any named individuals with contact details for staff to approach. There was a dedicated email address, but the alternative was for staff to use the main office number. Therefore, we were not assured the whistle blowing procedure was effective to ensure staff felt able to speak up.

Most staff confirmed they were able to raise concerns, but some staff continued to describe issues with communication with the office team. Care staff tended to speak with the care/rota coordinators at the office. They gave mixed feedback about the support they received, and not all felt supported or had much involvement with the managers of the service. A staff member said, “They don’t communicate with me; don’t think I’ve ever spoken to them.” Another member of staff told us, “We have emails and numbers to call if we need to contact but they do not answer at times and never getback to you.”Another staff member said, “Everyone is approachable, but we are not heard.”

People had not always shared their concerns about staff competency with the service. The provider told us this was not their experience when they sought feedback from people. This may suggest people are reluctant to speak up or room for improvement in the provider’s approach to engage with people; they planned for feedback to be gathered by an independent person to support with this.

The provider valued diversity in their workforce. They had policies to support fair treatment of staff. The service had an equality and diversity policy. Staff did not raise any concerns related to equitable treatment.

The provider’s processes to monitor the quality and safety of the service were not always clearly documented. People’s care was reviewed annually for changes in needs, but we did not see evidence of care record audits to ensure all documentation was included and we found some examples of discrepancies and gaps throughout records. The registered manager told us they checked care records and gave feedback to staff where amendments were required. We saw an example of this but their process to ensure all gaps in care records were identified was unclear.

The provider had implemented an electronic system; this allowed for real time monitoring of daily care and medicines records. Staff at the office received an alert when medicines were not administered and would query this with care staff. Daily logs had been allocated among various staff including those in the community to review and this had not always been completed in a timely way; we found some records did not evidence care completed as required and the provider had not identified this as the review had not yet been done. There were plans for some clinical tasks to have alerts to be monitored in the same way as medicines which would mitigate the risk of missed clinical tasks.

The provider’s process for monitoring staff competency refreshers was not robust. They had a tracker which listed all staff where the competencies they required for the people they supported were meant to be highlighted. We found several had not been selected, meaning there was a risk refreshers would not be completed as required. The registered manager told us these were admin errors with the tracker and rota co-ordinators always completed a manual check of staff competency before assigning them to people’s rotas.

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. A professional told us, “They are quick to raise concerns to us when there are any and collaborate well.” Another professional said, “Managers within Sugarman Health and Wellbeing are polite, understanding, caring, and work well and flexibly with the ICB when required. I believe the service is well-managed.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system.

The provider had a new system which was being implemented at the time of our assessment. The registered manager told us, “It has been life changing, and they [staff] have really embraced it.” It was being rolled out gradually, starting with electronic medicine administration records (EMAR) and daily logs. The registered manager said, “Wehave already started seeing improvements and we can see there have been feweralertsthanatthe start of December and an entry for every single due dose which shows all alerts have been actioned.”

There were further plans for incident reporting to be accessible on the remote tablets for care staff to complete at the time and share with the office team as well as implementation of reviews and supervision forms to be accessed and completed on the system to allow for immediate follow up. The provider also intended to have ‘friends and family’ access to the system.