Keem Healthcare Ltd

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 service. This key question has been rated requires improvement. This meant the service was not always consistently managed and well-led. Leaders and the culture they created did not always promote high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance at the service.

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 registered manager carried out spot checks, competency reviews and individual supervisions with staff to ensure expected standards were maintained. The registered manager worked closely with health professionals and participated in multi-disciplinary meetings to discuss people’s needs and the challenges some faced when they refused certain aspects of their care.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. Leaders understood the context in which the provider delivered care, treatment and support. They embodied the culture and values of their workforce and organisation.

It was evident from our visit, the registered manager and operations manager wanted to provide the best care. They had invested in electronic systems that managed their care call allocations, care plans, risks assessments and staff recruitment. The registered manager was confident they had the right staff and good links with other health professionals. However, the registered manager and operations manager needed to understand the importance of making sure people’s records were more detailed, and audit records demonstrated what they had checked.

A relative’s feedback to the provider showed they were pleased with their leadership. This relative said, “I am extremely happy with the service provided and would hate to lose this team as I can 100% rely on them to deliver the best possible care.”

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

Staff said management were approachable, available and supportive. Staff said communication was good. Staff said they did not always have meetings, but they did feel included through updates, messages and WhatsApp group chat. Staff said they had training which kept their skills and knowledge updated and felt able to share any feedback or raise concerns. The registered manager said they had an open door and staff could contact them anytime.

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 said they had taken sponsorship staff from other sponsors who could no longer provide the work needed to those staff. The registered manager recognised recruiting new staff was a challenge. They had considered various ways of recruiting staff, whether through local colleges, internet job boards and advertising. The registered manager welcomed a diverse staff team, and they had considered their rates of pay to help attract the right staff with the right skillset.

The registered manager said they treated people and staff how they wanted to be treated. The registered manager valued their workforce. Staff said they had consistency in who they supported which meant they had flexibility to work around their shifts. Staff we spoke with said Keem Healthcare was a good agency to work for and they felt supported through their training and had opportunities to share any concerns or feedback.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.

The provider had quality assurance processes built into their electronic systems and policies. We asked for examples of completed audits where we could see what was checked, when, by whom and what was identified, with any actions. We were not given any checks. The registered manager said, “I do checks but I don’t record what I have looked at.”

However, the registered manager had completed a check of people’s medicines management. That check failed to confirm a person who required to have thickened fluids with their medicines, received thickened fluids. There was also a high number of medicines being refused by this person, yet this check failed to include this. Checks also did not document what actions were in place, or being taken to ensure this person had their medicines when required. Where errors were identified such as a missing signature, in some cases it recorded further action as ‘not applicable’ meaning staff may not be informed of their error to improve their practice. This meant the provider did not have effective systems to assess, monitor and improve the quality and safety of the service. Quality assurance systems needed to become embedded in the running of the service to ensure they captured any organisational issues and risks.

We saw observed practice, spot checks on staff, people’s feedback and staff feedback helped the registered manager have some assurances about the quality of care provided.

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.

Staff recognised the importance of family members in people’s care and involved families when required to keep them updated. Relatives feedback was positive. Processes for working with and alongside other health and social care professionals was considered which benefitted people in their care. In some cases, more accurate record entries would help demonstrate what staff had done in response to healthcare professional feedback to meet people’s current and changing needs.

The provider was not always focussed on continuous learning, innovation and improvement across the organisation and local system.

During our visit, we found there were no effective systems to learn and improve across the service. The registered manager and operations manager were reliant on each other, rather than looking externally to CQC or other organisations who could help share information on themes, trends or topics. The registered manager agreed that they needed to improve and update ‘paperwork’. We found audits did not focus on specifics, or what was being checked, so they did not identify the issues we found or any learning. There was a lack of understanding of what a good audit was, which clearly impacted on what could be learnt.

The registered manager welcomed the inspection and assured us they would consider and review how they could make improvements in those areas we discussed with them.