Totus Care 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.

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 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 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. They did not always understand the challenges and the needs of people and their communities.

Relatives and the staff member we spoke with described the service culture positively. Feedback indicated that staff were caring, committed to the people they supported and focused on providing good quality care. The staff member told us they felt supported in their role and spoke positively about working within the service.

However, we were unable to obtain feedback from a representative sample of staff members to fully understand whether these views were shared more widely across the workforce. This limited our ability to assess how consistently the service's values, expectations and culture were understood and embedded throughout the organisation.

There had also been significant leadership changes within the service over the preceding six months. The previous Registered Manager had left the service and the manager who participated in the assessment left shortly after the assessment activity was completed. Frequent changes in leadership can create challenges in maintaining a consistent vision, culture and direction for staff and people using the service.

Whilst there was some positive feedback about the culture of the service, the limited staff feedback available and recent management changes reduced assurance that there was a clear and consistently embedded shared direction across the service.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Relatives and the staff member we spoke with were positive about the new manager and described them as approachable and supportive. Feedback indicated that the manager had begun to build positive relationships with people, relatives and staff. However, those we spoke with also recognised that the manager had only been in post for a relatively short period of time and was still becoming familiar with the service.

Despite this positive feedback, we identified concerns regarding leadership oversight. Records showed that the manager's mandatory training was not up to date, which reduced assurance that they had maintained the knowledge and skills required to effectively fulfil their role and responsibilities.

In addition, the manager left the service shortly after the assessment activity had been completed. This followed other recent leadership changes within the service and meant there had been limited opportunity to demonstrate sustained leadership or drive improvements over time. Frequent changes in management can impact continuity, oversight and the embedding of a positive culture.

We also found that the nominated individual did not always demonstrate a full understanding of their regulatory responsibilities. There had been issues with the submission of statutory notifications, and discussions during the assessment indicated they had a limited awareness of some aspects of the day-to-day operation and management of the service. This reduced assurance that governance and regulatory requirements were being consistently understood and effectively overseen.

Whilst people and staff spoke positively about the manager's approach and intentions, the lack of stable leadership, gaps in training compliance and weaknesses in regulatory oversight meant the provider could not demonstrate consistently capable and effective leadership.

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

Staff were encouraged to raise concerns, share feedback and discuss issues affecting the quality of care provided. The staff member we spoke with told us they felt confident speaking to the management team and would have no hesitation in raising concerns if they identified issues affecting people using the service.

Staff described managers as approachable and said they would be listened to and supported when raising concerns. This helped to promote an open culture where staff felt able to speak up and contribute to the ongoing development of the service.

We did not identify any evidence to suggest staff felt unable to raise concerns or that barriers existed which would prevent them from doing so. The feedback received indicated staff understood how to escalate concerns and felt confident that appropriate action would be taken.

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 provider promoted an inclusive working environment where staff were treated fairly and with respect. The staff member we spoke with described feeling supported within their role and did not raise any concerns relating to discrimination, unfair treatment or exclusion.

Feedback received indicated staff felt able to approach managers for support and were treated as valued members of the team. There was no evidence to suggest staff were disadvantaged because of their individual characteristics, backgrounds or personal circumstances.

Although we received feedback from only one staff member, no concerns were identified regarding equality, diversity or inclusion within the workforce. We also found no evidence through our assessment that suggested staff experienced barriers to accessing support, development opportunities or involvement in the service.

Overall, no issues were identified in relation to workforce equality, diversity and inclusion. The evidence available indicated that staff worked within a supportive and inclusive environment where they were treated with fairness and respect.

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

The provider had systems in place to monitor the quality and safety of the service; however, these were not always effective in identifying concerns or ensuring improvements were made. As a result, the provider could not demonstrate effective oversight of the service.

We reviewed audit records and found examples where audits had identified gaps within care planning documentation, but there was no evidence that the required actions had been completed. For example, a care plan audit identified missing information within one person's records, yet the care plan had not been updated to address the issues highlighted. This reduced assurance that audit findings were consistently acted upon and embedded into practice.

We also identified concerns regarding compliance with regulatory requirements. Statutory notifications had not been submitted for all notifiable incidents as required. For example, records relating to a safeguarding incident indicated that a notification had been completed; however, the relevant notification had not been submitted to the Care Quality Commission. This meant the provider's systems for monitoring regulatory responsibilities were not always effective.

Although a governance audit completed in June 2026 had identified some of the issues found during our assessment, not all concerns had been recognised. This indicated that quality assurance processes were not sufficiently robust to provide leaders with a comprehensive understanding of the service's performance or areas requiring improvement.

There was also a lack of clarity regarding management oversight during a period of leadership instability. A staff member told us the nominated individual did not play an active role in the day-to-day running of the service. However, the nominated individual informed us that they had acted as the manager following the departure of the previous Registered Manager in February 2026. This inconsistency reduced assurance regarding governance arrangements and accountability during this period.

The provider had developed a quality improvement plan to drive service development and address identified concerns. Whilst this demonstrated an awareness of the need for continuous improvement, records showed that a number of actions remained recorded as 'in progress' despite the stated completion dates having passed. This reduced assurance that improvements were being implemented within agreed timescales and effectively monitored to completion. In addition, the quality improvement plan did not address all of the issues identified during this assessment, including some concerns relating to care planning, mental capacity processes and governance oversight. This indicated that the provider's approach to quality improvement was not yet sufficiently comprehensive to identify and address all areas requiring development.

The service had experienced significant management changes in recent months, including the departure of the previous registered manager and the subsequent departure of the manager who participated in the assessment. Whilst the provider had sought to maintain continuity during these changes, the issues identified demonstrated that governance and oversight arrangements had not always been effective in ensuring the service was well managed and continuously improving.

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

The provider had systems in place to monitor the quality and safety of the service; however, these were not always effective in identifying concerns or ensuring improvements were made. As a result, the provider could not demonstrate effective oversight of the service.

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.

The provider worked in partnership with relevant professionals and organisations to support people’s health, wellbeing and wider needs. Records demonstrated that external agencies and healthcare professionals were involved when required to help ensure people received appropriate support.

Staff were aware of the importance of working collaboratively with others and were able to describe how they communicated with relevant professionals to promote positive outcomes for people using the service. Information was shared appropriately to support continuity of care and ensure people received coordinated support.

There was no evidence that people experienced difficulties accessing support from external services or that partnership working was ineffective. We did not identify any concerns regarding the provider's engagement with professionals, stakeholders or the wider community.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The service demonstrated some commitment to learning and improvement. The staff member we spoke with told us there had been positive changes since the new manager had come into post and described improvements in communication and oversight. They also told us that learning from incidents, concerns and day-to-day practice was shared with the staff team to support improvements in care delivery.

However, the manager had only been in post for a short period of time and a number of issues identified during this assessment had not yet been addressed. As a result, there was limited evidence to demonstrate that improvements had been fully embedded or had resulted in sustained positive change across the service.

The manager who participated in the assessment left the service shortly after the assessment activity concluded. Whilst the provider acted promptly to appoint a new manager, the service had experienced a number of leadership changes within a relatively short period. This included the departure of the previous Registered Manager and subsequent changes in management arrangements.

Frequent changes in leadership can affect the continuity of improvement programmes, the embedding of learning and the delivery of long-term service development. Whilst staff reported positive developments and there was evidence that learning was shared within the team, further management changes created a risk that progress may not be sustained and that outstanding improvements may be delayed.