Seren Healthcare Solutions Limited

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 service’s first assessment. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (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 values of the service were embedded in the provider’s systems, this included their recruitment and induction processes and team meetings.

Staff told us they were able to get to know people they supported well and communication between the managers and families assisted them in providing effective support to people. Staff said, “Yes, we have a positive culture. Everyone is nice and friendly. We have regular contact with everyone” and “We can have a meeting as group of staff who care for same person to talk through any issues. It’s helpful, to have those meetings and discuss so we are all aware.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The registered manager told us they had support to undertake their role well, they had access to regular external support, including registered manager networking groups.

People and relatives told us leaders were approachable, and they could speak to them when they wished to. A relative told us they had spoken with the registered manager, and said they were ‘really lovely, approachable and helpful.”

One staff member said, “Senior staff and the manager are always around. If I’m not sure what is happening or if I need advice, I know I can call them. They are always quick to answer and will try and sort any issues.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Managers promoted a culture of being open and honest.

Procedures were in place for people, their relatives and staff to provide feedback and speak up, this included supervisions and surveys. The registered manager told us a suggestion box had also been put in place to encourage people to raise anonymous concerns.

Staff understood the service’s whistleblowing policy and told us they were encouraged to speak up if they had any concerns. One staff member said there was an open line to call and communicate anything to managers as needed.

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.

Staff had completed equality and diversity training. The registered manager ensured systems were in place to support their diverse workforce. Where staff were not familiar with the local area or culture, systems were in place to support them, this included practical support as well as an information pack.

Staff had the opportunity to discuss their welfare, job satisfaction and any support they required within their supervisions. Staff told us they could raise any issues they had and would be supported and the registered manager was open to suggestions.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The registered manager understood their responsibilities in relation to their regulatory requirements around notifiable incidents. While no notifications to local authorities or CQC had been required, systems were in place to review incidents, accidents, complaints and concerns and report them as required.

The service had a business contingency plan and a system in place for prioritising people’s care in a crisis.

There was an overarching quality assurance process to monitor the quality of the service being provided which included monthly and quarterly audits, regular quality of care spot checks for staff and governance meetings. The processes were effective in identifying areas for improvement, for example a medicines audit had identified the need for an improved EMAR system to ensure accurate recording of people’s medicines administration, this was in the process of being introduced. However, they had not identified the requirement for individual decision specific mental capacity assessments and best interest decisions for people.

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.

People’s care records showed the provider worked in partnership with a range of agencies and incorporated guidance for people into the care they provided.

Staff told us they reported any changes in people’s presentations to their seniors or managers, who then made any referrals to external partners as required.

A professional told us the provider was, ‘covering the care effectively and liaising with the appropriate services’.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

The registered manager told us how learning from within the service was used to drive improvements. For example, they had introduced a buddy system for new staff to provide them with additional support from an experienced member of the staff team.

Staff members were supported to develop in their roles and with opportunities to further their skills and training, for example completing NVQ qualifications.

The registered manager and other leaders discussed innovation within monthly meetings. New initiatives which were in the process of being introduced included a new governance auditing system and electronic medicines system to provide more detailed oversight in these areas. The registered manager also had an action plan they were working towards to ensure compliance in the service they were providing.