CARE 24/7 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.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained as requires improvement. This meant the management and leadership was inconsistent and assurance processes continued to be ineffective in identifying areas of shortfalls. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service remained in breach of the legal regulation in relation to good governance.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders and staff shared the same direction of wanting to provide an excellent standard of care and personalised service to people. Staff were able to describe the values and mission of the service, and leaders had identified cultural issues within the service and had acted to resolve the issues successfully. However, we found that some risks were still not well managed for people using the service. Although some improvements had been made since the last inspection, the provider had still failed to make improvements around governance concerns identified.

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. For example, where previous concerns had been identified in relation to recruitment practices and changes had been made, leaders still did not follow their policy or legislation to ensure appropriate recruitment checks were in place.

However, staff and people told us leaders were visible and supportive and had the skills to lead effectively . The registered manager had the skills and knowledge to manage the service and the nominated individual had sought further training where gaps in knowledge had been identified.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff told us they had access to regular supervision, team meetings and support from leaders to raise concerns. When concerns had been raised, the provider had acted appropriately to investigate and resolve them.

The provider promoted and 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 told us how the team works together to support one another. A staff member told us how leaders supported them with reasonable adjustments to remain in work.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. Audits were being completed but continued to fail in identifying the concerns we found in relation to medicines, care plans, risk assessments, daily notes and recruitment practices. For example, we still found gaps in care plans around person-centred information about religion, nutrition and individual preferences. This placed people at risk because sufficient information was not available for staff to provide care and support to people based on their preferences. We found 1 risk assessment contained another person’s name in the narrative. Therefore, it was not clear if staff had the correct information when providing support to the person. Daily notes did not record how and when a person was being repositioned which placed the person at risk of skin breakdown. Furthermore, daily notes did not capture information relating to an incident that occurred, the incident report form contained different information to the daily notes. This meant it was difficult to establish exactly what happened and when and if the incident had been appropriately reported with actions and learning taken to prevent reoccurrence. Audits had also failed to ensure newly recruited staff had adequate recruitment checks in line with legislation and the provider’s policy. The service’s business continuity plan (BCP) had been updated since the last inspection but it still did not address how the service would identify and prioritise service users at risk in the event of an emergency, such as those requiring care in bed or living alone. Contact details within the plan was limited and areas within the plan had not been filled out fully. Staff we spoke with were not aware of BCP but told us they would communicate with leaders in a crisis. This meant that the BCP did not effectively communicate about what staff and management needed to do in an emergency in case they could not reach leaders.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. One partner told us the service did not always answer emails in response to updates provided and therefore, they were not assured the information they provided had been received by the service and subsequently acted upon.

However, appropriate referrals had been made to external health and social care professionals where this was required for people, and partners told us they had witnessed staff treating people with dignity and respect.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. Since the last inspection the provider had not always ensured learning and improvement had been made in some areas. For example, there had not been improvement in relation to managing risks for people, ensuring care plans, risk assessments and daily notes were up to date and accurate, audits being effective, and recruitment was in line with legislation and policy. Whilst we did identify shortfalls during this assessment, the provider was responsive to our findings and started to act on key areas of improvement. They had also resolved some concerns found at the last inspection in relation to the recording and reporting of safeguarding incidents and submitting notification of other incidents. The provider informed us they had purchased a new case management system which would allow them to improve their practices and they were in the process of transferring information into the system.