Essex Care Consortium - Colchester

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• 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

At our last inspection we rated this key question inadequate. At this inspection the rating has improved to requires improvement. This meant the service 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 continued to be in breach of legal regulation in relation to governance at the service. We looked at all of the quality statements for Well-led at this assessment. We found the service was not always well-led. Although some improvements had been made since the last inspection, the assessment found ongoing concerns about governance and oversight of the service. You can find more details of our concerns in the evidence category findings below. The provider continued not to have effective governance systems in place to identify risks to the quality and safety of the service. There was a lack of accountability and systems in place at provider level to safely manage risk. The senior management team did not keep up to date with statutory guidance in relation to supporting people with a learning disability and autistic people, specifically where periods of seclusion were carried out. The provider had learned lessons from previous incidents and made improvements to keep people safe from the risk of choking, but needed to ensure these improvements were embedded and sustained. Managers had worked well with partners to ensure people received joined up care. The service valued diversity in their workforce.

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’s statement of purpose included the vision and values of the service; however, staff were not aware of what these were to know what was expected of them. The provider was unable to demonstrate how they ensured staff knew, understood and implemented the core principles and objectives of the service, including the values, attitudes and behaviours expected. Our previous inspection found low staff morale due to a sudden death in the service, high use of agency and staff turnover. Staff told us morale amongst staff had improved. They felt supported and more optimistic about the future.

The provider was not always focused on continued learning and improvement. They had no development plan to drive improvements needed and ensure risks were understood an actioned within reasonable timescales. The NI told us changes in director and business managers, had led to issues being missed. They were looking to recruit a consultant to help direct the service moving forward to ensure they had clear vision and credible strategy to deliver high-quality care.

Whilst staff viewed managers as very supportive, we found they lacked knowledge about the legal responsibilities that go with the role. The NI and managers lacked understanding of the risks and issues facing the service, which meant legal requirements were not always fully understood or met. It was clear from discussion with management they had not engaged in local manager or national provider forums or development groups for best practice guidance, expertise or resources to improve the service and lead to better outcomes for people.

Managers were visible within the service, led by example and demonstrated a positive, compassionate and listening culture. However, there continued to be a lack of experienced leadership. Whilst the registered manager and assistant manager demonstrated a passion and commitment to the people using the service, they lacked support and direction by the provider. The training matrix reflected the NI and managers had completed limited training to ensure they had the skills and knowledge to lead effectively.

Staff were aware of the whistle blowing process and different forums available to them so they could speak up if something was wrong. Staff confirmed they were actively encouraged to raise concerns with managers and felt confident their voices would be heard.

The providers whistle blowing policy set out the procedures underpinning their approach to whistleblowing. This contained the contact details to the relevant organisations, and helplines for staff to raise concerns in confidence. All staff had received training about whistleblowing as part of the induction and were confident they could raise concerns. Staff meetings and group supervisions were also used as a forum for staff to speak up about concerns.

Staff told us managers were supportive and considered their wellbeing when planning rotas. This included flexible working arrangements accommodating their availability to work, alongside their own commitments, and personal circumstances. They told us managers had made reasonable adjustments to facilitate their protected characteristics and religious beliefs. The registered manager told us, they had included people using the service in interview panels when recruiting new care staff. This ensured they had a say on who would be employed and involved in the provision of their care.

The provider employed a multi-cultural and diverse workforce and had robust measures in place to ensure they were treated fairly in line with their equality, diversity, and inclusion policy. They had identified and taken action to address equal opportunities for staff and address any disparities in the experience of staff with protected characteristics. The NI confirmed the service did not currently have a workforce development plan, but confirmed they would complete this as a matter of priority. This is an essential plan for providers to ensure they have the necessary people in place to meet the business objectives now and in the future.

Feedback from the NI, registered manager and staff did not always provide assurance or evidence of robust, effective or well-embedded governance and oversight measures. Management and staff had not recognised and identified issues that impacted on the quality and safety of service provision. This did not provide the oversight needed to ensure effective development, improvement and sustainability to the quality and safety of the service.

There continued to be a lack of understanding around the principles of auditing and how results of audits can inform the quality monitoring and assurance cycle. Audits were not always used effectively to assess, monitor, and mitigate any risks relating to the safety and welfare of people using the service. This had led to a lack of oversight in areas such as risks to people’s safety, medicines management, and the need for better systems to manage cleanliness and hygiene. The provider failed to follow their own governance policy and statement. This required them to operate effective governance, including assurance and auditing systems and processes to assess, monitor and drive improvement in the quality and safety of the service. Recruitment paperwork was previously raised as a concern, documents were not easily located, including staff recruited under sponsorship. There was no clear system in place to ensure all recruitment documents had been obtained and checked to ensure suitability of employees. Policies and procedures essential for guiding staff on day-to-day operations, decision making and ensuring compliance with laws and regulations, were not up to date. These contained names of previous employees, and all were set to ‘draft’ status, and not reflective of current guidance and best practice. Whist reporting of incidents and safeguarding concerns had improved, where people had been authorised to be deprived of their liberty these had not been submitted to CQC, as required under regulation. The registered manager confirmed they would submit authorised DoLS retrospectively.

The service worked well and in partnership with health professionals to support care provision and joined-up care. Specialist services were involved, where necessary to ensure people received the care they needed to stay well.

Staff and managers told us they had good access to health professionals, which included input from physiotherapists, occupational therapists and the community learning disability team. Staff knew people in their care well, and when to seek medical attention to ensure people received care and treatment when they needed it.

Partner agencies told us engagement with the service had been positive over the last 12 months. No concerns, or safeguards had been raised. Professionals told us, the service had worked well with visiting professionals, including the learning disability team and SaLT.

Systems were in place reflecting the service worked well with the relevant external stakeholders and agencies. Weekley GP visits took place to assess, treat and monitor people’s health. Managers and staff worked collaboratively with the SaLT and dieticians which had led to improved systems to protect people from the risk of choking. Staff sought advice and worked well with other professionals to support people to manage behaviours, associated with anxiety and distress.

The service fostered a positive culture where people and staff felt they could speak up and their voice would be heard. Staff told us they had access to regular supervision and support from leaders and felt able to raise concerns with managers.

This quality statement requires providers to have continuous focus on learning, innovation and improvement across the service. Although the service had made improvements, the provider was unable to demonstrate how they were monitoring the improvements to ensure they are embedded and sustained. Whilst we did identify shortfalls during this assessment, the provider was responsive to our findings and acted immediately on key areas of improvement.