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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

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.

During this assessment, we found a breach of regulation 17. Some staff training levels were not sufficient. As a result, we were not assured that all members of staff at the service had the right skills and knowledge to deliver safe and effective care. We have requested an action plan from the provider for staff training. There was also not enough efficient auditing over some areas of people’s: medications, nutritional intake, weight monitoring, mental capacity and ability to consent.

This service scored 57 (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. Managers were aware of the requirements needed for improving the service and outlined these to us on Inspection. The service is currently in the process of becoming more digitalised with its technology and will be supported by the organisation (Sheffield Royal Society for the Blind) to achieve this. Managers told us they felt assured they would receive the correct support from their Nominated Individual during this transition. Staff told us becoming more digital would improve the efficiency of the service and enable staff to carry out their duties more quickly and concisely. However, some staff were not aware of the vision and values of the service and didn’t always feel as though their ideas were listened to for promoting a culture of collaboration. One staff member told us, “[Managers] don’t listen to feedback from us [staff], staff meetings focus more on what we [staff] are doing wrong.”

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. We received mixed feedback from staff, some staff told us they felt that supported in their roles, they received regular supervisions and appraisals, and felt positive they could approach management with issues. One staff member told us, “I find supervisions useful and feel listened to.” However, some staff said that they didn’t feel supported in their roles and there was a negative culture within the service which needed addressing. One staff member told us, “I don’t feel I can approach them [managers] with my issues, the working relationship with some staff at times, isn’t very professional”.

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

Staff understood their responsibility to raise concerns about the people they cared for. Staff understood ‘Whistleblowing’ procedures and could confidently explain who they would raise concerns to. One relative told us, “I feel comfortable escalating concerns about [relative] to [managers] and feel listened to, they are very responsive.” Another relative told us, “Communication with managers is good. If I have any worries about [relative] they will sit and listen to me.”

The provider valued diversity in their workforce. They worked towards an inclusive culture by improving equality and equity for people who worked for them. The provider had policies and procedures in place regarding equality and diversity. Fair recruitment processes were in place, which helped to protect the rights of staff under the Equality Act. Risk assessments and reasonable adjustments were utilised if required for staff. Examples being, leaders supporting a staff member with their training due to Dyslexia and managers encouraging a staff member with Epilepsy to put awareness posters in the staff room.

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. Although systems and processes were in place to ensure oversight of the quality and safety of the service, such as daily manager walk-rounds. We found training records for some staff were incomplete. Whilst we found no evidence people had been harmed, the provider had failed to continuously ensure that the staff at the service had the correct knowledge and skills to provide safe and effective care. Medication audits also failed to highlight issues around PRN medication protocols and the need for competency refreshers for staff. Retrospective to our Inspection, managers put PRN protocols in place. However, governance and audit systems required improving to ensure they identified concerns in relation to mental capacity, consent, weight monitoring for people unable to weight bear, records in relation to people’s food/fluid intake and maintaining a positive culture within 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 service engaged with external professionals to support improvements within the service, for example working with the local authority. They maintained regular contact with health and social care professionals and supported people to attend and engage with services in the local community.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research. Mixed staff feedback told us, “There is immediate action from [managers] when we raise things, and I can see the changes happen.” Another staff member told us, “We have very thorough team leader meetings, where we can speak about residents care or discuss supporting new residents.” However, some staff feedback told us that their opinions and improvements were not actively sought from leaders. We found staff were not always given opportunities to reflect in meetings on when things go wrong and develop these skills. One staff member told us, “They [managers] have meetings with us [staff], but nothing changes when raised with them.” We found no rewards for innovation or evidence of staff being involved in additional training opportunities, such as champion schemes which could positively impact staff and the services development.