Adjoy Healthcare Westberkshire

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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

We found a lack of management oversight in the service. Although senior management told us they carried out audits, they could not provide us with evidence of these. In addition, they had no contingency plan in place to ensure information stored electronically is protected. Although staff and management knew people well, we found not all care plans were sufficiently detailed to ensure staff were provided with as much information about people as possible. There was no system to ensure staff stayed the full time with people and use this as a learning opportunities for any late visits. This was a breach of Regulation 17 (Good Governance). People were happy with the service they received from the service, telling us staff were kind and attentive towards them. Staff said they felt involved in the service and were happy working for the agency.

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.

Staff felt there was a shared culture within the agency. They told us, “I do feel we have a shared direction and a good working culture within us” and, “The mission, vision and values of the agency was a key focus during my induction and I believe all these are embedded in the agency’s strategy and other working documents which sets the stage and serve as guide or reference for me as I go about my work.” Management told us, “We have an intelligent team who are eager to learn. We support staff who stay with us for 6 months. We want to keep staff as that will support our growth.”

Management told us they had a continuing improvement plan which included staff learning and areas for improvement. However, at the time of our assessment we were told that the flash drive which contained much of the information and evidence we needed to review has crashed. This meant management were unable to show us everything on the day, but instead sent it through to us following our assessment visit. We also received evidence of staff training which showed staff undertook equality and diversity training. In addition, regular staff meetings were held in which staff said they felt they could contribute towards.

Management told us they were all experienced in the care industry, with the registered manager registered as a nurse and the care coordinator undertaking her NVQ Level 5. Staff felt supported by management. They told us, “I feel the management are capable, compassionate and inclusive leaders by their words of encouragement and directions” and, “When we hold meetings and have discussions, they always give room for us to make suggestions, state observations and give our opinions about certain situations. They care about our welfare. They are very considerate when they make decisions.”

During our assessment visit we were told that the flash drive containing much of the information related to the running of the service had crashed. This meant senior management were unable to provide us with much of the documentation we needed to review. There was no contingency plan in place and as such management had to send us the information following our visit. As a result, management were not always able to give us the information we required or answer our questions. For example, they told us they had an improvement plan but were unable to provide us with the detail of this. In addition, they told us they carried out reflective practice with staff, but could provide no examples of these. Following our visit, management were still unable to provide us with examples.

Senior management told us staff had been information through their induction to always speak up and that they could call management individually if necessary. Staff confirmed this, telling us they felt able to speak up. They told us, “If I had any concerns about any aspect of my role, the running of the agency or management I will have the confidence to report” and, “ I will speak up about any concerns. The management have listening ears.”

Staff supervisions were used to discuss any conflicts and to remind staff if they wished to whistle-blow it was their right to do so. Staff meetings were held were staff had the opportunity to raise concerns, make suggestions or share information. We reviewed the minutes of two meetings and read that staff had felt comfortable raising some issues for discussion with management.

Management fostered diversity within the staff team by sponsoring staff from abroad. They told us, “We have permanent staff. They are mostly sponsored. We guarantee them 39 hours work a week.”

There were policies and procedures in place that staff were expected to follow and staff had diversity and inclusion training.

Senior management told us, “We carry out audits, we hold staff supervisions quarterly, complete routine checks on staff unannounced and contact clients to check they are happy with the service.” They added, “We carried out a client survey in December 2023 and had six responses.”

Management told us they carried out audits of people's care plans, risk assessments and through the electronic care system staff time keeping and length of time at a call. However, they were unable to show us the outcomes of these audits either during our assessment visit or after which meant management could not evidence they were completing them. Despite carrying out a client survey, the responses had not been collated to look at learning or areas that required improvement. In addition, medicine administration records were not always kept. This meant a risk of people not receiving the medicines they required, although this risk was minimises by the fact people were aware and knew the medicine they needed. There was no system to ensure any trends of safeguarding concerns or complaints could be identified or evidencing that the review of daily notes took place. We found some people’s care plans lacked relevant information, such as whether the person required two care staff on each call, how long calls should be for and no background history about the person to help staff get to know them. This demonstrated a lack of management oversight by senior management. It meant management would be unable to identify themes or areas that required improvement. However, at present the agency was still delivering support to a small number of people and we found both staff and management had a good knowledge of people, which meant the risk of poor care was reduced.

We were unable to obtain feedback from people due to the service not working closely with partnership agencies and other stakeholders.

The senior management team informed us they belonged to online social media groups for domiciliary care agencies. However, other than this, they could not give us further examples of working with partners.

We were unable to obtain feedback from external partners and stakeholders due to the service not working closely with them.

Senior management told us they did not have any particular links with national organisations or peer groups. They did not attend meetings or participate in training or learning which may help with developing the agency. We spoke about learning specific to staff in relation to caring for people with a learning disability or autistic people, as we were told this was the area the agency wished to move. However, management were not aware of the requirements introduced in 2023 relevant to this, such as the Oliver McGowan training.

The registered manager told us, “We have a continuing improvement plan and we should develop an audit plan to add to this.” They added, “We look for ways to improve people’s care such as one person whose memory had started to reduce. We suggested they got a safe to store their medicines which was what happened. This helped them to remain safe.”

We reviewed the continuing improvement plan provided to us following our assessment visit. We found much of what was included covered what we had discussed with management on the day as suggestions for improvements. This demonstrated a lack of innovation from senior management or an understanding of where the agency needed to develop. This lack of oversight was in part due to the absence of audits taking place. Because of this management were unable to determine any shortfalls or areas for learning.