Sure Care Chester

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 requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The provider was in breach of legal regulation in relation to governance at the service. Governance and oversight processes were not effective at ensuring people received safe and high-quality person-centred care. People were at risk of neglect and harm as care had not been delivered as planned or in line with people’s preferences.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were not assured managers always promoted a culture of wanting to provide the best possible care to the people they supported, as people had not always received the care they needed. We were not assured leaders always promoted a positive culture which was person centred and achieved good outcomes for people. People had not always received the level of care to meet their requirements and preferences.

This location has a condition of registration that it must have a registered manager. At the time of inspection, no manager was registered (although an application had recently been submitted to CQC). The service had undergone changes in management over the last 2 years, although there was a new temporary manager in place, a permanent manager had been recruited and appointed during our assessment.

The manager told us, “I love it here. My line managers are so supportive, and I believe in the Sure Care ethos, the provider wants quality of care for people. It's a family run business with good values here.”

Policies were in place to help ensure equality and diversity were promoted. We saw how people’s protected characteristics did not act as a barrier to accessing care and support.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

People, their relatives and staff told us the service was not always well led. Managers had not always demonstrated a proper understanding of the risks facing the service. People had been left without care, sometimes without prior notice. This meant people were at risk of neglect and potential harm.

As a result of missed care calls, some people had to rely on family members for their care and support. This did not demonstrate compassion by leaders.

Leaders were not always capable managers. Some staff told us they were often asked to cover staff sickness, often at very short notice, which meant call duration for people overlapped.

People did not feel they could speak up and their voice would be heard.

People told us when they did speak up they felt their voice was not always heard. Comments included, “I have told them [Manager] I don’t want a certain staff member to come as I don’t really get along with them, but they keep sending them” and “I don’t really feel listened to, and I am not asked for my feedback.”

Staff did not always feel they had the freedom to speak up. Feedback from staff was mixed. One member of staff told us they could speak up in meetings. Comments from other members of staff included, “Staff are reluctant to speak up, they are afraid of losing their jobs,” and “When I do speak up, I don’t feel my concerns are acted on.”

Processes such as a complaints policy, were in place to help ensure when concerns were raised, leaders investigated, and lessons were shared and acted on. Staff surveys and questionnaires were used to gather staff feedback. We viewed staff feedback questionnaires, but the provider was not able to confirm when this had been collated as the paperwork was undated. The manager told us they planned to send out questionnaires to staff in the very near future.

During our assessment, the management team told us how they planned to visit people who had voiced concerns to apologise, and to start putting plans of action in place to resolve any issues. This demonstrated the provider’s commitment to building a culture where people could feel their voice would be heard.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

We were not fully assured staff were treated in an equitable way. Some staff had experienced overlap in care calls, and were not given enough travel time between calls, which had left staff feeling dissatisfied with their role and not fully appreciated.

However, processes were in place which helped to protect the rights of staff under the Equality Act. Risk assessments and any reasonable adjustments measures were located in staff’s personnel folder. This helped to create a more equitable and inclusive organisation.

The manager shared examples of supporting people with childcare commitments, by providing hours which fitted around their responsibilities.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Where systems and processes were in place to help ensure effective governance, management and accountability, these had not always been used effectively. Shortfalls in practice had not always been identified, such as missed and late calls, short call duration, recruitment processes, risk assessment scoring, gaps in staff training and lack of staff supervision and appraisal. This was a breach of Regulation 17, good governance.

Although some individual audits had been carried out for people, there was a lack of overarching governance and oversight. Although missed, late and cancelled calls were recorded, there were no audits of this information to analyse the information. When we asked the manager about this, we were told the electronic call monitoring systems were checked daily to ensure calls were monitored, however, there were no written records to evidence this. This meant we were not assured the provider had an accurate picture of risk across the service at any one time. When we relayed people’s feedback about some recent missed calls for 2 people, the manager wasn’t aware of the situation, and we were told they would need to investigate.

Missed calls were more frequent during managers absences. Meaning there was no effective forward planning when it came to staff deployment and staff rotas. We raised a safeguarding with the Local Authority (who commissioned many of the care packages) to alert them to the situation and to keep people safe. Audits and monitoring that did take place were misleading, for example, missed calls were categorised as ‘cancelled calls’ as the provider had given some prior notice. However, this was not truly reflective of the situation, where care had in fact been missed and not delivered to the person.

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.

We could not be assured processes were effective enough to help people receive positive outcomes with regards to their care and support, given some people had not received the care and support they required.

The manager was able to share some examples of working with external agencies such as the local authority commissioners, to help ensure learning was taken from any incidents and practices improved as a result.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Processes were not effective to ensure adequate learning happened when things went wrong. For example, staff supervision and appraisal processes were not carried out as often as they should have been. We also found some staff had not signed their supervision record until several months after the event. Some staff’s supervision input had not changed for years, meaning current goals and issues were not properly explored. This meant there was limited opportunity for staff to learn from past practices.

Feedback from leaders confirmed they had some understanding of how to make improvement happen and how improvement was an ongoing process. The manager was new to the service and had begun to identity and act on the cause of any shortfalls in the safety and quality of care. The manager was in the process of overhauling current practices and introduced new auditing documents to help better monitor the quality of care and to prevent any shortfalls in practice recurring

Whilst we did identify shortfalls during this assessment, the provider was responsive to our findings and had devised an action plan to help address the issues. A further manager had also been recruited to the service during our assessment, to help with risk management and to help implement immediate improvements at the service. In addition, 3 new care staff had been recruited.