Generations Care Ltd

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 remained 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. The service was in breach of legal regulation in relation to governance at the service.

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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. Staff spoke positively about the provider and their experience working for the service. They understood and shared the provider’s vision and values. One staff member said, “Generations has made a great difference, I didn’t have a lot of confidence, and they have helped me to be confident. At the beginning it was hard, but they gave me support and training and motivated and encouraged me to do better and now I feel I am better.” Processes to involve people and staff in developing the culture included seeking people's feedback, observed staff practice and questionnaire’s seeking people’s views on the quality of care and service provided. Where suggestions were made, action was taken.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, leaders did not always have the skills, knowledge, experience and credibility to lead effectively through their own quality assurance. For example, whilst quality assurance processes were in place these were always effective because there was no record of actions taken. One registered manager said, “We do checks but don’t record what we have done.” The issues we identified during our assessment had not been identified in their checks or acted upon. Staff told us the registered managers were approachable, supportive and available when they needed advice or had concerns. Staff were valued and the provider ensured positive feedback was shared with individual care staff. Systems were in place to guide staff on what was expected of them through staff meetings, observed practice and one to one meetings. Processes were in place to recognise people and staff’s achievements and to celebrate these.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff were aware of the provider’s whistleblowing policy and procedures to report poor practice. Staff felt confident to report any concerns and felt they would be listened to, and actions taken. One staff member said, “It’s the right to speak up for the client or even me. For example, if I had concerns about a staff member, I would tell the coordinator.” Another staff member said, “To me it means to protect the client from harm such as isolation, neglect and assault. If I had any concerns I would inform the coordinator, manager and CQC.” Staff had their practice observed to ensure any training and learning was applied.

The provider 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 felt they were treated fairly and said they felt able to speak up if they had concerns or something went wrong. Managers had an open-door policy and welcomed feedback from staff. There were effective processes for staff recruitment and induction. Staff received training in equality and diversity and other areas to keep people safe and to treat people as individuals and with respect. Staff care call rotas were considered for reasonable adjustments, such as considering travelling time between calls by planning them into geographical areas. Records of staff meetings highlighted staff’s awareness of treating people equally and in a way people preferred.

The provider did not have clear responsibilities, roles and systems to manage effective good governance. Through their own quality assurance system, they did not act on the best information about risk. Following our last visit the provider sent us an action plan telling us how they would improve their quality assurance. We found some areas had improved; however, the registered manager told us they did not always keep records of what was checked, how frequent those checks were completed and what had improved. For example, a provider monthly audit reviewed medicines records and daily records for a small number of people they supported. It was evident from those checks; they had not identified some of the issues we have reported on. Where checks were delegated to others, there was no evidence to show those checks had been undertaken by staff with the knowledge and understanding of what needed to be checked to keep people safe. Daily record checks were not always completed fully so we could not see people received the right support. Medicines audits did not check some medicines continued to be given safely so the provider could not be confident processes kept people safe. We found similar issues at the last inspection. This was a continued legal breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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. People and their relatives told us the provider worked in partnership with healthcare professionals who supported them. One relative told us, “The carers and other professionals complement each other and work together for example carers letting the district nurse know about [person’s] bed sores, and carers and OT (occupational therapists) working together to come up with an alternative to the rotunda.” This relative went on to say, “The carers had listened to the dementia nurse, who had told them that [person’s] dementia will mean that they will be much more confused in the morning, which is when they have to wash them. So, they take their time, remind them who they are and what they’re doing.” Staff told us the provider worked closely with health agencies, families and people who they supported. Technology included use of an electronic application enabling people and their families to be able to see the care delivered at each care call. Families could add notes and instructions for staff to follow at certain times or at each care call. One healthcare professional shared, “I am aware they (Generations) complete a very detailed assessment, creating an individualised care plan, including a ‘this is me’ section for the people they support.”

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. Processes included regular reviews of care with people and families, however some of those reviews had not identified changes were required to ensure people received the right support. Learning from other inspections had not driven the improvements needed to ensure their audit systems were effective, embedded and robust. The provider told us some actions from other inspections had been implemented, but more knowledge and understanding was required. The provider needed to ensure checks delegated to others were robust and they had ownership of quality assurance across the service.