Care at Home (Midlands) 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 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. The service was in breach of 1 legal regulation in relation to good governance at the service.

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 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’s overall purpose and culture. They told us there was a positive team working approach across the organisation. One staff member said, “The aim of the service is to provide good care and support people, to enable them to stay at home as long as they can, we promote independence and provide piece of mind for their family. We do this by working together.”

The provider’s systems and processes included a review of people’s daily care records to ensure staff were meeting people’s assessed care and support needs. There was good evidence of where shortfalls were identified, this was followed up with staff. Staff meeting records confirmed how the management team had discussed complaints and actions required to improve service delivery.

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. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. Throughout this assessment the management team were found to be open and honest and showed a great commitment in wanting to improve the service. In response to our initial assessment feedback, the management team took immediate actions and implemented new and improved systems and processes.

Staff spoke positively about the management team who they found approachable, supportive and responsive. They had confidence in the ability and willingness of management team to act on any issues or concerns brought to their attention. A staff member said, “Both the registered managers are very good, anything we need we can ask; they are very approachable and always available. The whole of the management team are brilliant, all of them.”

The management team told us how care staff had the opportunity to further develop within the service, this was via an apprenticeship scheme and senior care positions had been created. The management team were all able to support the care staff in the delivery of care if required, and a staff member gave examples of when this had occurred.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The provider had created systems and processes, including policies and procedures such as Freedom to Speak Up, Whistleblowing and Safeguarding to support staff to raise any concerns.

Staff told us they had access to the provider’s policies and procedures and felt confident to speak up when required.

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.

The service benefited from a diverse workforce, which promoted equality and diversity. People had the opportunity to be supported by staff from similar cultural backgrounds. Staff confirmed the management team were fair, treated them equally and they had not experienced any form of discrimination.

Through their communication with staff, including one-to-one and group supervisions, they had found ways to engage with and involve staff, so they felt empowered to raise any concerns. Staff received training in equality and diversity to raise their awareness of these principles.

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, or share this securely with others when appropriate.

The provider’s systems and processes to assess, monitor and mitigate risks were not sufficiently robust or fully effective. Shortfalls were identified in the oversight and monitoring processes of care calls. Whilst we were aware the provider had recently transferred to a new electronic system, this required further time to fully embed and be sustained. The previous system had not effectively monitored care calls to ensure people were receiving the correct care call time and duration as assessed as required.

This assessment identified shortfall’s in how staff were formally supported. We found evidence staff had not received supervisions, spot checks and welfare checks at the frequency the provider expected. Staff meetings were happening in geographical areas, however the frequency of these were also variable.

The provider had investigated complaints and had taken action to make improvements. However, they had not always recognised when these were safeguarding concerns, and therefore had not reported them to the local authority safeguarding team or informed CQC as required.

Medicine management practice was not sufficiently robust. Documentation errors regarding administered or missed doses were not always identified in audits. Although monthly medicines audits were conducted, they failed to identify errors found during the inspection, indicating a need for improved oversight.

The provider had no audit process to ensure people’s care plans and risk assessments were sufficiently detailed and personalised.

The management team agreed improvements were required and immediately took actions and implemented new and improved monitoring systems and processes.

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.

Overall, feedback from people and relatives was positive about the service they received, with many people telling us they would recommend the service to others. One person said, “This is a good company with excellent carers and staff and yes, I would recommend them.” A relative said, “Yes this is an excellent company-my mother is happy and so am I and it is to be recommended.”

Staff confirmed how they worked with external professionals and how this was supportive in enabling them to meet people’s individual needs.

An external health care professional was positive about partnership working and said, “I find the management team open and honest I find them to be transparent working with their partners. Trusting, encouraging, having shared goals, and agreeing on what they want to achieve. Resilient, they are prepared to learn from experience.”

The providers systems and processes however, identified incidents people had experienced that had not been shared with the local authority or CQC. Whilst this was a lack of oversight by the management team, it identified improvements were required. It is important information is shared with partner agencies as soon as identified, to support people to achieve positive outcomes.

The provider had a commitment to continuous learning, innovation and improvement across the organisation and local system. The provider was an accredited trainer and examiner. The management team attended a variety of local forums with the two local authorities they worked with and attended a local Homecare Alliance meeting. This enabled attendees the opportunity to share good practice, access specific training and to develop new and improved systems and process based on evidenced based practice. However, from reviewing management meetings there was limited evidence of how the provider had implemented any learning and innovation to the service.

The provider encouraged creative ways of delivering equality of experience, outcome and quality of life for people. We reviewed examples that captured some people’s experiences and actions of staff that had enhanced people’s quality of life and well-being. For example, one person had a number of long term health conditions that impacted their independence and risk of social isolation. This person was supported by a regular staff team who had a holistic approach to care, enabling the person to live independently and enjoy a fulfilling life.