Best Solutions Health Care Ltd

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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

This key question remains rated inadequate. We reviewed 7 quality statements for this key question. The registered manager did not have oversight of the service. Staff reported the manager was supportive, and they felt engaged with the service however processes did not support this. The quality assurance processes in place were not effective and the provider had failed to make improvements since our last inspection. We identified a breach of the legal regulations.

This service scored 25 (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 said they have a vision which is based on been open and transparent. Managers told us they are a respectful provider and are trying to learn and improve. However, improvements were limited and not yet embedded in practice. There was no evidence this was discussed with staff.

The provider did not have systems and processes in place to share and drive the culture in the service. There was no evidence of staff engagement for example staff meetings. The provider did not demonstrate an understanding of the challenges the service faced and had failed to make improvements since our last inspection.

Staff spoke positively about the registered manager, they said the registered manager was supportive and approachable. However, the provider did not have robust systems in place to capture the views of staff. There was no evidence the provider demonstrated how they listen and respond to staff when concerns are raised.

The registered manager did not have an adequate understanding of their role and lacked oversight of the service. The registered manager did not provide evidence to demonstrate how the service was well led. The lack of systems to monitor the quality of the service and provide effective managerial oversight did not allow for lessons to be learnt. There was no evidence actions was taken to drive improvements in the service. This placed people at risk of harm. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Management told us that they foster a positive culture where people feel that they can speak up and that their voice will be heard however there were no systems in place to formally capture the views of staff. Staff told us they felt confident to speak up when needed. Staff were able to demonstrate their knowledge and understanding of their responsibilities relating to reporting concerns.

There were no systems in place to support open and transparent ways of working. Although the service had appropriate policies in place, there was no systems to formally capture the views of staff. The provider was unable to demonstrate how they are listening and responding to staff when concerns are raised. Staff were not supported and their performance was not assessed and monitored.

The service had an equality and diversity policy in place. Management told us staff are trained in equality and diversity however, staff were not up to date.

The provider had policies in place to support fair recruitment, induction and training for staff however the provider was unable to demonstrate these processes were followed. The provider did not have organisational processes to follow to identify and address concerns with staff's working environment or access to development opportunities. The recruitment policy was not followed meaning staff were not recruited safely. Records showed staff did not receive regular supervisions. Supervision did not encourage staff involvement, and staff was not up to date with training. Staff performance was not assessed and monitored and staff meetings were not held regularly and there were no meeting minutes. This was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Management told us there was a new system in place to support with governance. However, we found systematic and widespread failings in the management of the service, which meant service users did not always receive safe care. For example, records of care were not complete and quality assurance systems were not effective. Care plan audits had not been completed and care plans had not been reviewed, Audits of daily notes, repositioning charts and food and fluid charts had not been completed showing a lack of effective quality assurance systems in place.

Processes in place did not support good governance. During the assessment there was systematic and widespread failings in the management of the service, which meant people did not always receive safe care. The provider failed to ensure the quality of the care and service provided was effectively monitored, assessed and there was no steps taken to improve the quality and safety of the services provided. This placed people at risk of harm. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and relatives told us the provider worked well with other agencies when needed. However, we found examples when the provider should of accessed support for people and had not.

Staff told us they were asked their ideas for learning and improving the service. However, there was no staff meeting minutes to show how this was evidenced and used to improve the service.

We did not receive any concerns from partners and stakeholders however, we found examples of the provider not referring people to external healthcare professionals when needed.

The provider did not evidence continuous learning within the service. Quality assurance systems had not supported consistent improvement. We found feedback from our previous inspection had not led to improvement to governance systems during this inspection. Audits to monitor the quality of the service were not completed.

Staff and leaders told us that they were aware of how to report and investigate events and incidents. However, the provider did not effectively record or investigate incidents. There were no systems in place to analyse and identify trends. Therefore, we could not be assured the provider was preventing future incidents occurring.

The provider failed to act on the findings found at the previous assessment to make improvements to the service. There was no evidence of learning and innovation across the organisation There was a significant lack of oversight and monitoring of the service by management. The provider did not maximise the outcome and quality of life for people. During this assessment we found continuous breaches of regulation in relation to safe care and treatment, need for consent, staffing, and governance. This placed people at risk of harm. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.