South Norfolk Carers Limited

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 inspection we rated this key question requires improvement. At this inspection, the rating has changed to inadequate This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in breach of legal regulation in relation to the governance of the service.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities. The service had not met their own aims, objectives and expectations. People and staff told us this and our assessment findings confirmed it. This had negatively impacted on people, their relatives, and staff. The culture of the service was poor and this had resulted in low staff morale and staff feeling undervalued, deflated, unheard, and frustrated. The service did not have the processes in place to demonstrate it listened to and acted upon concerns, were open and responsive to suggestions, and used systems to drive improvement; all of which helped to ensure an open and transparent culture was in place.

The service 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. Staff did not feel the service was consistently well-led or that the registered manager had the appropriate skills, knowledge, and credibility to manage the service. They told us the registered manager did not demonstrate empathy, respect, or the values they would expect from an inclusive and positive leader. One staff member said, ‘The management team are not particularly approachable or supportive. When I've asked questions before the tone and manner which comes across in a reply makes me feel stupid. When I've gone into the office sometimes people don't speak unless I try and make conversation. It's not a very warm and inviting environment and the management staff can talk quite abruptly.’ Staff told us that due to the close personal relationship between the two most senior leaders, there was sometimes a hostile or tense environment in the service and they felt they were not treated entirely fairly because of this relationship. Whilst the provider had a policy in place acknowledging the risks associated with this type of relationship, they had not followed this and taken steps to reduce the risk.

Staff told us they did not feel they could speak up and that their voice would be heard. Staff gave us examples of where they had previously spoken up and/or raised concerns where they did not feel listened to, taken seriously, or had confidence their concerns would be investigated and acted upon. One staff member told us they felt like they were there just to do a job and that staff’s opinions ‘did not matter.’ Despite the provider having a ‘Freedom to Speak Up’ policy in place, the service could not demonstrate they had paid due attention to this and used it to inform practice. Whilst there were some systems in place to actively seek staff feedback, such as staff surveys and supervisions, these had not been fully effective at ensuring staff had open and safe opportunities to provide feedback which they felt would be listened to and influential in helping to improve the service.

The service did not work towards an inclusive and fair culture by improving equality and equity for people who work for them. The service had a diverse workforce in place, however staff did not feel they were treated fairly and equitably, mainly due to a conflict between the two most senior managers within the service. The provider’s associated policy acknowledged this risk but hadn’t taken appropriate and robust steps to mitigate it. We heard examples of where staff’s wellbeing had not been fully considered and cared for. Some staff told us they felt pressurised into working when they were unwell and one staff member gave us an example of the service’s unrealistic expectations of them. Staff had received training in equality and diversity and the service had assessed staff’s health in case any reasonable adjustments were required.

The service 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. The governance system in place had failed to ensure a consistently good service was delivered and had not identified the widespread shortfalls identified at this assessment. From the governance records we viewed, we saw that quality monitoring audits were not robust nor used meaningfully and whilst the provider had systems in place to oversee the service, these too had failed in identifying concerns. The people who used the service, and staff, raised concerns about the governance and management of the service. A relative told us, ‘I would say management have to improve their systems. They need to make sure rotas are accurate so I know who will be making the visits and at what time.’ Out of the 12 staff who gave us feedback on the quality of the management of the service, eight told us this needed improving.

The service did not always understand their duty to promptly collaborate and work in partnership, so services work seamlessly for people. They did not always promptly share information and learning with partners or collaborate for improvement. Whilst in practice the service worked in collaboration with other stakeholders, they did not always make robust records around this and there were sometimes delays in reporting issues. This meant it was difficult to audit and fully understand the care and treatment people had received, or when professionals made recommendations and this placed people at risk. The service did not always fully and openly collaborate with the people who used the service and the people that were important to them; people told us they did not feel the relationship they had with the management team was consistently open and honest and people often felt their concerns and experiences were dismissed. Staff did not feel they were given the opportunities to influence how the service was delivered and effective systems were not in place to share learning from incidents; the records we viewed did not demonstrate that the service worked in collaboration with people and staff when they raised concerns or shortfalls.

The service 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. The service could not demonstrate they had a good understanding of how to make improvements happen or that they used reflective and collective practice to problem-solve and make improvements; people and staff told us this and the records we viewed confirmed it. As described throughout this report, the service had failed to involve people, their relatives, and staff in developing and improving the service. Despite being given opportunities for improvement, the service had not used these to ensure people’s experiences were the best they could be.