Blossom HCG 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

Relatives and staff felt the service was well managed and the management team were approachable. Governance systems did not identify where improvements were required and as a result meant that they could not implement lessons learnt to improve the support people were receiving. Processes had not ensured staff held a shared vision of the values needed to consistently provide safe care and support. The management team did not have a well-developed understanding of Right support, right care, right culture.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us there was an open and honest culture and that the management team were approachable and supportive. Staff said there was a positive culture among the staff who worked hard as a team to ensure they had a positive and supportive place to work. Staff at all levels were approachable and keen to talk about their work. They demonstrated a strong level of commitment, dedication and were very proud to work at the service. Although we found improvements needed to develop the culture and visions and values of the service, the management team were transparent throughout the assessment and responsive to the feedback given to them. They accepted our findings and began putting measures in place to reorganise the management of the service and to develop their vision and values with input from people, relatives and staff. This redeveloped approach to a shared vision, strategy and culture would enable the improvements found at this inspection to embed into good practise.

Although staff feedback to us was that there was an open, caring and people first culture, we found there was an organisational culture where restrictive practice was embedded. For example, in the homes we visited people were not free to use all areas of their home. We found kitchen cupboards, food cupboards and fridges were locked. When speaking to staff about the rationale as to why these restrictions were in place staff were unable to provide a clear rationale for this. The training provided had not ensured a clear understanding and promotion of people’s rights under the Mental Capacity Act 2005 or safeguarding at all levels in the staff team. Staff were not always knowledgeable about what constitutes safeguarding matters. Staff described events where restraint was used, and where restrictive practice was used that was outside the guidance, however then told us they have not reported any safeguarding or witnessed any safeguarding concerns. Staff spoke about the lack of formal debriefing when incidents occurred. Risk assessment and care planning processes had not always resulted in care plans which reflected and acknowledged people’s diverse needs. The lack of embedded processes enabled elements of a closed culture to be present in the service that did not promote transparency, equity, equality or human rights. Through our discussions with the provider it was clear that they were passionate, enthusiastic and motivated to provide a good quality person-centred service. They placed importance on people having equity within their communities and equal opportunities. We acknowledged the absence of the provider for a significant period of time, and the appointment of a senior manager who was later dismissed had impacted on the providers ethos. However, through our assessment they demonstrated to us their commitment to making improvements across the service.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us they felt supported by the management team to carry out their role. One staff member said, "I am very lucky that I am part of a great team. We support and understand each other and all work together. Morale can sometimes dip due to pressures of the job but Management are always there to support, guide and listen, which is something I wouldn’t have said a couple of years ago.  I have been working for Blossom for a long time. At times, it has been very frustrating and I’ve felt unappreciated but things have improved massively. Management now manage. "

There was a lack of clarity about the management roles in the service. Each had a team of support workers, a team leader and a service manager. They then reported to the registered manager, who reported to the provider. During the assessment it became evident that the role of service manager was not operating as it needed to, and the provider responded by removing this post after consultation. They redeveloped the management structure to streamline this and provide greater accountability to staff. Governance systems in place were not always effective. Audits were completed but lacked specific detail or analysis. For example, the care plan audit asked if consent had been sought, but did not review the quality, content or ensure these were updated as needs changed. There was no system in place to monitor restraint and although falls, incidents, injuries etc were logged, no analysis of this had been completed to understand possible trends. Audits completed by staff and management had equally failed to identify the improvements we have identified, including inconsistent reporting and investigation of accidents and incidents and insufficient provision of training. The provider was unable to provide us with an overarching service improvement plan. They told us they had discontinued use of the one developed by the previous operations manager and would develop a new improvement plan based on this assessments findings and their own internal checks. Policies and procedures were not always fit for purpose or followed by staff when they were complete. For example, the ‘restraint’ policy did not set out what provider systems were in place to put regulatory or national standards into practice. There was no information about what staff needed to do if they used restrictive practices.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.