Flamelily Independent Living

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 ratings inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant there were shortfalls in service leadership. Leaders and the culture they created did not always assure the delivery of high-quality care. The service was in breach of the legal regulation in relation to the governance of the service. Governance procedures were not always effective. The provider had not identified all the quality or risk concerns we found. This meant prompt action had not been taken to address shortfalls. The provider had appropriate policies in place. Most staff felt supported by management and were aware of the values of the service. Management was keen to learn and make improvements to the service

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew the aims and values of the organisation and felt there was a positive and open culture at the service. All the staff we spoke with were aware of the provider’s values. One senior member of staff told us, “Values are respect one another, confidentiality, promoting independence, service to others. We discuss staff values in every staff meeting, supervisions and come up in emails and administrations.” The registered manager said, “We have done impact training, leadership training and talked about the values and devised them with staff. In our office they are on a table and on the wall and discuss in team meetings. Our email signature has our values at the bottom of it so if I send an email to staff will have the values at all times.”

The provider’s values were shared with staff through training and team meetings. The service had a business plan and statement of purpose that set out their aims and visions. The provider had policies in place to support equality and diversity.

Most staff felt management were approachable and listened to their views. Staff felt able to contact the office at any time for advice or support. One staff told us management were, “Approachable any issue I am always calling the office, open door policy. In team meeting the manager will say you can ask me anything and you can raise any issues.” Senior management felt fully supported in their role and that they worked well together and felt it was more like a family here and loved working for the company. One said, “If I wasn’t supported I couldn’t continue to work for the company.” However, there were concerns with some management knowledge gaps in relation to their understanding of their role in relation to the MCA.

There was a stable and consistent management team who were caring and motivated to develop their skills and knowledge. They were clear about their own specific roles and responsibilities and how they contributed to the overall success of the service. They were open to feedback throughout the assessment process and took prompt action when needed.

Staff were aware of whistleblowing procedures and knew how to share any concerns. Most staff we spoke with felt able to speak up. Leaders told us they were fairly positive that staff would speak up if they had any concerns about people through a phone call or coming into the office. However, they were aware some staff did find it difficult to speak up and they were working at ensuring staff develop their confidence in doing so. To support their development the provider had relaunched their Speaking Up policy and again reminded staff during a team meeting about their right to speak up and provided assurance action would be taken to address their concerns. This was newly introduced, and time was needed before we could judge this to be effective.

The provider had appropriate polices in place as well as a policy on Duty of Candour to ensure staff acted in an open and transparent way in relation to care and treatment if people came to harm. Minutes of meetings showed this was discussed with staff on the importance of raising concerns.

Most of the staff had come from overseas on a sponsorship programme and felt valued and welcomed. One staff member told us, “I would say there are equal opportunities for everyone.” A member of the management team told us, “I would like to think any one that walks in the office feels welcomed communication is key and checking in with them and having these conversations.”

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. Systems were established to make sure staff were supported when needed and had equal opportunities. The provider held regular meetings with the staff to discuss any concerns. These included office meetings, team meetings and person specific meetings. These informed staff of any updates on people’s health and training opportunities. Records of meeting minutes showed these had been used to reinforce the values, vision and purpose of the service.

The management team told us they were hands on at the service and regularly carried out visits to people for quality improvement purposes. They were aware of how staff were working and carried out monitoring regularly. The registered manager told us they used to have a quality assurance manager in place, but not at present. They carried out audits themselves along with members of the management team and used management reports to monitor the service. Leaders were not aware of some of the concerns we found in relation to covert medicines, risk assessments and people’s records and therefore could not describe the actions they were taking to address the shortfalls. When reviewing accidents, incidents and safeguarding we were not assured all notifications had been sent to CQC as part of their registration as required. The provider felt this was an oversight and has since sent them to us. The provider was looking at ways to improve the duration of people’s care visits as they were aware this was an area of concern.

Records showed improvements were needed and governance systems did not pick up our concerns. The provider and senior staff used a series of audits to monitor the quality of the service. These included audits of medicines, recruitment files, care plans, complaints and compliments. However, these had failed to identify the concerns we found in relation to people’s care, medicine and decision making records. For example, care calls being cut short and people not having choices about who was visiting them in their own home. While some concerns had been identified by the provider and action being taken to address these concerns in relation to care calls being cut short. Further concerns were needing more robust action to make the care person centred to people’s needs.

People told us they were happy with how the agency worked with services in the community. One relative told us, “The management team that I speak to [staff members names] have been great at staying in touch about everything, including developments or improvements. The manager has personally visited my relative and I several times to ensure that his care is the best it can be.” Another relative said, “I know the manager who has kept in touch. The company is very good and I am pleased that they are looking to engage some activities for Mum at a day centre.”

Leaders told us how they engaged with community teams of health and social care professionals on a regular basis. The registered manager told us they worked closely with the local authority and commissioners and kept them up to date with people’s care. They took other agencies feedback on board and acted on it to make improvements to people’s care. The registered manager told us they attended local provider forums to share best practice and to keep up with the latest updates.

A professional told us, “We have a good relationship with the provider and no concerns around this area were raised.”

Records showed the leadership team and staff worked effectively with health and social care professionals to meet people’s needs. Staff had undertaken reviews with relevant healthcare professionals as people’s needs had increased and made referrals to occupational therapists, community nurses and GPs when needed.

Management told us about improvements they had made to the service and they were always keen to learn and make improvements. For example, they worked with the local authority and attended their training and webinars events to improve the service in leadership management. The registered manager told us they were a member of a national association in relation to home care and attend meetings to improve learning and develop best practice.

Staff meetings and supervisions showed these were used as a way to make improvements to the service. It showed staff’s feedback was valued and these improvements were then shared amongst the team. Staff were rewarded for high standards of care and shared feedback was shared amongst the team to improve staff wellbeing. Following our visit staff had been reminded they needed to ensure people received their full visit time and this would be monitored by the provider to ensure this improvement was made. The effectiveness of some audits needed to improve to ensure the provider would always identify all areas that required improvement.