East Anglia Domiciliary Care Branch

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

Governance oversight and processes in place, as well as the ethos, values and behaviours of managers and care staff did not always ensure people using services lead confident, inclusive and empowered lives. RSRCRC principles were not always meet or integral in policies or processes. Quality governance systems and management structures were not effective in identifying and addressing shortfalls to ensure good quality, safe care and support was always being provided and giving oversight of staff to ensure they had the training and supported to deliver the care people needed safely. The service did not have clear visions, processes for learning and driving improvement. These concerns resulted in breach of Regulation 17.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found leaders of the service did not demonstrate the required experience or capability to deliver person centred care or to ensure risks were well managed. They failed to recognise they had developed a culture that did not robustly promote or uphold people’s rights. We found the provider and registered manager was not always open and transparent with others involved in people’s care or during our assessment. This meant professionals and people’s representatives were not always in receipt of information to make an accurate judgement about the quality and safety of the care provided, which put people at risk.

Policies and procedures were not always fit for purpose. For example, the restrictive interventions policy did not refer and cover regulatory or national standards such as RSRCRC. It referred to the MCA 2005 but failed to explain expectations of the service to carry out MCA assessments and did not refer to best interests decisions at all. The auditing and monitoring process stated in the policy was not effective or evident to pick up examples of restrictive practice happening that we identified as part of this assessment. The training staff had received had not equipped them to identify restrictive practices and challenge it if they saw it, which has led to a poor culture within some homes.

We were not assured there was sufficient capacity, capability and integrity to ensure that the organisational vision could be delivered, and risks were well manged. Staff did not always feel supported. The management structure had recently changed, leading in a reduction of locality managers who had oversight of a group of services and service leads who had to day to day management responsibilities for a group of homes. There were 2 locality managers one of whom was not currently working which left 1 to manage the whole area. Due to sickness and vacancies the locality managers were covering more homes then had been planned. Leaders were frustrated as they felt the standard of the homes they had originally covered had slipped due to how many more homes they were covering. Although we received positive comments from some staff and leaders, we were not assured by the management of the service. The provider was aware there was a poor culture in the way staff worked in homes, which may affect the quality of people’s care. We were not assured that these matters were being addressed as we identified concerns during this inspection they were already aware of but had not put actions in place to resolve.

There was no real oversight for the provider to identify there was a lack or no staff supervision taking place. There was a supervision tracker which covered 5 service leads and no support staff or locality managers. There was also a lack of competency assessment to ensure staff were working in a safe way. Although service leads said they worked closely with staff to check what they were doing, it would be a challenge to address poor performance issues with staff who do not have this supervision, and checks in place.

We found number of restrictive practices which staff did not speak up about. This appeared to be due to a lack of knowledge, training to identify the practices as restrictive and feeling able to. This included locking of doors, spending and dubious intimate practices.

There has been a lack of promotion by the provider and managers to staff, people who use the service and relatives about how to raise concerns and support to be able to do this safely. This has led to low reporting and complaints.

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.

The system of oversight by senior managers was disjointed with some information being held centrally and not locally, such as training and audits. The locality manager who covered a network of homes told us they did not routinely have oversight of competency assessment, training or details of audits and was not involved in any governance meetings on the running of the service. This meant they did not have oversight to manage what was happening in the homes they covered. The locality manager carried out monthly quality checks on services but there was no written format of these to catch the actions, or to identify ongoing themes, trends or delays. We spoke to a service lead who had undertaken administrative duties prior to the restructure. There was now no one in the office to undertake these duties and there was no admin support to the service leads. This service lead was expected to day to day manage 2 homes in 19 hours including taking on the administrative duties. The administrative support used to check hours people worked, and such things as ensuring agency profiles were up to date and manage the paperwork for archived. This has resulted in agency staff being used who had not had the correct training, not all agency staff profiles being held, and paperwork being kept in people’s homes resulting in spare rooms becoming offices.

The governance system in place was poor and did not give the provider the oversight they needed to ensure the services run safely. Quality assurance processes and audits were not routinely completed. When actions were identified, there was a lack of oversight to ensure these were completed. There was no overall system in place to ensure people’s individual risks were identified and for such things as who their relative and next of kin were, which did not support contingency planning. There was no corporate training plan giving details of what training should be given when, the frequency of refreshers and competencies, which made it hard to see exactly what training should have taken place. There was no analysis of accidents, incidents or complaints to identify patterns or themes. There was no complaints system. There was no system to give oversight of house or support staff meetings or supervisions.

Feedback received from people and their relatives was mixed. Some relatives told us referrals to health care professionals, such as GP, were made when needed. Some said they were informed when this happened, the majority said they were not. They were not all made aware of any involvement by health care professionals and most did not receive updates on their person’s care.

We found examples when referrals had not been made to health care professionals when they should have been. This included when a person had bowel monitoring in place, with guidance about when to refer to the GP. We found a number of examples when referrals for this person should have been made and were not, which put the person at risk of decline in health. There had not always been open and transparent working with the Local Authority for such things as safeguarding, people’s finance and management changes. The provider has now been working with them and appropriate measures put in place to ensure people’s monies are safeguarded.

The system to give oversight did not provide sufficient monitoring to identify when health referrals were not being made. We identified epilepsy care plans which had not been reviewed since October 2022, which stated they should be reviewed by epilepsy nurse every six months. This put the person at risk of not having their epilepsy appropriately managed.

The structure in place for management did not allow for complete oversight by local managers which impacted on their ability to learn and make improvements. This led them to be disempowered to lead staff to learn, improve and be innovative.

There was a lack of process to identify areas of learning and improvement. We identified concerns detailed in staff meeting minutes of risks to people which had not been actioned prior to being highlighted as part of this assessment. There was no monitoring to identify such things and learn. There was no analysis of incidents, accidents, events or complaints that had occurred to consider patterns or themes to aid learning and improvement.