Dimensions Lincolnshire Domiciliary Care Office

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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

We found there was good, compassionate leadership in place who were all passionate about providing quality person centred care and ensuring the wellbeing of their staff teams. People and staff felt able to speak up and make suggestions or raise concerns. Staff shared similar values the provider employed the services of family consultants to help shape the future of the organisation while ensuring people first. The provider worked hard to promote awareness of the risks of closed cultures and how to prevent them. Diversity of workforce, equality and inclusion of all was actively encouraged and incorporated into the providers policy and procedures. There was good partnership working and system in place to ensure oversight of quality of care at all levels.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Not all staff were aware of any formally shared values of the organisation, however, the values they had personally, aligned with the providers ethos and was evident in their practice. Leaders told us about how they ensured staff were aware of the principles of CQC’s policy on Right support, right care, right culture (RSRCRC). A senior staff member told us, “The (RSRCRC) is covered off in induction not that term but we look at good practice and the culture and what that looks like we talk about it out meetings, closed culture check list, can be sent, [registered] managers talk about that in their own meetings and information comes through [communication systems].” Staff also told us about recognition schemes called the ‘inspiring people awards’ they have in order to share excellence. Staf are awarded vouchers and thanked for their inspiring contributions to good care. They also told us about another scheme called ‘Working together’, where they share with people the outcomes of the organisations aims and objectives so that feedback is structured to compliment the informal feedback shared at local level.

The provider’s work with family consultants also helped to shape and inform the values and shared direction of the organisation. The provider had done a lot of work around closed cultures and ensuring this was shared with the workforce to promote awareness and prevention. The aims and objective and values were regularly reviewed.

There is good leadership in place at all levels of the organisation. Leaders had the same drive and passion to deliver person-centred, inclusive care that respected the diversity of people's needs, identify and culture. They had the skills and knowledge required to do their roles and shared this with staff teams. Managers were understanding of the pressures staff faced and individual staff situations that required flexible working. Staff told us they felt valued and supported. One staff member said, “The [registered manager] is really nice. I could go to them. Senior managers, they do come round and we see them at the office and when on training. We could go to them to too.” Another staff member said, “The [registered] manager and deputy manager are very supportive They are both really approachable they get back to you straight away. I am happy to raise any concerns.”

Systems were in place to recruit and train staff and leaders with a view to succession planning and ensuring the right staff were in the right roles. They provided additional mentoring and senior managers conducted checks and audits to ensure tasks were delegated appropriately and staff and leaders had the right support.

Staff were aware of the whistleblowing procedure and how to reduce the risk of developing a closed culture. They told us they all felt happy to speak up and there were plenty of forums and opportunities to do so. One staff member told us, “I like the [registered] manager, they are really supportive and have really good interaction with the people too. They speak to them all the time and have meetings. If there were ever any issues you could just call the [registered manager] and they would act on it.”

There was a culture of speaking up and supporting various initiatives and groups where people, their relatives and staff could voice concerns or share feedback and ideas. For example, listening events, newsletters, complaints and compliments process, conferences and surveys. People told us they felt genuinely listened to and did influence change as a result. This was positive as it meant this was delivered in a meaningful way.

Staff felt there was a culture of equality and this was promoted though an awareness of cultural events, fair and equal pay across genders and supporting diverse needs of staff with reasonable adjustments and flexible approaches to work. A senior manager told us, “We do huge pieces of work as part of the great place to work initiative, our local HR advisor is lead of the local equality, diversity and inclusion, the heading in the induction is, ‘I feel I belong here and talks about all kinds of diversity and equality and we talk about how we make people feel. When some of our teams were saying we want to celebrate differently we wondered if that was to do with culture so we are looking at other religious events and celebrations, we also have a monthly document that is cultural events of the month and lists all the events and so everyone is aware.”

The values and inclusivity programme promoted by the provider helped to ensure compliance with the workforce race equality standard and the workforce disability equality standard. There were audits and systems in place to check on equality and inclusion and fair pay across genders.

Senior staff told us, manager competency was checked regularly through individual supervision, annual appraisals, spot checks, quality meetings, managers meetings and on training courses. A staff member said, “Our roles are delegated through the organisational structures, which are made clear and they have clear expectations of us. The operations director will ensure we are fulfilling our roles.”

There is a system of quality assurances processes in place that mean all staff and managers could access information on site or remotely relevant to their roles. This helped them to ensure they had the latest information to review and analyse incidents and performance to identify actions for improvement. Systems were secure and information shared appropriately. The provider had plans in place for emergencies and other types of contingency and worked towards succession planning by continually developing the staff team and offering opportunities for professional growth such as shadowing any role within the organisation.

People and relatives told us they thought the staff and registered managers worked well with other professionals and agencies to meet people’s health, environmental and financial needs.

There was clear evidence showing how staff and leaders worked in partnership with external professionals and communities to share information and learning. Staff told us examples of how they contacted health professionals or social workers when concerns came up or a person needed more support. They said communication was good and understood the benefits for people of working together as a multi-disciplinary team.

External professionals gave very positive feedback about work achieved and the impact this had on people's lives. They told us they enjoyed working collaboratively as teams and as a provider as staff acted on advice and were always open to suggestions. One professional old us, “We hold quarterly relationship meetings and annual visits and they are very well attended by all registered managers and a [senior leader]. In my last quarterly relationship meeting both the lead practitioner and myself commended them on the many examples of positive outcomes for those being supported. This included, charity coffee morning/cake sale attended by neighbours, holidays, reductions in medication, support to obtain mobility vehicles, decreases in incidents, GP compliments regarding end-of-life care provided and Improved family relationships. I recently had a very positive visit to a new service of theirs and spoke with a person supported at length, who appeared to be very happy with the service and was undertaking plenty of activities."

The registered managers held regular meetings with other professionals to review all holistic needs of people, give updates about the organisation and identify and share any barriers to good care. They were open and honest about their processes and sharing what had worked well and what had not to agree ways to improve joined up working.

Staff and registered managers were keen to continuously look at ways they could improve the quality of care provided. They told us about plans to look at using digital/video care plans for people in the future, ways they are reviewing how to better support people at times of distress and how they continually review the format and content of care plans. One registered manager told us, “We were transferring support plans last year to digital, so we have been holding quality assurance reviews of the support plans, where we look at each section. They are good, we look at [people’s] risk management and health history. It has been a massive learning process and managers would say, ‘I didn’t think of that’, so now have round 2 of quality assurance.” We saw a compliment from LeDeR following a review of the care and treatment of a person during the end of their life. LeDeR wrote, “We are writing to you on behalf of the Lincolnshire ICB Senior LeDeR Team. We have recently conducted a review of [person’s] life and death and following presentation of the review to the LeDeR Governance Panel, we would like to take the opportunity, on behalf of the LeDeR Governance panel members, to acknowledge the outstanding care and support provided by your team at Dimensions. This undoubtedly enabled [person] to live their best life in the community. Governance panel members, following the presentation wished to share this positive feedback with [person’s] care and support team and to commend you all for your commitment and dedication to them. A senior leader said, “I am really proud of[registered manager] and our end of life and good death work, we try and promote it for people it is outstanding and we have had a compliment from LeDeR for the work we have done, it was last year. We talk about informing LeDeR in our meetings,”

There was culture across the whole organisation of learning from incidents and other events and promoting further professional qualifications for staff. As a provider they actively researched best practice and new ways of working and shared these with teams. Creativity for meeting people's individual needs was proactively encouraged and new ideas rewarded.