HF Trust Cheshire

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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

The provider did not ensure there were effective governance oversight and the processes in place were effective, as well as the service being in a turnaround process, the volume of turnaround and changes with the leadership and recent restructures had destabilised the workforce. Right support, right care, right culture principles were not always meet. 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 ensuring oversight of staff through effective regular team meetings, regular supervisions and appraisal processes, they were not being completed to ensure staff had the training, supervision and feeling supported by their peers to deliver the care people required. The service was not well-led and did not have clear processes for learning and driving improvement. These concerns found resulted in a 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.

Staff gave mixed responses; some staff were looking forward to working with the new management team and had attended recent huddles. However, staff members were feeling despondent due to the turnover of leadership, lack of leadership and support, mixed messages, not listening to concerns and the concerns they had for the future of the services they were working in. Leaders told us, ‘’Our values are we appreciate everyone is unique, so we champion equity, diversity and inclusion. Our compassion shines through everything we do. We focus on finding solutions, partnering up for progress and getting others involved. We are proud to paint a picture of what best life possible could look like. The values underpin everything we do, they are woven through the supervision to ensure staff understand and abide by the values but equally feel part of the values and promote fulfilled lives for people we support and comes part of value based recruitment where we look for people to have a feeling of being kind, diversified, visionary.''

There was limited evidence of how the management team instilled a shared vision, strategy and culture. Staff meetings and supervisions were infrequent and when complaints were raised by people or their families, these were not followed through by the provider. There were limited opportunities or systems to enable staff to provide frequent and constructive feedback to improve the culture. There was an action plan in place from 2023 with brief ideas recorded on how to engage staff and people in shaping the culture and direction. However, there was no evidence of progress towards completing this. The auditing and monitoring process 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 and poor outcomes within some homes. Some of the services developed a culture that did not robustly promote or uphold people’s rights.

Leaders told us, ‘’ We are creating an environment where open communication and trust is encouraged. All managers are custodians of culture and lead by example ensuring transparency in their own actions and decisions. All managers are encouraged to own their mistakes and to see them as a learning opportunity and to share them where appropriate. Where possible involve the team in decision making processes especially for things that directly affect them while underpinning the values HFT promotes. The CEO completes quarterly huddles that are open company wide and this shared a range of plans and actions we all need to embrace and being the best care and support partner for people we support on a national scale’’.

There were a lack of systems to monitor oversight of care delivery. As a result, the management team did not readily share information with external partners in a timely way. The management team acknowledged their quality assurance framework meetings had identified issues, but action to address these had been slow. Due to the high turnover in the management team, visits to people and the services they were residing in had not been frequent enough. As a result, people, their families and staff were often unsure who the management team were, and the management team had not fostered an effective and collaborative relationship with people and staff. We were not assured there was sufficient capacity and capability to ensure that the organisational vision could be delivered, and risks were well manged, both improvement plans that were being worked through were large. Staff did not always feel supported. There was a recruitment campaign in place to recruit more staff to also include team leaders and deputy managers to oversee services. The provider was aware there was a poor culture in the way staff had previously worked in homes, lack of identifying safeguarding incidents for example which may affect the quality of people’s care. We were not assured these matters were being addressed as swiftly as possible due to the volume of work required.

Staff told us they did not feel supported, ‘’We do not have a team leader, our manager was going to be the registered manager, who has now just left, there is no firm structure, it’s whoever answers the phone in the office.'' Staff stated that, ‘’Staff morale is low, core staff shifts shared, hour cross over in the morning, who do we go to, to ask about things, 'Assess net' is horrible to use, we don’t get a debrief from managers after incidents, the form asks you this, we do the debrief with the person but we do not get a debrief from management.'' And, ''I Don’t feel valued as a staff member, staff don’t get supervisions after feeling down. Monthly team meetings are not occurring, May 2024 was the last one I think.'' Staff shared, ‘’Issues were ignored and you never really felt like you could push as the management would blow it off. It is sad to say that you just go on with doing your job.'' Leaders told us, ‘’The service has improved their culture to enable staff to speak up and we showed we listened.'' Staff told us, “We are now learning together, and it's nice to hear feedback and staff have stayed and are committed.”

There were limited processes in place to enable staff to speak up should they need to. Not all staff had completed their safeguarding training and supervisions for staff were infrequent. There were no systems in place to enable staff to understand how to escalate concerns should they need to. Staff told us changes in the management team were frequent and they would be unable to escalate concerns above their line manager due to not knowing who was in the management team. The turn around manager had recently introduced forums with staff, people and relatives to enable them to seek views, they had also implemented a challenge charter. There were processes in place for staff to use such as an email inbox or leave a voicemail anonymously. Staff we spoke with were unaware of these new systems.

Leaders told us, ‘’We promote a diverse workforce through our recruitment process; we meet with the recruitment team weekly as we gather feedback on the diversity and choice of workers to match to services and attend service meetings for the people, we support alongside following the equality and diversity road map.'' The provider was seeking to extend peoples time working on visas who had built relationships with people using the service.

There was an equality and diversity policy in place to ensure people were recruited to the service safely and fairly. This was supported by an equal opportunities monitoring form which was used during recruitment to ensure potential candidates were not discriminated against. However, we were not shown a completed example of this. The service had a diverse workforce and had worked to improve communication skills for staff whose first language may not be English.

Staff feedback was mixed. Staff spoke about recent improvements and said they had a staff meeting every month for the two staff teams working across days and nights. One said, “We always get asked to share our experiences and share a positive and a negative and everyone gets involved and has a say.” However, staff told us they did not participate in regular team meetings due to no management oversight or team leaders in post or they were not a matter of routine. Leaders told us, ‘’Support workers undertake health and safety checks this includes infection control. Deputy service manager undertake these monthly, this is for all services and a weekly audit in services for finance and medication. service managers undertake weekly themed audit such as support planning, and a monthly focused audit such as nutrition and hydration. Regional service managers complete a monthly service visit which audits all of the checks for one service. There are yearly fire audits from an external auditor. A yearly full inspection from the quality and improvement team. health and safety team complete 3 monthly audits and actions plans. We are working through integrated action plans that work towards all the improvements being made across the services.''

The provider was working through a service improvement plan with the turn around manager, this action plan included a quality review action plan that was undertaken by the local authority with immediate actions required for compliance. Audit reports from the internal quality assurance framework (QAF) identified a lack of compliance and oversight from the regional service management audits, these had not been completed in the most part from January to July 2024 to include the service visits not being conducted. This led to ineffective management and oversight of services. Issues found from the QAF process were identified as far back as March 2024 and had not been addressed. Staff training compliance was low. The progress to complete actions on the action plans were slow. Staff had told us they wanted more training on the use of the systems, we observed gaps in recording in electronic monitoring as staff were not using the systems effectively. Handover records were poorly written, lacking in detail and incomplete. Staff did not receive effective supervision to share the organisational culture, learning and development to also include annual appraisals.

Family feedback was strong in relation to the management of the service, engagement from leaders and collaboration with the service. Many people we spoke with felt the service was currently being managed poorly. People were unaware of who the manager was. One relative told us, ‘’There is a constant change of management, and never kept informed.'' A family member told us that they didn't feel listened to by management, and feel they were constantly trying to chase everything up themselves and getting nowhere. Another family member told us there were regular changes in management. There has been a recent financial issue where family had been trying to get this issue resolved. Another family member did not think the service was well managed right now. They felt that staff induction and training wasn't sufficient and lacked management oversight. Staff weren't given the support and guidance need which resulted in them leaving. Many relatives said they did not know who the current manager was, and although managers appear to listen, nothing changed as a result. One family member said, ‘’I would like the service to be more people focused.'' Family members shared they felt that as a service provider, HF Trust used to always have an excellent reputation, however they fear this reputation may have recently declined. They said the deputy manager of the home is under tremendous pressure but is doing very well under difficult circumstances, they kept in regular contact with them. Family members feel HF Trust had made big mistakes as a provider and had taken over too many other organisations and homes and had spread themselves too thinly. They felt they should have focused more on the homes they already had. A family member shared that on a local level the managers were doing the best that they can, and things were "reasonably managed''. However, on a larger level they had doubts around the service as they felt it had become too big and disconnected.

Staff told us there were several people they supported that attended work opportunities, day centre provision, work and social events.

Partners raised concerns with us regarding the providers partnership working. Partners expressed frustrations at trying to obtain information about people's needs and support and commented that information was not disseminated to staff members by the management team. At times, staff approached professionals with queries regarding services as the management team had not kept them up to date with ongoing changes. Partners told us it was difficult to establish effective communication with the management team.

Partners commented due to gaps in rotas, it was unclear which staff were supporting people at any given time. This made effective partnership working difficult and staff often had to contact the management team on behalf of partners to try and rectify this. Processes for recording and reporting safeguarding, accidents and incidents were ineffective at times. This meant referrals to the local authority and the CQC were not always completed, hampering effective partnership working.

Staff feedback was mixed, some staff reported positively on learning and some staff members reported negatively on a recent event and how this was poorly managed and handled by the senior leadership team. A number of staff reported on incidents that were not debriefed with staff after events. Leaders told us, ’’Our culture is one that learning is seen as part of everyday work. Managers support in training and in professional development opportunities. The partnership working gives us access to the necessary tools and resources to learn and innovate. We ensure continuous learning through reflection and feedback, learning from success and failures to help services evolve’’. And, ‘’We are working through a range of culture promotion for the better and creating a management team that are accountable at driving changes for improvements across the region. Key areas of audit and compliance are improving, and we are looking to stabilise the region and embed the right practice to ensure care planning, concerns / incidents etc are linked towards actions and focused on better outcomes for people we support and staff working in service.''

There were missed opportunities for a lessons learned process following safeguarding referrals, accidents and incidents. There was no monthly analysis undertaken in these areas and learning from audits from the management team had not taken place. Learning was not shared with staff members through supervisions or staff meetings. The management team acknowledged these failings and agreed to take action to rectify this.