Clarissa's Home Healthcare Services 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

We identified a breach of the legal regulation relating to good governance. We found the service did not always have effective governance oversight, management systems, information about risks recorded to effectively improve care. We identified concerns in relation to care plan consent forms not always being fully completed and there was inconstant recording between the care plan records and consent forms. It was not clear how decisions were made when assessing people who had been assessed to have fluctuating capacity. Due to inconsistencies identified in the training matrices, we requested from the registered manger (also the nominated individual) the full, current and most up-to-date training matrix. The training matrix also did not accurately reflect safeguarding training had been completed in line with the safeguarding policy. We did not receive a response to this communication. The employee review survey did not always evidence the actions taken when issues were raised. The records did not always show audits had been completed regularly. The business continuity plan was not updated to reflect accurate and up to date information. Where we had requested and followed up 12 months of records including minutes of staff meetings and audits, these were not always provided. We received feedback in relation to concerns of training of the carers, communication skills and emotional skills and care. Some of the competencies including medication competencies did not reflect the competencies had been completed and nor were the dates of the competencies recorded in line with the training plan of the service.

This service scored 61 (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 the service, “puts their service users at heart” and “is open to new ideas.” Staff felt “feel that the organisation is promoting and encouraging open, friendly and inclusive workplace” and the vision of the company is to “become a big company providing high quality of care to the vulnerable people.” Staff commented, “We have as an organization a vision to provide excellent person centered care” and, “Together we will make the most and improve quality of life.” Leaders told us they wish to expand but they would need to look at staffing and they were “not going to jeopardise what we have now.” Leaders told us they are looking to progress in learning disability and palliative care.

The service had a service user guide outlining how were people were to be supported and welcoming ideas for improvement from people. The service user guide detailed information on their philosophy of care, working with professionals and involved people in their personal care and health care. The business continuity plan outlined plans to support with challenges such as fuel shortages and staff shortages to meet any challenges and support the needs of people. Additionally, the service had an adverse weather policy and procedure.

Staff generally gave us positive feedback about the leaders. Staff told us, “The manager is visible within the service and leads by example” and “The leaders have shown great knowledge and skills and are very credible.” Staff described their experience with the service as, “amazing” and “They have listened to us.” Leaders spoke about the vision of the service and told us the “vision is to give the community the respect they deserve and give clients respect and dignity.” However, we also received feedback the leaders are, “…transparent sometimes depending on the situation” and “I think my voice can be heard if I contribute with the same goal as others.” We also received feedback not all the leaders knew the processes and are not always contactable when support is required.

The service had an organisational flowchart which included details of the leaders and their roles and responsibilities. This confirmed the registered manager was the main point of contact for staff. The service had an equality and diversity policy and procedure. The employee handbook included information about benefits for staff, equality and diversity and contact details for an employee assistance programme. However, feedback received did not provide assurances the leaders were always accessible for support which may impact on the delivery of care.

Staff told us they, “feel confident that I could speak up if I felt that something was not right or needed to change at the organisation” and “Our Management listens to us and are involved in problem solving.” Staff also told us they felt their voice would be heard and the service encouraged employee feedback and engagement, “by fostering an environment of open communication and constructive feedback” along with “They do listen to us.” Leaders told us they ask staff how they are feeling, “listen to staff in staff meetings” and the carers can call the leaders any time. However, the review of the processes identified the service did not follow their processes to address issues raised.

The service had a raising concerns, freedom to speak up and whistle blowing policy and procedure. The service also had a quality and quality assurance policy and procedure. The records not always provider clear information on how any issues raised by staff gathered through completion of the employee satisfaction survey forms were resolved, in line with the policy. The service had a business continuity plan which stated staff meetings would be held monthly. However, the records did not always show staff meetings were held monthly.

Staff told us they felt, “the service embraces diversity and is inclusive in its approach towards staff” and the service was, “fostering inclusive leadership to create a safe team environment.” Staff also told us,” Staff wellbeing is supported by our management” and “they also have their employees at heart.” Leaders told us they promoted diversity in the workforce and with regards to staff well-being, they have an, “Open door policy so they can ask anything.” Leaders also told us when supporting with staff well-being, they talk to the staff, make sure they have their breaks and actively promote an open dialogue and create an atmosphere of trust and respect.

The service had policies and procedures for equality, and diversity, recruitment, staff retention and also an employee handbook.

Staff told us roles and responsibilities are made clear and “management is happy to assist in whatever way to make sure high quality care is been delivered.” Staff told us, “Clarissa's Home Healthcare Services is capable of getting people to work together and communicate effectively” and “The service manages the resources well, is not wasteful and considers the impact of what it does on the environment.” Leaders told us roles and responsibilities are made clear, they use an online system and the care plan is talked through with the carer and people so there is reassurance. Leaders also told us, “We go through their responsibilities and roles and identify training needs.” However, the review of the processes identified the service did not have effective procedures in place to support governance and oversight of the service.

The service provided more than one training matrix. Due to the inconsistencies identified in the training matrices, we requested from the registered manger the full, current and most up-to-date training matrix. We did not receive a response. Some of the competencies including medication competencies did not reflect the competencies had been completed and nor were the dates of the competencies recorded in line with the training plan of the service. Medication competencies were not completed in line with the overview of the training plan of the service. We received feedback in relation to concerns of training of the carers, communication skills and the delivery of emotional skills and care. Some staff are showing as not starting their training, some are showing as overdue and staff are listed on one matrix but not the other. The training matrix did not accurately reflect safeguarding training had been completed in line with the safeguarding policy. Where we requested and followed up on the service submitting 12 months of documents and information, these were not always provided. The care plan consent forms were not always fully completed and there was inconstant recording between the care plan records and consent forms. It was not clear how decisions were made when assessing people who had been assessed to have fluctuating capacity. There is conflicting information recorded as to whether or not people had capacity. Some sections were not fully completed to reflect the person’s wishes (eg) the section ‘confirm / do not confirm. ’There were gaps in the employment records. Where references had been obtained, they did not always match the employment history on the application form. It is unclear from the supervision policy how often supervisions would be actioned. The records did not always show staff meetings were held monthly. We were not assured the service had systems of accountability and good governance in place to support people, staff and the service.

People did not inform us the service worked in collaboration with external agencies. However, relatives told us if health problems were noticed, the service contacted the relative and if needed, the appropriate health agency. This included the ambulance service, physiotherapy, district nurse, G.P’s or occupational health. Relatives told us “They’ve (Clarrisa’s) said that if you need extra help that they will sort it out for us” and “The office is brilliant. The service is well managed. We are all very happy with the service.” Relatives told us people with long standing chronic conditions had advice from agencies, such as the Stroke Association, Age UK and Parkinsons Society. Relatives fedback the service was approachable, helpful, responsive to concerns and complaints.

Staff told us, “I am encouraged to work in partnership with other organisations, agencies and people” and “we are aware of our duty to work in partnership with other organisations.” Staff also told us they, “Have constructive working relationships with other professionals” and “By having constructive working relationships with other professionals. It helps to ensure that the care and support meets diverse needs of individual people and communities.” Additionally, staff told us, “we speak to GPs to make sure client is getting the best care.” Leaders told us they, “involve the carers, GPs, pharmacy” and they work with the multi-disciplinary teams, district nurses, Parkinson’s nurse, diabetic nurse and the occupational therapist. Leaders told us they work with other care providers and they “communicate together with the multi-disciplinary team professionals working together” Additionally, leaders told us they tell their carers, “we never work on our own” and they work with the right people for the need.

We received mixed feedback from partners. Partners fedback communication and collaborative working could be improved. However, professionals also fedback the service was developing better relationships with professionals,

The service worked with a quality monitoring partner and implemented an action plan to make improvements across some aspects of the service. One of the areas that required improvement included working towards partnership working. The service had introduced a communication book between the service and other teams and where there is more than one provider involved in people’s care. This also included exchanging direct numbers.

Staff told us, “I have gained experience from working for them” and “they are encouraging us to learn.” Staff also told us the service wants, “To provide health care at its best while making sure the employees are well educated on how to look after those who need the services” along with, “Together we will make the most and improve quality of life.” Leaders told us learning is encouraged and staff ask about progression. Leaders told us they worked as a team and their team has, “different strengths in different areas.” Leaders told us they will give their opinions on how things would work better and they are listened to. Leaders also told us they learn from feedback from families and clients and staff and they, “Turn weaknesses into strengths.” Leaders told us they check incidents as a learning curve and “take advice from other departments and put systems in place to make sure it does not happen again.” Leaders feedback they action training and work with professionals. However, a review of the processes identified there was not effective oversight of continuous learning and improvement to support people and the service.

The service had policies and procedures in place in relation to quality and quality assurance and good governance. The employee review survey did not always evidence the actions taken when issues were raised. A review of the action plans whereby the service worked in conjunction with professionals, identified one of the areas that required improvement in relation to ‘client views and involvement’ was not carried forward to the most recent action plan. The service had noted on the previous action plan the recommendations and the progress as ‘ongoing.’ However, this was not carried forward to the most recent action plan. It was not clear from the comments section in the action plan, what the next steps were and it was unclear why this action had not been carried forward in order to support people. The action plan stated the staff training matrix will be completed to show every staff member and the training they had completed. However, the review of the records did not show this and we did not receive a response from the manager when we had followed up regarding the training matrices. The records did not always provide clear information that audits had been completed regularly. The business continuity plan (BCP) did not document when it had been regularly tested nor did it document the actions had been reviewed in line with the BCP. The action plan dates on the BCP had not been updated to confirm the audits had taken place. The BCP referred to staff using equipment and making a clinical decision which was not in accordance with their training. We were not assured the service had supported continuous learning and improvement in line with their policies.