A1 Quality Homecare Limited Eastbourne

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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

There was an open and transparent culture at the service. The registered manager was aware of the duty of candour and had reported any concerns to the appropriate agencies. There was a clear management structure at the service and staff knew who they needed to approach to raise any concerns. They told us they felt confident in doing this. People, relatives and staff were all given regular opportunities to give feedback and felt listened to when they did so. The service worked well with partner agencies, and we received positive feedback from professionals who worked with them.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager told us that the service was values based, concentrating on providing the best possible service to people. Business and contingency plans were in placed which covered unexpected issues for example: pandemic, extremes of temperature, significant staff sickness. The registered manager explained that all of these contingencies had been tested and that the service was able to continue to provide the agreed support to people. The registered manager actively sought best practice by attending registered manager forums and then sharing ideas and practices with staff at their service. Similarly, they attended regular meetings with the local authority to ensure that support was still being provided appropriately and in line with people’s changing needs. Staff told us that they were kept informed of changes and the reasons behind them. They said they were also encouraged to contribute to suggesting areas to improve and that they felt empowered to do that.

All plans were regularly reviewed by the registered manager and brought up to date when needed. Managers attended regular forums and meetings to share and learn about best practice. Any changes for service were discussed with all staff before implementation. As a large service the registered manager’s vision for the future centred on maintaining high staff numbers and focussing on the best quality of care for people. Part of the staff induction program now involved a social responsibility session which considered the service impact on global warming and carbon emissions and any means possible to contribute to their reduction.

The registered manager had created management and supervisory roles that supported each other and care staff. Staff told us that the managers were approachable and supportive, comments included, “Very supportive. Even when have domestic issues will support,” “Management very sensitive to staff issues / problems. Managers very supportive” and “Supervisions every 2-3 months but can speak to line manager anytime, they are very good.” Staff were encouraged to progress and take on supervisory positions if they wanted to and were capable. Supervisors had additional responsibilities for example, the management of spot checks and staff and managers all told us that these systems worked well. The registered manager made sure that they and their management team, kept up to date with issues affecting adult social care by attending county wide and local meetings where developments were discussed.

An on-call system was in place staffed by 5 managers covering all care call working hours, 7 days a week. Staff regularly used this system to get advice, report incidents or to update managers about care call times. A rolling recruitment process for staff was in place which made sure that the service, which employed over 100 staff, always had enough staff to cover all calls. Some management functions were delegated by the registered manager for example, completion of some supervision meetings, some auditing processes and the management of spot checks. The registered manager however demonstrated oversight on all of these areas.

Staff told us that they had opportunities to speak up, raise issues and that they were listened to and actions were taken where needed. A member of staff said, “We have team meetings which cover the key issues at that time. For example, weather extremes – carry more water at the moment. At the meetings the managers always say a 121 meet is possible after. Can always arrange a personal meeting – these happen anyway after errors, sometimes more training given.” “Meetings, yes. I tend to send emails rather than speak up to get points across. They do get back to me and resolve the issues.” Staff told us they had regular supervision meetings where they discussed all aspects of work and their own welfare issues. Staff were confident to use the whistleblowing process if needed.

Systems and processes were in place to support staff in speaking up and allowing their concerns or observations to be heard by managers. There were a series of regular meetings some involving just managers, others supervisors and some all staff. Similarly, people surveys were completed each year, giving people and their families an opportunity to rate the service, comment on good practice and to raise issues or suggestions. An example of a suggested improvement was carers handwriting being hard to read. This resulted in a manager calling and discussing the issue and it being raised with staff for improvement. In addition, telephone monitoring calls took place where people and relatives were contacted to seek their feedback.

Staff and managers told us they were treated fairly and with respect. They told us their working conditions suited them, they were provided with uniforms and plentiful supplies of PPE. Managers were able to be contacted at any time for advice. Staff also said that they were given enough time to travel between care calls and enough time at the calls themselves. Staff told us it was a good company to work for and several said it was the best they had ever worked for. They told us that securing leave and short notice time off for emergencies was never an issue.

Service policies were in place for workforce equality and diversity and human rights; safe and fair treatment and lone working.

The registered manager explained the service auditing and quality assurance processes. Some processes were delegated to managers and team leaders but the registered manager maintained oversight. Managers understood the duty of candour and were honest and open with us throughout the assessment process. Services are legally bound to inform the local authority and CQC about certain significant events that occur at their service. This legal obligation had been fulfilled. The service had a manager dedicated to quality monitoring. This staff member carried out monthly medicine audits, telephone monitoring and co-ordinated spot checks across all staff. Similarly, the registered manager completed monthly auditing and had oversight of all processes and checks. There had been a recent review of staff pay and an uplift had been made. Some processes were reviewed annually for example, outcomes from quality assurance questionnaires and complaints and safeguarding. If needed, actions plans were put in place to chart improvements where concerns had been identified. All annual reviews could similarly be brought forward in the event of a particular concern or incident.

Policies and procedures were in place and were kept under sections that reflected CQC’s key question areas. All of these documents were subject to annual reviews although reviews would take place more frequently if needed, if for example, there was a change in policy or there had been an identified concern. In addition to the auditing processes the registered manager carried out a separate quality monitoring review and had recently carried out a ‘mock CQC inspection.’ These had identified some areas for improvement relating to staff induction, medicines and care call times. Changes were immediately made to rectify the issues identified. People and their families were given a ‘service user guide’ which contained all of the information they needed for example, complaints processes, how to contact managers and lists of tasks that staff could and could not assist with.

People and their relatives told us that staff work with other agencies to ensure their support is robust and effective. For example, people were supported to contact GPs or adult social care should they need to. A relative said, “Once, [person] had a ‘turn’ when a carer was present, the district nurse was also present so they didn’t need to contact the GP but I am sure they would have if necessary”.

The registered manager told us about local sponsorship that the service were involved with. The service had sponsored several local young people and local sporting team and displayed logos on staff uniforms to represent their involvement. Staff told us they attended local job fairs and had had a float in the local carnival. Service cars had the service logo displayed.

The service worked well with partner agencies and within the community to ensure good outcomes for people. Professionals told us that staff worked collaboratively to enable both good practice and positive learning if and when things went wrong. Feedback about management was also positive. One professional said, “Anytime I phoned them they have been brilliant. Anytime I’ve had emails from them I follow that up with a phone call and have always found the managers to be very helpful. The communication is great.”

Regular sponsorship and involvement with local events raise the profile of the service. Managers would meet to discuss these connections and how they would benefit the service. Regular meetings were held with the local authority who were responsible for placements, funding and reviewed best practice.

Staff and managers told us there was a strong ethos of continuous improvement at the service with an emphasis on learning. A staff member told us, “It’s not a blame culture, we are learning. Never made to feel bad. We have meetings to discuss the issues and any lessons learned for us.” The registered manager told us that their quality monitoring processes were designed to drive continuous improvement and that some of the issues identified that have now been addressed have improved thew quality of the service being provided to people.

Themes and issues identified through quality monitoring are often fed back into the training manager for the service. New and better training modules were then rolled out to all staff including additional training as part of staff induction. An example of this was the nutrition and hydration lessons now included in the induction process which provided staff with a greater insight into the importance of diets and how this varied according to people’s needs. Telephone monitoring responses were also reviewed for any themes or trends where improvements could then be made.