London Care - Brighton

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

We identified 1 breach of legal regulation in relation to governance. The provider had governance systems in place, however, they were not robust and had not identified shortfalls found during this assessment. People had raised concerns, but these were not always documented, or appropriate actions taken. Leaders failed to recognise incidents and safeguarding concerns from complaints. These had not always been monitored or analysed to prevent reoccurrences. This put people at risk of avoidable harm. Staff told us the provider held care awards to recognise their good practice. Although staff were encouraged to progress to senior roles, not all were effectively supported to ensure they had suitable skills for the role. Appropriate checks were not done to make sure they were capable to supervise and monitor staff. This meant concerns were not always picked up or where they had been, action was not taken. There was not a clear management structure at the service and most staff did not know who the registered manager was. Staff did not understand what the vision and values of the service were, or how they could help to shape it. Most staff were not aware of the whistleblowing policy or how to raise concerns about colleagues. Staff had not always shared their concerns with leaders. Staff and leaders did not always engage with people, communities and partners to share learning that resulted in continuous improvements to the service. These networks were not always used to identify new or innovative ideas that could lead to better outcomes for people.

This service scored 39 (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 the provider had a shared vision and strategy based on the ‘hearts and minds of people and staff’. However, it was not always clear this message was regularly shared with staff, nor how they could help to shape it. People, professionals and staff told us there had been a turnover of leaders. Most staff did not know who the registered manager was. Comments included “Not sure who [Registered Manager] is, haven't met them” and “[Branch manager] is our manager - we confide in them. [Registered manager] helps and has worked in the field” and “Lots of senior staff have quit. Two people have said they are leaving, and 1 senior has left already.” Supervisions and a staff meeting did not reflect any discussions about the providers vision and values. Leaders told us they had sought feedback from staff via their computerised app. However, staff were not aware how their feedback was used to help to shape the providers vision and values.

The provider had business and contingency plans in place. However, this did not include how to cover unexpected issues during adverse weather conditions or contain branch key contact details. The provider updated this during the assessment. Leaders did not attend regular provider forums and meetings to share and learn about best practice.

Staff were encouraged to progress and take on senior or supervisory positions if they wanted to. However, not all staff had the experience and knowledge, nor received additional support and competence checks to ensure they were capable. The provider had an on-call system staffed by the branch manager and the field care supervisor. This covered all care call working hours on a weekly basis. However, 1 staff reported the negative impact the on-call system was having on their personal life. A possible resolution was listed, but no additional support offered nor timescales to review it. The registered manager and branch manager did not keep up to date with issues affecting adult social.

The registered manager did not have effective oversight of the service. They told us they were reliant on the branch manager to complete tasks. Some management functions were delegated by the branch manager, such as assessment processes, supervision meetings and spot checks. These were not always carried out by capable staff. The registered manager had not performed their own checks to ensure leaders were capable.

Staff were not always confident to raise concerns about colleagues. One staff reported how the branch manager had been rude to them. They said they did not report it. Another staff member said, “Some colleagues got on well with others. I have felt we haven't worked too well together. I always try and not let that affect the client but have felt over-whelmed by some colleagues. I just went along with what is supposed to happen and didn’t report it as I may not see person [staff] again. It is not so much now as I mainly do singles.”

The registered manager told us about systems and processes in place to support staff in speaking up. Most staff told us they could tell the manager if they had concerns. However, staff said they were not aware of the providers whistleblowing policy. Staff had not always reported their concerns. We were not always assured a positive culture of honesty and openness where staff feel they can speak up was fully embedded.

Staff told us the service was not always flexible when they requested leave or needed to change their availability. They told us they had to give 4 weeks’ notice which wasn’t always possible. We reviewed staff team meeting minutes. The minutes contained information on working arrangements such as “please remember if changing your availability, we still require either 1 day every weekend or the whole weekend every other weekend” and “likewise do not book an appointment on the day you work unless you work all week.” Flexible working arrangements had not been considered or offered to care staff to support their wellbeing or accommodate personal needs and responsibilities. Staff told us they were not paid for travel time and had to pay for their own transport. They told us the impact it had on them including that some staff did not always enjoy their job or give it their best. Staff did not feel empowered or confident that their concerns would result in positive changes to create a more equitable and inclusive organisation.

The provider had policies in place for lone working and equality, diversity and inclusion in employment. However, we were not always assured the provider had systems in place to ensure fair treatment and the wellbeing of staff.

Leaders did not always understand their roles and responsibilities to ensure good quality care was provided to people. The registered manager told us how they were reliant on the branch manager to run the service. The branch manager told us their responsibility was for the day to day running of the service, ensuring people had received their calls. The registered manager told us the branch manager was responsible for dealing with complaints. However, the branch manager did not know how to use the providers computerised system for recording concerns from people or evidence actions taken. This meant concerns were not monitored or analysed for themes or trends to ensure people consistently received good quality care and support. The registered manager told us the branch manager was responsible for recording, reporting and investigating accidents, incidents and safeguarding. However, the branch manager did not always recognise incidents and safeguarding concerns from complaints. These were not recorded on the providers computerised system to monitor or analyse to prevent reoccurrences. This put people at risk of avoidable harm. The registered manager told us the branch manager was responsible for the management of staff. This included spot checks, supervisions and competencies. Tasks relating to monitoring staff were also delegated to supervisors. However, these were not checked to ensure appropriate actions had been taken or that supervisors were competent in the role. The registered manager did not have effective oversight of the service. They had not undertaken their own checks and audits to ensure staff were capable to do their roles. The registered manager and the provider were not aware of the extent of the concerns found during this assessment.

Quality assurance systems were not robust and did not operate effectively to ensure people consistently received good quality care and support. There had been no audits at the provider level to identify the shortfalls found within the assessment. The provider had shared an action plan with the local authority. The branch manager told us, “We are climbing a hill at the moment. When I came in there hadn't been a manager. It's a work in progress. We have an action plan; it's slow and steady but we're getting there. It's not financially viable to chuck a load of staff in there to get it sorted in a week, so we're trying to sort it alongside our daily jobs.” The action plan was not effective due to some leaders not understanding their roles and responsibilities, and gaps in their knowledge had not been identified. The provider had failed to identify 5 events that were reportable to CQC. This meant external scrutiny was not possible to ensure people were safe. The provider has been receptive to feedback and provided us with an action plan to make improvements. However, this will take time to embed.

People were at risk of inconsistent and uncoordinated care. People told us there had been a high turnover of managers. One person told us how carers just turned up one day without them knowing they were going to receive care from the provider. They said, “I was very irate. [Branch manager] apologised and told me she wasn’t going to take the job as manager because everything was in such a mess. Well, that’s not something you should be saying to a person who was paying for their services.” Some care plans lacked information. For example, care plans for people living with diabetes did not contain vital information about other health care professionals who visited to administer insulin. There was no guidance for staff about monitoring blood sugar levels, such as what to do if they were really high or low and which professional to contact.

The branch manager told us they could access healthcare professionals when they were needed. However, some staff did not understand the importance of working closely with a range of other agencies. Staff did not know why other professionals were visiting or how it linked in with the care they were providing.

The provider did not always work effectively with other healthcare professionals to provide good outcomes for people. For example, one healthcare professional reported a person had not had their morning call for vital support to manage a health condition. They called the service and were advised a staff member had already attended the call. However, the professional explained they had been present the whole morning. The service said they would look into it and call back. The professional contacted the service again who told then told them the staff member was running late. The professional was concerned about the potential impact to the person if they had not been present to provide that support.

We were not always assured staff and leaders engaged with people, communities and partners to share learning with each other that resulted in continuous improvements to the service. The registered manager and the branch manager told us they had not joined forums or meetings with other providers. This meant they were not always able to identify new or innovative ideas that could lead to better outcomes for people.

The registered manager told us they had learned lessons about staff training. They said, “There’s a good initial induction but we’re looking at getting additional training. A lot of staff don’t have experience of care. We ask staff areas they need support in to plan for additional help. We report and enter it on our system so all can have a look at it to review. We have supervisions and reactive supervisions when things go wrong. Supervisions are now called engagements. We have themed engagements such as continence or choking risks.” People told us they had raised concerns about incidents, poor conduct or competence of staff. We reviewed records for incidents. None had been recorded which meant there had been no analysis to prevent reoccurrences. We reviewed supervisions and found they had not always taken place to address concerns with specific staff, nor additional training and support offered. This meant it was not always evident what lessons had been learnt.

System and processes were not effective at identifying areas of improvement we found throughout this inspection. We identified shortfalls relating to dignity, assessing and managing risks, care records, safe medicine administration, audits, staffing and notifiable events leading to breaches of regulations. This meant quality performance had not always been assessed, potential risks to people not always identified and lessons learned to drive improvements had not always been possible. People had been placed at risk of avoidable harm. The provider has been receptive to feedback and provided us with an action plan to make improvements. However, this will take time to embed.