Fosse Healthcare - Nottinghamshire

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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

During our assessment, we have identified a breach in relation governance. We assessed 2 quality statements in the well-led key question and found areas of good practice and concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. There were governance and management procedures in place. The safe running of this service had been affected by a sudden reduction in staff. Measures are in place to address this before this had a serious impact on people’s care. However, staff wellbeing has been affected. Staff understood their roles and responsibilities but did not feel that the concerns they raised were understood, valued, and would be acted on. Staff had lost faith in the management team. Managers accounted for the actions, behaviours, and performance of staff. Data or notifications were consistently submitted to external organisations as required. There were robust arrangements for the availability, integrity and confidentiality of data, records, and data management systems. Information is used effectively to monitor and improve the quality of care. We have asked the provider for an action plan in response to our concerns.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff spoken with had lost faith with the current management and felt unsupported by the office-based staff. Many staff told us their mental and physical health had been affected with unrealistic expectations being placed on them regarding the number of calls they were expected to do, with not enough travel time and/or break time given to them. Many felt they weren’t listened to and undervalued. A staff member said, “Approachability with management is very hit and miss. Especially if it's a stressful time in the office. It can take us a few hours to get a phone call back or quite regularly we don't get a phone call back. Truthfully, I don't feel like I can always go to the management, they come over quite abrupt a lot of the time and stern. I have gone to discuss problems and I feel I've just been brushed off and nothing changes.” A second staff member said, “Even though Fosse states that we are a 'team' it couldn't be further from the truth if you tried. Unreliable and poor members of staff are treated better than the reliable staff that always turn up to work and the reliable members of staff get punished and penalised. No one is treated the same.” A third member of staff said, “Not one of them (management team) are capable of leading they do not listen that’s if anyone answers the office phone, and they do not reply to emails.” Staff were aware of the whistleblowing procedure. We received positive comments from some staff. One said, “The company is a good welcoming place that welcomes all cultures/ religions, and we work together with everyone despite any differences between us.” The nominated individual told us they were aware that staff had faced some difficulties in the past few months. They told us they were confident that staff experiences would improve as more staff were employed. They told us they would work with all staff to improve relations to ensure a more cohesive working environment and would review and act on the feedback from staff.

The provider had a number of systems in place that enabled staff to report any concerns they had about their role and/or the safety of people. Staff were encouraged to report any accidents and incidents, and these were analysed by senior management to help identify any themes or trends. Where the provider was found to have been at fault for an accident or injury, there were examples where the provider apologised to the person formally through a written letter. However, despite these processes being available to staff, we found that they were ineffective as staff did not feel able to use them.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider had a number of quality assurance and auditing processes in place that were designed to support the continuous review and assessment of the care provided and staff wellbeing. A wide range of audits are place. These assess the effectiveness of the management of medicines, quality of care plans, staff performance, accidents, and incidents and much more. When fully staffed, and all staff are fully up to speed with the requirements of their role, these processes should work effectively in highlighting any areas of concern before they impacted people’s wellbeing. Relevant agencies were notified of accidents, incidents, and safeguarding concerns. People’s electronic records were secured. Access to people’s records was restricted. Any unauthorised access would be identified quickly and action to address this.

The majority of the care staff we spoke with raised concerns about the way the service was managed. They felt this impacted on their ability to carry out their role effectively. Staff understood there had been a reduction in the number of care coordinators which has caused some difficulties when planning their care calls. However, many felt this had not been well managed and contingency plans were ineffective. Staff told us they received supervisions of their role and competency assessments, some found this to be a useful process that helped them to identify any areas of improvement in their work. The registered manager and nominated individual told us they understood the concerns of the staff and they were confident things would improve with the recruitment of the new care coordinators.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.