Access Dignity Care Limited Also known as Access Dignity

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 looked at all quality statements for Well-led at this assessment. The service was not Well-led. This showed a decline since the last inspection. Systems and processes were not effective to ensure good governance and oversight. The provider did not independently identify risk which impacted on people’s safety and welfare. The approach to learning, improvement and innovation was inconsistent across the service and did not include the measuring and analysis of outcomes and impact. Further work was required to demonstrate effective partnership working with other stakeholders. Legal requirements were not consistently met, such as the systematic failure to submit statutory notifications. Whistleblowing policies and procedures were in place for staff to speak up freely. Leaders were aware of supporting equality, diversity and inclusion in the workforce. The provider was committed to driving improvement at the location, and put an action plan in place. During our assessment of this key question, we found concerns about governance systems, which resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff felt supported which helped to develop a positive culture, however, strategic direction was unclear. The registered manager confirmed they would review the service Statement of Purpose, to ensure they were supporting and empowering staff to meet their own organisational vision and values going forwards.

Processes were not in place to support a clear shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and communities. For example, at the time of assessment, the service was registered for supporting the specialist service user band of people with a learning disability and/or autistic people, which requires in-depth provider awareness of national best practice guidance and CQC guidelines. Whilst there were no people with these care needs being supported with the regulated activity of personal care, there was a lack of awareness of best practice. The registered manager confirmed they would consider whether they wished to continue to be registered for this specialist service type, and whether this met their organisational vision for the future.

Improvements were required to demonstrate consistently capable leadership. The registered manager was open in acknowledging shortfalls identified at this inspection, and proactively created an action plan to address many of the issues raised. This included reviewing systems, strengthening processes, and seeking staff training. Staff told us they could raise any queries or concerns with the management team, and all staff we spoke with told us they felt supported and valued in their role. A care worker told us, "[Management] are always ready to help us." Another staff member said, "I love working here, everyone is so supportive.”

Leaders operated with openness and modelled an inclusive approach towards staff. However, failure to have consistently safe and effective systems in place meant oversight was lacking. This did not demonstrate consistently capable and compassionate care.

Staff told us they feel well supported and respected by leaders and the management team. However, whilst staff reported they were able to ‘Speak up’, there was limited evidence concerns were acted on appropriately, as office staff did not always have the skills, understanding and competence to escalate concerns raised as required. This meant issues were not always investigated fully and lessons learned were not always identified, shared and acted on as a result.

Whistleblowing policies and procedures were in place for staff to speak up freely. We saw evidence of staff having the opportunity to provide feedback on the running of the service. However, complaints responses did not always show people received a full written apology when things went wrong. As there was no analysis or robust oversight of themes and trends in complaints and concerns, the provider could not demonstrate how they would prevent similar issues from happening again.

The provider had begun developing systems to support equality and inclusion through workshops. However, the training matrix showed staff did not receive formal equality and diversity training to support wider awareness in the role. Systems were in place to seek staff feedback in areas such as the setting up of the rota, to promote fairness amongst the staff team. There were opportunities for staff training and career development, including access to driving lessons. The registered manager had not developed a long-term staff recruitment and development strategic plan to show how they balanced staffing the service with meeting people’s preferences and needs.

Feedback from leaders showed that, whilst there were many actions taken to ensure staff workforce equality, diversity and inclusion, there was a failure to assess, monitor and record the impact of these actions. For example, engaging staff training was taking place in areas such as food preparation and exploring cultural differences. However, this was not being analysed for impact or improvement. The service encouraged apprenticeships, including for autistic colleagues. Feedback from staff showed they felt supported and happy working for the service. Whilst staff told us they felt well supported, they were not always empowered to provide the quality of care meeting the quality standards.

Feedback from staff and leaders across the organisation at all levels did not provide assurance or evidence of robust, effective or well-embedded governance and oversight measures. This had an impact on people using the service. Staff members had been delegated the responsibility of overseeing parts of the service did not demonstrate sufficient understanding to fulfil their role. The provider told us they would strengthen their systems going forwards and produced an action plan in response to our feedback.

Governance processes were not well established and monitored to ensure safe and good quality care. There was no evidence of effective provider oversight in areas including assessments, care planning, safeguarding and audits. Audits were insufficiently detailed to address issues of concern, and care plans were not updated in a timely way. Legal and regulatory requirements were not consistently met, such as failure to submit statutory notifications. These are notifications the provider must make to the CQC for certain issues such as safeguarding concerns or serious injuries. Checks that visits had been completed as planned were done manually. There was no monitoring system in place to assist the management team to identify missed visits and take prompt action. This meant it would not be possible to be alerted quickly in the case of missed visit or missed medication. The business manager acted on our feedback to put this in place.

We received feedback people could contact the office if required, and staff were approachable. However, some people told us they were not always able to work in partnership with the service and be fully involved in their own care. A person’s relative told us, “Access Dignity’s website states that staff have time to develop trusting relationships with the client and that they make sure you receive a reliable service that is not rushed. They also state that if person caring for you needs to change at short notice you are told so that you know who to expect. It also states you are introduced to any staff who are going to provide your care. None of this seems to happen or hasn't happened to us.” Another person’s relative told us, “The office says the right things and sound helpful, but they are not really on the ball, and they are very slow to respond.” However, the service had also received a number of compliments from people who were satisfied with their care.

Systems and processes required improvement to show how the management team identified and escalated concerns and referrals to other professionals in a timely way, to support people to receive good quality, safe care in partnership with the person and considering their views and wishes.

Whilst further work was required to demonstrate consistently effective collaboration with other stakeholders, we received positive feedback from the local authority about the provider's proactive approach to drive improvement following CQC feedback. A professional who works with the service told us, "Support will continue to be given the care agency for the time being, but we found [registered manager] and [business manager] to be open to making improvements, such as new systems which would collate information together to better organise as necessary."

The registered manager told us they had achieved a Social Value award from the local authority for setting up a local community dementia café. This needed to be further developed to see how it could support more of the people using the service, including those people unable to leave their own homes. The registered manager also told us of their plans to strengthen their working relationship with the district nursing team going forwards. The service is currently working with the local authority organisational safeguarding team and quality team, with the aim of improving the standard of care.

There was a training plan set up by a dedicated training manager, which showed an engaging and supportive approach for staff, including access to specialist equipment needed for practical learning. However, wider governance processes were not well developed and embedded, placing people at the risk of harm. This did not show a service which learns and improves, including from serious incidents and safeguarding matters. We raised an organisational safeguarding so additional support and training could be provided by system partners.

Feedback from staff and leaders did not demonstrate a focus on continuous learning, innovation and improvement across the organisation and the local system. The management team did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people, nor actively contribute to safe, effective practice and research. Staff could not always explain learning from adverse incidents, and investigations into serious incidents were not always robust. Although the management team were responsive to CQC feedback and put an action plan in place, continuous improvement outside of the assessment process was not evidenced through discussion with staff and managers. The registered manager was receptive and positive about driving change, and told us, "It’s a learning curve.”