Top Option Healthcare Limited

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At the last inspection this key question was rated requires improvement. At this assessment this key question has remained requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. During our assessment of this key question, we found concerns around the provider's systems and processes. This was a breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 – Good Governance.

This service scored 46 (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.

Staff’s comments relating to management were variable. Some member's of staff told us they do not feel valued or supported by the manager and they don't feel the registered manager is very professional. A member of staff told us they felt the manager needed training to become a better leader. A staff member told us, “At most times the manager uses her emotions. [Manager] tends to use her emotions when it comes to situations. It feels like sometimes you can’t voice out what you want to say, or she’ll cancel your shift, so you have to go with whatever she says because you want to work”. Another staff member told us, "I wouldn't be listened to if I made a complaint. [Manager] doesn't listen to anyone, we just have to do what she wants." Another member of staff told us, “I think she’s approachable for me I don’t know about anyone for me she’s approachable. She’s strict, she knows how she wants things to be done, but if you make a mistake, she will just correct you in a nice way but for me I think she’s approachable”. A staff member told us, “The manager is very good, supportive, in company there is a positive environment, colleagues are good helpful, good staff relationship”.

The management have been working closely alongside the local authority. Feedback from a health professional stated “A PAMMS assessment was undertaken for Top Option by Southend City Council in August 2023, and it came out with an overall Poor rating. Support and guidance from the quality team was given following this and a further PAMMS assessment was carried out on the 10 June and the rating has now changed to good. People we spoke with including staff and individuals did not report to us any concerns about the service and there were no concerns about the safety of the service and staff were up to date with their training at the time of the assessment.” The day to day running of the service was managed by the registered manager. There was a clear staffing structure in place which included 2 care team leaders. The registered manager at the previous inspection told us they were appointing a deputy manager to assist with the overall running of the service. However, the registered manager told us, "I am still looking to find the right person with the right skills needed for the role." The registered manager recognised improvements were needed to ensure governance and leadership was more robust and effective in managing the day-to-day quality assurance of the service. This would ensure all actions identified in quality audits were followed through and sustainability was embedded into the service.

Staff’s comments we received were variable. Some staff members told us they did not feel able to speak up. A staff member told us, “When it comes to speaking up, sometimes you can, sometimes you can’t”. A staff member told us, “When it comes to employees, the manager is not very nice, doesn’t talk to us nicely. “However, a staff member told us, “I feel I can speak to the manager because she is someone who is open and understanding. Another staff member told us, “Whenever we raise a concern the management will make sure you are heard and do something about it, I do feel valued in the company”.

The registered manager had policy and processes for staff to follow on ‘whistle blowing’. Staff meetings were being held regularly. We reviewed minutes and saw they included information about the service as well as reminders about training, staff rota’s, safeguarding and PPE. However, there were no action plans completed to evidence how issues raised were to be addressed, dates to be achieved and if actions had been resolved or remained outstanding. The registered manager sent surveys to people using the service to gather feedback about the service and discussed feedback with people who used the service. However, there was no formal record of discussions that took place following the survey and results were not always analysed for themes or trends.

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.

Staff told us they had regular supervisions. A staff member told us “The manager carries out regular supervision and we also have observations where they just turn up and observe us.” Staff told us they had an induction when they first started, and this helped them prepare for their role. The registered manager had implemented new extensive induction booklets which included shadowing shifts. However, we found gaps in the induction booklets for some staff.

The quality assurance and governance arrangements in place were not always effective in identifying shortfalls at the service. The audits carried out by the registered manager lacked detail and were mostly a tick box exercise and did not identify the shortfalls we found. This meant effective auditing arrangements were not in place to assess, monitor and improve the quality and safety of the service provided and lessons learned. There was no formal record for how the registered manager learnt from lessons following incidents. Staff meeting minutes did not include action plans completed to evidence how issues raised were to be addressed, dates to be achieved and if actions had been resolved or remained outstanding. The service did not have a service improvement plan in place. A service improvement plan includes checklists and examples that help identify the necessary actions for enhancement and aid in developing an action plan to implement the required changes. Statutory notifications were also not being sent to CQC as required. Effective systems to monitor and improve the quality of the service were not in place. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.