Nurtured Care NE

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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

The registered manager and staff team worked hard but there was a lack of effective governance of the system used to plan and deliver care. This has been in place a number of months but understanding and application of its functions has failed to identify or significantly improve a range of issues with call times and durations over a period of months. Aspects of the organisation had not been operated with person-centred care at the forefront of planning. Continuous learning and improvement was limited.

This service scored 50 (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 recognised there were a range of improvements to make at the time of our inspection, particularly with regard to planning calls. They recognised the need to change the culture, but were integral to the existing culture. Office staff demonstrated a positive approach and were keen to embrace new systems, but there had been a lack of effective or proactive leadership regarding how they were to interrogate and use the electronic call monitoring system to benefit people and staff. There had been some widespread misuses of the electronic call monitoring system and this had not been adequately addressed by the provider. At the time of inspection and in the weeks following, the provider was working more openly with a range of partners to rectify these issues. External partners did not always have confidence in the service. They worked with the service but there had been times when the service provided incomplete or inaccurate information to them.

The registered manager and other leaders did recognise the need to collaborate with others externally, and to change their approach to planning and delivering care. The most significant areas to improve and change had been identified by external partners rather than the service’s internal processes, for instance through reviews of audits or feedback from people who used the service.

Aspects of the culture that needed significant improvement had not been identified and acted on quickly enough or effectively enough by the leadership. Leaders had not always displayed the capability to identify and improve the areas of the service and the culture that needed improvement. Staff we spoke with did feel well supported and able to contribute.

The provider had in place a range of checks, audits and IT systems to allow for detailed analysis and open reflection. The registered manager and others had not always interrogated the data available to them and made the changes needed to ensure the service was more responsive. Staff were however supported through supervisions, meetings and regular updates via email.

We received limited feedback from staff. Those we spoke with felt able to raise concerns and felt their suggestions/comments would be valued and dealt with appropriately.

The provider had whistleblowing policies and procedures in place and had responded to suggestions to improve signposting to external sources, for staff who felt the need to ever raise concerns. There were improvements to supervisions and other means of capturing staff feedback. The office was a welcoming environment during our inspection.

The registered manager had not ensured the planning, delivery and review of care calls had been done safely or efficiently, over a period of time. This led to poor experiences for some people and heightened risks. The provider had taken recent steps to make improvements in this area, but during our inspection visits there were some core areas that fell short of expected improvements, such as the real time monitoring of calls. The registered manager committed to rectifying this in the weeks following the inspection visit.

There were a range of systems and processes in place to help capture data and meaningful information about people’s care. These had not however been implemented effectively. For instance, the audits of incidents, accidents and other information had not identified the need for more robust environmental risk assessments. Likewise, risks around self-neglect and oxygen administration had not always been identified and responded to as would be expected with a robust auditing and governance approach. The registered manager was responsive to our feedback and had begun to address these issues during the inspection process.

People’s experience of the provider’s partnership working was limited, as they largely were not party to it. They raised no concerns and benefitted from the provider’s approach. The evidence gathered during the inspection however indicated that better partnership working would have led to more consistent outcomes for people.

Leaders had been meeting external stakeholders regularly for a number of months to try and improve the service. Office staff demonstrated some good knowledge of the systems in place that could be used to improve consistency and safety of care delivery. Work with the provider of the electronic call monitoring system had not been conducted in such a way that allowed for making best use of the data it held and the functions it could provide.

Partners did not always have confidence in the provider’s ability to ensure all care calls were appropriately rostered and met people’s needs. The relationship with external stakeholders had not always been open and collaborative. The registered manager gave assurances that they wanted to work more collaboratively with stakeholders and were attending regular meetings. They had produced an action plan which was open to scrutiny and did provide a framework for improvement.