Pharos Supported Services

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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 provider’s governance and quality assurance systems were not always effective to ensure the delivery of good quality care and support to people. Although a number of audits and checks were completed, this had not enabled the provider to identify and address a number of concerns we found during this assessment. These included shortfalls in the assessment and management of risks to people. This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider responded to issues raised during the assessment and took some immediate actions. This provided reassurance about people’s safety but demonstrated a reactive rather than a proactive service. It was not evident that high-quality leadership was embedded at all levels.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us things had been unsettled with lots of staffing and management changes. However, they told us things were improving, and felt supported by the management team. Staff knew how to speak out if they needed to and knew about the provider's whistleblowing procedures'. Staff told us about some ways in which they supported people with their diverse needs. Staff and managers recognised the importance of listening to people and learning when things went wrong. However, we found learning was not consistently shared across the service. We received some mixed feedback from staff about the culture of the service. Prior to this assessment, we had identified some cultural concerns through reviewing statutory notifications the provider had sent to CQC. During the assessment, we found some concerns around the culture within the service., Although investigations into these had taken place, it was not always clear how learning was taken forward.

Staff one to one meetings had been infrequent, these are important for promoting communication and building on a positive culture. The registered manager told us plans were in place and improvements in the frequency of staff supervisions were now taking place. Progress had also been made on recruiting to vacant posts to provide a more stable work force. We saw a programme of staff induction was established. The registered manager told us at the start of the assessment they had progressed well with their own action plans. However, this is not what we found through the assessment process. Risk management was not always robust, care planning was not always inclusive and collaborative. Complaints were not always dealt with in accordance with the provider's policy. Improvements were needed to the oversight of people’s rights under the Mental Capacity Act so the provider could clearly demonstrate they were fulfilling their responsibilities. It was not always clear when investigations took place, how the learning from these was taken forward to inform future practice. People and their relatives were provided with information on how to raise suggestions and concerns about the service. However, these were not always robustly followed through in practice and this meant some opportunities for learning and improving were not followed through.

Staff told us there had been a number of changes at care staff and management level and this had impacted on the quality of the service. Staff told us that things were starting to improve. Some staff told us they had infrequent contact with senior managers. All staff told us they could speak with their line manager when they needed to.

The provider's processes were not implemented effectively across all supported living properties. When action was needed to improve outcomes for people this was not consistent across all supported living properties. The provider had plans in place to make changes to the structure of the current service and increase the management oversight of the supported living properties. This work was in progress when we carried out this assessment, and the relevant applications had been sent to CQC.

Staff told us they could speak to their line manager when they needed to. The service had a whistle-blowing policy in place which meant staff knew how they could raise a concern and be supported in doing so.

Incidents of concern had taken place in some of the supported living properties and indicated that further awareness and training was needed to ensure all staff acted with openness and honesty. For example, there had been incidents of financial abuse of people’s money and incidents that indicated a poor culture. Although the provider had investigated, it was not always clear what had changed or improved.

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 and managers could tell us about their role and responsibilities and the provider had a range of audits and checks in place. However, audits and checks had not always been effective and had not identified the shortfalls we found during the assessment.

Issues identified during our assessment had not always been identified by the provider’s own quality assurance systems or if identified, issues were not always dealt with in a timely way. Notifications were submitted to CQC as legally required but often the learning from incidents was not clear. Investigations did take place, but these were often reactive in nature and the lessons learnt to improve things were not always clear. People’s records and risk assessments were not always up to date or reviewed fully when an incident took place, so it was difficult to know if current measures to mitigate risks were working effectively.

People and relatives told us they were supported to access healthcare services as needed. However, some people’s health action plans (HAP’s) were not up to date with current information about how their health needs were being met. For example, one person received specialist support for a particular health need, but this was not recorded in the HAP and staff were not aware of the specialist services involved. Relatives told us the service was generally well managed but did raise concern about the turnover and changes within the management team.

Staff and management told us they collaborated with all relevant professionals, stakeholders and agencies, such as social workers and speech and language therapists (SALT).

We received some positive feedback from stakeholders about how the provider had worked well with them when supporting people when transitioning into one of the provider's supported living properties. However, we also received mixed feedback from external stakeholders about some inconsistences in the service due to staff and management team changes, which had impacted on the quality of the service.

Processes were in place to ensure external partners were notified of relevant information. For example, the management team completed CQC notifications, based upon information brought to their attention and had raised safeguarding concerns with the local authority safeguarding team. Where action plans were in place with the local authority quality team, the registered manager told us all actions were completed. However, this did not provide an accurate reflection of the ongoing work that was still taking place.

Staff understood how to make improvements to people’s care happen. We saw some good interactions between staff and people, and staff told us they would raise issues and concerns with the management team. We saw some people had been supported to develop their skills within a risk assessment framework. However, for some people improvements were slow to happen. Staff told us there had been many staff and management changes and this had impacted on improvements happening for people. The provider told us they involved people and their relatives in improving the service through care review meetings and conducting periodic care surveys. However, we found reviews of people’s care plans and risk assessments were not always consistent or robust. It was not always clear how learning was shared when things went wrong, and how learning from incidents was used to improve people’s care.

Systems and processes to support learning and improvement in people’s care were not always effective. Regular meetings took place with the senior leadership board for the organisation. However, the focus was primarily on reacting when things went wrong as opposed to a proactive approach, demonstrating continuous learning and growing.