Courtyard Mews

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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

We identified one breach of regulation in relation to Good Governance. The registered manager was unaware of their regulatory responsibilities with regards to safeguarding people from abuse. Governance and oversight of the service was poor. The providers quality assurance systems failed to identify the issues we had identified within this report. The registered manager did not understand their legal responsibility to fully assess the risks to people they supported. This put people at serious risk of harm. There was a failure to provide adequate guidance and information to staff so that they could safely undertake their roles. There was a failure to provide adequate training to staff to ensure they fully aware of the needs of the people they supported and to ensure they could provide safe and effective care.

This service scored 25 (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 failed to embed a shared direction and culture for the service and staff working at the service. A staff member shared their concerns regarding the approach of the registered manager towards staff. They told us that staff were impacted by unrealistic expectations in their scheduling. The staff member said, “I think they (management) can improve in how they are professional. Sometimes I feel they can be too hard on carers in the sense that the work is quite hectic, if you are on the go. Sometimes some clients want specific times, and we can't be there at the same time. If the manager was a bit understanding that we can't be at the same place at the same time." Although some staff provided feedback to inspectors, we received information during the assessment process that the registered manager had told some staff not to answer their telephones from inspectors. It had been alleged that only friends and family who are employed by the registered manager were to provide feedback to CQC. We cannot be assured of the validity of this feedback.

The registered manager and staff did not demonstrate a positive culture where concerns raised by those they supported were actioned and improved. Some people we spoke to stated that they would often have to reiterate wishes and preferences of their support to staff before things were changed. One person said, “No one ever rings me. They should call me. I haven't complained at all (about issues to the office). I didn’t want to tell anybody. I don't like ringing them up (office) and reporting much in case they think I'm being awkward.” The registered manager produced survey results which were conducted over the telephone, the results showed people were generally satisfied with the service. However, people told us they were not asked their views and opinions of the service they received and that the registered manager failed to engage with them. Staff worked with people to ensure that any diversity needs and considerations were considered and met. For example, one person’s religious needs and routine were considered so that a regular care call was undertaken outside of time of prayers. The service had an equality and diversity policy and training in place.

The registered manager did not evidence they were a capable leader due to their lack of knowledge in respect of regulations and responsibilities. They did not lead by example to promote an inclusive culture and failed to assess the quality of care people were receiving. The registered manager ignored the need to robustly assess people's health needs and to include people in these assessments, care records that were shared with staff were inadequate and did not equip staff to provide a high quality and safe service. The registered manager told us of their accolades and qualifications they had achieved, however, they did not demonstrate they possessed the skills, knowledge and experience to lead the service safely and effectively. The registered manager told us they had employed two nurses to support the management of the service, however, it was not clear how their involvement drove improvement. One of the nurses completed a mock inspection of the service in 2022 and had deemed the service to be 'compliant' with no areas of improvement identified, however, we identified significant concerns at this assessment. Feedback from staff was positive on the approachability and support from the registered manager. One staff member said, “(The manager) is a nice person, she is ok. If she wasn’t I wouldn’t be there. There has been a time I called her and asked her to come out in the field, she dropped everything and she came out.” Although feedback from care staff was positive, there was a lack of awareness, and concern, from staff on the absence of risk information and guidance around people’s health conditions which left people at significant risk of harm.

The registered manager failed to evidence their understanding on the priorities and responsibilities of aspects of their role. They demonstrated a lack of knowledge of the priorities of the quality of service by failing to understand, acknowledge and facilitate the important safety aspects of care delivery, such as the management of risk, effective and safe care planning and the training needs that care staff required to effectively carry out their role. The registered manager was unclear on aspects of their regulatory role with regards to safeguarding. The registered manager had a background and experience in public health care but failed to understand that risks to people’s health need to be assessed, understood and information and guidance shared with staff who deliver care and support. This demonstrated that the leadership of the service was not able to fully ensure that organisational priorities and risks were delivered safely. People told us that they mostly dealt with care staff directly. While some people said they had spoken to the registered manager and received positive support, some people told us that they did not recall seeing or speaking to the registered manager in the time they had been receiving care.

The registered manager did not promote an open culture for staff and people to speak up. During the assessment process, we received information that some staff were told by the registered manager to not speak with inspectors from CQC and only staff who were friends and family of the registered manager were permitted to speak with us. We were told staff were concerned about losing their right to work in the UK and sponsorship. When we phoned for general feedback, a staff member asked the inspector if they could keep their telephone number if they had any problems. Another staff member said, "The inspection is affecting our hours, we were told and know you were going to call." People were not listened to and their concerns were ignored, people told us they had not spoken with the registered manager which meant they would not be aware of who to speak with or how to speak up if something was wrong. Staff told us that the registered manager was open with them and open to suggestions regarding people’s care and support. One care staff member said, “They know me for that, and they do listen, as we are the ones who see the clients, any concerns we raise, and they do listen.” We found significant concerns regarding people's care and support, however, there was no evidence of staff speaking up to escalate these concerns internally or externally. The registered manager stated that staff could freely speak to outside agencies when they felt that concerns could not be raised directly with them. The registered manager said, “I cannot be the judge and jury of my own case.”

The service had a whistle-blowing policy in place, however, it was ineffective and not used by staff. Staff told us they were aware that they could call the local authority or CQC should they have concerns about the leadership of the service, however, staff had not recognised there were concerns or were not comfortable to follow the policy. The registered manager was also the provider of the service and had appointed two Freedom to Speak up guardians, these were the two designated external clinical nurses, the registered manager told us that staff could speak with the nurses confidentially should they have any concerns about quality of care or concerns about the registered manager. When speaking about the Freedom to Speak up guardians, the registered manager told us, "My support is the nurses who support us. If I have concerns about mental health, I can deal with it as its my background. I can get overwhelmed, especially during audit time, they are happy to take one or two (audits) off me." And, "It's important to me that they are the 'go to' people to support me." As the clinical nurses supported the registered manager, it created a risk of closed cultures should staff and people approach them as Freedom to Speak Up guardians.

Staff we spoke with told us they feel included and supported to undertake their roles. However, we received feedback from people that there could be communication barriers with staff. A person told us, " The registered manager told us they supported overseas workers who were new to the country, they said, "The first month we support them, including food, shelter until they are able to pay bills. This is during the induction, I see this as being fair so that they can get acclimatised with society, support with information, such as, registering with GPs and how to access facilities in community." Although the registered manager told us about the practical support, there was no evidence of how staff were helped to adjust to differences in culture when living in the UK; this included overcoming communication and language barriers. Although some staff provided feedback to inspectors, we received information during the assessment process that the registered manager had told some staff not to answer their telephones from inspectors. It had been alleged that only friends and family who are employed by the registered manager were to provide feedback to CQC. We cannot be assured of the validity of this feedback.

Systems and programmes were in place to support staff inclusion and needs. An external employee assistance programme was available for staff, providing practical, emotional assistance to support them to carry out their role. Staff needs and workforce planning was considered and adjusted. An example was provided where a staff member required workforce adjustments to allow additional focus on their child’s support needs and schooling. Scheduling was adjusted so that care calls were prioritised during school times. Support was provided to overseas workers to facilitate their transition with practical support to adjust. Staff were supported with registering with local GP’s and community engagement. Equality and Diversity training was in place for all staff to complete as part of their core training.

The registered manager had failed to understand or fulfil their regulatory requirements and notify CQC of potential safeguarding concerns. The registered manager is required to notify CQC of certain incidents, events and changes that affect a service or the people using it, such as abuse or allegations of abuse. The registered manager told us that they did not know they were required to do this. This demonstrated a lack of governance and oversight of safeguarding incidents. We could not be assured that systems around GDPR and access to people’s information was secure or accessible to staff who needed it. We were informed that documents relating to people’s medicines was held in the registered managers home, while other important care information could not be accessed directly by office staff as this was held within the registered managers own systems. There was a lack of robust arrangements for the availability and integrity of records and data. CQC were informed at the assessment that the registered manager held some records, relating to people’s care and support on their own system or off site. When requested, the care coordinator was unable to access these for CQC to review or if required when the registered manager was off site.

There was a lack of clear and effective governance. The registered manager was unclear and unaware of their regulatory responsibilities, and failed to ensure that care and support needs were effectively risk assessed. There was a failure to understand the impact and importance of assessing people’s risks in full and ensuring that staff has access to important information and guidance around health care conditions and risks in order to safely and effectively undertake their role. The registered manager approach to information sharing with care staff was poor. The registered manager stated that they did not want staff to be overloaded with information. This disregarded the importance of staff having access to read and understand the important risks and healthcare conditions that could impact the support they provided. Quality assurance systems were poor. The registered manager had quality assurance checks in place although the consistency and effectiveness of these was poor. Audits had failed to identify the issues and concerns identified in this report, such as risk assessments, medicines, staff training needs, regulatory requirements, ineffective environmental assessments etc. Care plan audits had been completed but audits did not specify the person being reviewed therefore we were unable to review these against people’s support. Processes to review people’s care was inconsistent. People we spoke to could not fully recall their care needs being reviewed. Many people supported by the service had been discharged from hospital with complex conditions and care needs which were likely to change and require consistent oversight to adjust their care and support. One person’s moving and handling information, and the equipment they used, had been incorrect for approximately two months. One person told us, “They don’t regularly update. I don’t think they’ve reviewed. The other agency used to do it every 3 or 4 months. I can't remember this company doing that."

People did not benefit from staff and management working collaboratively and in partnership as the registered manager's communication with outside agencies was poor. The registered manager failed to ensure people's information was accurate and up to date to be shared with staff and external agencies when needed. For example, a person using the service would frequently leave their home which meant staff were not able to support them. The registered manager had not informed the relevant professionals for further input and potential referrals to other teams. The failure to engage with partners in care could lead to people experiencing significant harm and neglect.

The provider failed to ensure people's safety because they did not communicate appropriately or work collaboratively with relevant organisations to support people's care provision. One partner in care informed us of concerns around staff unawareness of risks, lack of reporting of safeguarding incidents and failure to notify the local authority regarding the safety of one person that they care managed. The professional told us that even when initial concerns were raised with the service, further incidents were unreported, putting the person at risk. The professional told us, “The gentleman wasn’t home for several days. They hadn't contacted us to tell us that the person was missing. It was important for us to know they weren't delivering the care. The client was the priority.”

The registered manager and staff did not always collaborate effectively and openly with relevant stakeholders and agencies to ensure that people were safe and received the support they needed. While records showed that referrals were initially made to professionals and stakeholders when additional support was required, there was poor ongoing communication, information sharing and highlighting of risks and care needs by the registered manager and their staff. People were at risk due to the absence of processes to support collaborative working with partners, including sharing information and improvement that could be made to people's support. Processes for following up professional advice and guidance was lacking. For example, a person had been assessed by professionals to require a hoist, this did not suit the person and the registered manager and staff relied on the person's relative to arrange reviews, the person remained being cared for in bed which could cause a potential negative impact to their well-being.

Staff spoke to us about the shadowing, checks and core training they received as part of their induction process. One care worker said, “Yes, with this work, you get to learn more every day, you can’t join and say you know it all. When I first joined the training was fine, I shadowed when I started, this was for a month. There is a difference between learning online and doing it yourself. Before I started on my own, I had someone check that I was doing the right thing and get correction if there was any mistake.” Although some staff provided feedback to inspectors, we received information during the assessment process that the registered manager had told some staff not to answer their telephones from inspectors. It had been alleged that only friends and family who are employed by the registered manager were to provide feedback to CQC. We cannot be assured of the validity of this feedback. While the staff we spoke to expressed that they were generally happy with the learning they were provided, our assessment found learning and improvement systems did not meet the expected standards.

The leadership of the service did not always demonstrate a good understanding of how some improvements needed to be implemented. During and following the assessment, we discussed our serious concerns about the lack of risk management around people’s healthcare conditions with the registered manager. Although the regulatory and legal requirements were discussed and reiterated with the registered manager, there was a lack of understanding that assessment and management of all risks to people they supported should be considered and incorporated into their support plans and assessments. The registered manager failed to show an understanding and focus on the learning and development of staff to ensure that they had the training and skills to support people’s needs safely and effectively. The service provided care packages to people with complex health needs that impacted on how staff safely supported them. There was a lack of training provision or guidance for staff for most of these conditions, staff did not receive robust training and their competencies had not been assessed to provide safe care. This left people at significant risk of harm. We received information during the assessment process that the registered manager had told some staff not to answer their telephones from inspectors. It had been alleged that only friends and family who are employed by the registered manager were to provide feedback to CQC. We cannot be assured of the validity of this feedback. This is an indication of a closed culture where the registered manager is not open to learning from feedback from staff and people.