Total Care Norfolk

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

During our assessment of this key question, we found concerns relating to good governance which constituted 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. Systems and processes which were designed to ensure people who used the service received safe care were not always effective. Audits and spot checks to monitor the safety and quality of the service were not always robust and had not picked up the issues we identified during this assessment. Recruitment systems were not fit for purpose and did not protect people. There were processes in place to enable staff to speak up about concerns and issues and staff told us they felt confident making their voices heard. However, records did not evidence staff meetings and supervision sessions were open forums with an inclusive approach. A diverse workforce was in place and staff had received equality and diversity training. The provider lacked an ongoing proactive approach to supporting overseas staff once in post. Learning was not intuitive. Staff were not always well supported during initial online training, some of which took place before employment. Systems for checking knowledge and understanding were in place but needed to be more effective.

This service scored 61 (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.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Although there was a whistleblowing policy in place, not all staff were aware of it. Although staff told us they felt listened to and understood how to speak up, we found staff meetings and supervision sessions were not inclusive formats. Records relating to these showed them to be a forum for the provider to deliver information rather than a two-way process. The provider was not always proactive in seeking out the views of staff.

The provider had a whistleblowing policy in place. Some further work was needed to ensure staff were able to make their voice heard.

Feedback from staff was broadly positive about their experiences within the team.

The greater part of the workforce had been recruited from overseas, through the government sponsorship scheme. We found a lack of structured ongoing support for these staff, following their initial induction. The provider did not have a proactive approach to support and integrate them into the wider staff team. Some of these staff were very inexperienced in care and had English as their second language which were additional challenges.

The provider and registered manager were not clear on the regulations relating to recruiting staff safely. We discussed our findings at a feedback session and both demonstrated an incomplete understanding of the relevant regulations. Immediate changes were made to the application, interview and post interview procedures as a result of our assessment. We discussed feedback about some staff's level of spoken English. The provider and registered manager explained they had not had any negative feedback about this but people told us they had mentioned this and we saw people had commented about this in their satisfaction surveys.

Serious concerns relating to the recruitment process meant we could not be assured staff had been safely recruited. Audits relating to the recruitment of staff were inaccurate and stated actions, such as reference checks, were in place when they were not. The provider and registered manager demonstrated a poor understanding of their responsibility to operate an effective recruitment system which protected people from unsafe care. Staffing shortages at management level meant auditing had not always carried out in a timely way by staff who had the training and accountability required. The provider had begun to address this by recruiting staff to some senior roles. The provider gave new staff online training modules but did not robustly check staff knowledge and understanding – especially those new to caring roles and from overseas. For example, staff being unclear about safeguarding procedures despite having very recently completed their safeguarding training. Where issues had been raised, such as in the service users’ annual survey, patterns and trends had not been analysed and it was not clear what action had been taken. We identified a failure to ensure communication with the public was accurate and transparent. The service’s website states care staff were ‘CQC registered’ which is not accurate and could be misleading. Care staff are not themselves registered, as nurses are, but the service itself is registered.

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.

The registered manager told us about their plans to continue to develop the service following on from the last local authority quality monitoring visit. However, some of the issues they had identified in 2023 were still not addressed at this assessment, although some improvements were evident. An induction was in place for new staff and observations were plentiful, but poor performance was not always followed up and addressed. When we raised this issue with provider they appeared to make a judgement about the person carrying out the observations rather than the staff member being observed. Learning was not continuous other than the repetition of some mandatory training. We identified some gaps in staff knowledge and understanding which the provider was not aware of, most notably safeguarding. The provider has set up additional safeguarding training to address this. However, people who used the service were confident in the skills and knowledge of the staff and trusted them. Some specialised training had not been accessed for staff to help them meet one person’s specific needs.

The provider and registered manager were not aware of CQC's new ways of working when we rang to announce the assessment and did not ensure they were always clear on best practice throughout the sector.