Knightingles Healthcare Bedfordshire Limited

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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

As part of this assessment, we looked at 7 quality statements for the key question of well-led. These were ‘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 and learning, improvement and innovation’. Staff had a good understanding of equality, diversity, and human rights, and they provided safe, compassionate care. The management team were very experienced and had an excellent understanding of the key principles and focus of the service, based on the organisation’s values. The management and staff team demonstrated an open honest and transparent culture, and all staff were confident their voices would be heard. There was a strong organisational commitment and effective action to ensure there was equality and inclusion across the workforce. There were robust governance arrangements and staff understood their role and responsibilities. The management and staff teams worked in partnership with key organisations to support quality care. There were processes in place to ensure that learning happened when things went wrong, and best practice guidance was sought and shared.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a strong focus by managers on inclusion, equality and diversity issues. This meant people who received care and support benefited from a management team with a positive sense of direction and strong leadership. This was evident in discussions with management and staff. Staff were aware of the organisations values and were able to describe these. One staff member told is, “We do talk about the values and the things that are most important to people when we give them personal care. Kindness is so important. You can’t do this job if you are not kind to people.” In discussions with people who used the service, health and social care professionals and staff we found these values and standards working in practice. The staff training, supervision and support systems fully enabled staff to progress within their roles, and to achieve their full potential. One staff member told us, “This is the best company I have worked for. It’s all about giving the best care and the best way to do that. The managers share lots of information with us and they are very supportive.” There were robust communication systems in place to ensure all information was shared across the organisation and with all staff, irrespective of their roles. The operations and development manager informed us, “In the all-staff meetings, all available managers will usually attend alongside staff, and often one of the directors will attend as well to give updates on the progress and strategic direction of Knightingles. Standards of operation are reinforced, and all attendees are afforded an opportunity to ask questions and receive immediate feedback. Our staff meetings are themselves evidence of the culture we aim to cultivate at Knightingles; one of togetherness, sharing, learning and direct support from management. They have been an effective way to allow staff to feel heard and kept up to date with any developments.”

Staff were required to complete an equal opportunity form when they first commenced their employment. This was based on equality and diversity whilst highlighting people’s own protected characteristics and cultural backgrounds. There were regular updates for staff through meetings, emails and intranet postings. The provider had a single detailed record for each person and managers used this to communicate any changes and how these would affect the care being provided. During the management's daily catch up or operational meetings they would agree on any agenda items that needed to be added to all staff supervisions, including any changes about the service, to ensure information was shared across the organisation. There were group supervisions of various staff teams, specific service management teams, and team leaders, where expectations were shared and in turn filtered down to all the staff teams.

All of the staff expressed great respect for the management team and spoke of their commitment, passion and pride working for the service. The feedback, culture, and attitude of all the staff was that nothing was too much trouble; and everyone involved was willing to go above and beyond expectations to ensure people’s needs could be fully met. Comments from staff included, “I was lucky to find this company. They are excellent and treat their staff really well. As a result, the staff are loyal and always striving to do the best they can. We are valued and that motivates us.” And “The managers are very caring and that is reflected in the staff team. We want to make them proud, so we give the job 110%.” Staff told us how this culture enhanced morale and assured them that their efforts were greatly appreciated by management. A well-established staff team and clear communication meant that all staff understood their roles and effectively contributed to an exceptional team ethos. Staff felt valued and listened to and they told us that if there were any issues, they were quickly sorted out

We found the leadership, management and governance of the organisation assured the delivery of high-quality, person-centred care. It also supported learning, innovation and promoted an open culture. The service had a well-defined organisational structure. The management team had the experience, capability and integrity to ensure the smooth running of the service and that risks were well managed. For example, the management team consisted of qualified Registered General Nurses, Registered Mental Health Nurses, Accountants, Marketing professionals and a Criminologist. Eight of the managers attended and completed a 5-day Mini MBA course in Professional Development. This was an accelerated programme to upskill the managers and bring their leadership knowledge up to par with the latest standards. A further 3 managers had enrolled on a Senior Leadership Apprenticeship course which they had just completed the first of the two-year programme. Risk assessments addressed people's diverse needs. For example, people's specific needs around dementia and mental health. Risk management plans were proportionate and centred around the needs of the person. They were regularly reviewed with other health care professionals, and they took note of equality and human rights legislation. Records demonstrated that strategies were in place to make sure that risks were known, anticipated, identified, and managed. The provider was committed to continually motivating the staff team and recognising their commitment to their role. For example, staff special occasions and achievements were recognised and celebrated and there was a summer BBQ where all staff could attend around their shifts. The minutes to staff team meeting showed these were very interactive which meant staff felt valued and included in the organisation.

All staff we spoke with told us they were encouraged to speak up and this was always discussed in team meetings. One member of staff said, “The managers are very open and honest and encourage us to speak up if we have any concerns.”

Freedom to speak up was highlighted in the staff handbook which all staff had a copy of when they first commenced employment at Knightingales Healthcare. Staff also had access to ‘SPEAK UP’ information via the whistleblowing policy and safeguarding was discussed in staff meetings. Surveys were sent out to people and staff so that they could share their views on the organisation or raise any concerns. There was a ‘customer information guide’ that detailed ways in which people and their families could share their views, make complaints and raise concerns or give feedback anonymously if required.

The service worked towards an inclusive and fair culture by improving equality and equity for staff working at the service by embracing and valuing differences, such as those related to gender, race, ethnicity, age, disability and professional backgrounds. Staff members from diverse backgrounds felt valued and respected because the provider had implemented strategies that promoted cultural diversity and understanding. For example, staff were supported to observe religious holidays and embrace various cultural perspectives and traditions. One staff member said, “I am lucky that our managers understand how important my faith is to me. I know a lot of other staff feel the same.” The operations and development manager informed us, “We have an open-door policy that means that all staff are able to approach any manager if they feel they are not being treated fairly and heard. The Supervision platform also allows for staff to share their concerns with managers. These are dealt with as soon as they are highlighted, and staff are aware and that they have an avenue to raise their concerns. The annual training reinforces our core values and reminds staff of the boundaries around equality, diversity, and inclusion.” As part of the recruitment process interviews were conducted in line with a values-based guidance. We were told, “We ensure that we employ compassionate people that are interested in working in the sector. We recently conducted interviews for Team leader positions. We used a task-based approach to ensure that we promoted on merit and not on popularity. This approach also allowed us to be fair and inclusive to all who were interested in the opportunity.”

There was a strong organisational commitment and effective action to ensure there was equality and inclusion across the workforce. To extend diversity, equity, and inclusion to the recruitment process the provider had implement several impactful strategies. For example, incorporating structured interview questions that evaluated candidates based on their competencies and qualifications, rather than subjective opinions. Staff completed surveys so they could give their views and opinions. We saw from the minutes of the staff meetings they were fully informed of what was happening in the service and any incidents were shared for lessons learnt. Staff completed training about Equality, Diversity & Inclusion as part of the mandatory training and this covered unconscious bias training. This training was refreshed annually for all staff including the management team. Topics such as ‘how to eliminate or reduce instances of discrimination, protected characteristics and values and support’ were covered during the training. Staff also completed training on bullying and spotting the signs of bullying. There had not been any instances of this, but we were told it would be addressed with a zero-tolerance attitude.

The management team demonstrated they were committed to improving the service they provided. Staff described supervision and appraisal as regular and supportive, with staff praising the high level of support they received from their line managers. One staff member told us, “If we have any problems, whether is personal or to do with work, the managers go out of their way to help us and support us. They genuinely care about their staff.” Staff were motivated and proud of the service. All the staff we spoke with said they had great job satisfaction and were supported to develop their skills, giving them lead roles and empowering them to drive improvements and new initiatives.

The provider had successfully embedded a very robust auditing system. This included regular internal audits in areas such as accidents and incidents, risk management plans, staff training, staff supervision, reviews of people's goals and recruitment records. We saw there were actions plans in place to address any areas that needed further improvements and we saw actions were taken swiftly. Best practice was shared throughout the team, identifying what had worked well for each person, or what had not worked well. There were reporting systems for critical incidents and identifying risk with strategies to make sure that risks were known, anticipated, identified, and managed. For example, there was a risk register that identified risks to people, and these were regularly reviewed. Risk assessments addressed people's diverse needs and risk management plans were proportionate and centred around the needs of the person. They were regularly reviewed with other health care professionals, and they took note of equality and human rights legislation. There were robust systems in place to ensure lessons were learned when things went wrong. The management team closely analysed all accidents and incidents and they worked with people, their families and other healthcare professionals to continually review identified risks with the aim of reducing the likelihood of repeat incidents. There were daily catch-up meetings which were attended by all managers and team leaders. The meetings ensured that the management team were made aware of any incidents and other important matters. The meeting was also an opportunity for senior managers to guide and mentor mid-level managers and team leaders particularly regarding recommended practice for different scenarios. Through these meetings, the provider had created a culture of continuous sharing, learning, growth, and real-time feedback to maintain and improve operational effectiveness.

We saw numerous examples of collaborations between the service and other agencies demonstrating positive outcomes for people. For example, we received positive feedback from health and social care professionals involved in people’s care. One commented, “I have supported Knightingales Healthcare in the past with writing and reviewing PRN protocols for their service users. I was impressed at the way staff at Knightingales Healthcare asked for support when it was required, rather than trying to muddle their way through. I met with a staff member from Knightingales Healthcare on Teams and we wrote the PRN protocols together. The staff member had good knowledge of the service user and their preferences. I provided the clinical oversight. More recently, they have contacted me again to review the protocols, which I will be doing with staff in due course.” Another comment read, “I have carried out visits with Knightingles for joint manual handling assessments as needed over the last 3 years. I find the communication with them very good; they always answer the phone and are receptive and proactive to advice given. The [care manager] in particular is very experienced and understands the needs of the clients extremely well and is able to communicate this to us. They have a very person-centred approach and are kind natured and forthcoming in carrying out review visits as required, to review cases if there are any changes or concerns. The care agency value the importance of Occupational Therapy input and are accommodating to adjust care calls and ensure carers are present for Occupational Therapy assessment and assist with this process.”

We received very positive feedback from health and social care professionals. One told us, “I have worked with Knightingles for just over 18 months to support a discharge from a long-term hospital stay. Knightingles were supportive and acted appropriately to discharge the person into their own home. The person in question did not have many belongings or family to support them and Knightingles worked over and above to support the person to build themselves a home.”

The service was transparent, collaborative, and worked in partnership with key organisations to support care provision, service development and joined-up care. Contact with health professionals was made promptly to ensure joined up care was effective and met people’s needs. For example, continence teams, GPs, district nurses and occupational therapists. We saw they had worked with the care home pharmacist on the preparation of ‘as needed’ (PRN) medicines documentation. There was also collaborative working with the safeguarding team who they used for advice and guidance. For example, there had been a recent query about medication for one person and the safeguarding team signposted them to the GP for a medication review. The medication was changed from liquid to long-acting tablets based on the advice given. There were good links with the local community. For example, we saw that the provider sponsored a young person’s football team and the operations and development manager told us, “We want to help the young to stay active and healthy.”

There were processes in place to ensure that learning happened when things went wrong, and best practice guidance was sought and shared. A staff member told us, “In our team meetings we always discuss any accidents or incidents and what we can learn from them. Recently we were provided with extra training and supervision about pressure sores after a person had developed a sore. We have an app that also gives us guidance about how to care for a person with wounds.” We were informed by the operations and development manager, “We have acknowledged that people learn in different ways and as such we have, for some time now, had refresher training with staff face to face. This means that we can gauge their understanding and adjust our delivered content.”

The provider was committed to improving the service they provided and had introduced a number of initiatives to help make improvements. The provider produced an integrated quality and safety report. This looked at complaints, incidents, safeguarding concerns, the risk register where 12 risks were recorded and the results of surveys. An action plan was produced when this had been reviewed within a set timescale. For example, the provider commissioned an external immigration law firm to oversee their sponsorship program to ensure best practice. There was a focus and importance placed on ensuring staff had the skills to do their jobs well with opportunities for continued learning and development linked to the needs of people. The provider embraced success and promoted good practice. For example, if there was a gap in staff knowledge the registered manager would organise training and workshops to meet that need. This ensured that people’s treatment and support achieved good outcomes and was based on best available evidence. Supervisions and team meetings were used to openly discuss training needs and further training would be accessed if staff felt they needed it, which in turn better supported safe and effective practice. Since the last Quality & Safety report lessons had been learned following safeguarding alerts. For example, recognising the critical nature of pressure area care, the provider had implemented a company-wide requirement for all staff to complete the Pressure Area Care module on Care Skills Academy. This had been beneficial to educate staff, ensuring they gained the knowledge to prevent and manage pressure ulcers effectively. In addition, as staff completed their refresher training, the provider introduced reference cards for all staff, providing them with quick access to vital information on recognising the signs of sepsis and heart attacks.