Archived: Hartwig Care (Waltham Forest)

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

We identified 1 breach of regulations. Improvements were needed as the provider's governance systems were not always monitored or operated effectively to ensure the quality and safety of people's care. There were concerns around the honesty and transparency of the management team as during the assessment process we were given documents that had been falsified by members of the management team. Due to this, we could not always be assured about other records we received as part of the inspection being genuine documents. We discussed this with the provider who had taken this extremely seriously and took the strongest possible disciplinary action against the staff involved. Incidents that had occurred across the schemes had not always been notified to us. The service was in a period of transition, as a new manager had recently started in their role and the provider was in the process of transferring across to a new digital software system. The provider had systems in place to obtain feedback from people about the service they received. Whilst there were also systems in place for staff to provide feedback about their working experience, some staff told us they did not feel confident in speaking up due to the culture of the service.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The majority of feedback from staff about the shared direction and culture was positive. Staff told us they put people first and this was a key reason why they enjoyed their work. Staff told us they felt supported to meet people’s needs and could approach the management team if they had any concerns. Positive comments from staff included, “It is a good company to work for and they give us good advice” and “Even with the changes, they try and listen to us and have been understanding.” However, some of the negative feedback highlighted issues around the openness and honesty of the service and a lack of confidence in the management team. The provider acknowledged where concerns around openness and transparency had been identified. They told us after the inspection they had recruited a new manager to ensure positive changes across the service.

The providers systems and processes did not always ensure there was a transparent culture across the service. People, staff and external partners had not always been involved effectively to support the development of the service. The management team did not have full oversight of the service as there were inconsistencies across the 4 schemes.

Feedback from staff was mixed about how capable, compassionate and inclusive leaders were in the organisation. Positive comments included, “I do feel respected and valued” and “[Registered manager] is visible, has told us we can contact him anytime, has given us his number. I feel there is an open-door policy.” Comments of a negative nature focused around the visibility of the management team and felt that concerns were not always taken seriously. A staff member said, “In some aspects we get support, but in others we don’t. I do think they need to look at how they support staff wellbeing and morale.”

Processes for submitting statutory notifications to the CQC about incidents that had occurred across the service were not in place at the time of the inspection. There had been a lack of oversight as a number of safeguarding incidents had not been reported to us or picked up by the providers own monitoring systems. The provider acknowledged this oversight. We reminded the provider of their legal requirement to submit the relevant notifications without delay. Notifications that had not been submitted were retrospectively submitted after the site visits. At the time of the inspection, some members of the management team did not embody the culture and values of the organisation and did not work with integrity, openness and honesty. Members of the management team had falsified records to cover up for gaps due to a lack of oversight they had across the service. This meant leaders did not lead by example and were not proactive to addressing a poor culture, which risked people having negative experiences and issues not being identified and resolved in a timely manner.

We received mixed feedback from staff about how comfortable they felt in speaking up and raising any concerns. Where staff had no issues in this area, they told us they felt confident their concerns would be listened to and addressed. However, some staff did not feel comfortable talking to us openly in the presence of the management team and contacted us directly. Feedback highlighted a lack of support to those speaking up with a fear of reprisals and not knowing who to turn to. Some staff had also made contact with the local authority regarding their concerns. We discussed this with the provider after the site visits who told us to ensure staff felt comfortable raising concerns, they had introduced ways staff could feedback anonymously. The new manager would also be carrying out some drop-in sessions for staff across all the schemes to provider support and reiterate their commitment to support staff speaking up.

The provider had recently implemented ways to hear from staff to ensure they felt supported and would be confident in speaking up if needed. Where there had been changes in management, this had impacted how frequent team meetings were carried out. A scheme leader told us this was due to workload demands, however they hoped going forward, they would return on a monthly basis. The provider had a whistleblowing policy in place but not all staff were aware of this.

The majority of feedback from staff about this area was positive. Staff told us they felt they worked in a supportive and inclusive work environment and were treated fairly by their colleagues and management team. A staff member said, “I feel it is a very inclusive company to work for. There are support systems in place and I feel I am treated equally, without any bullying or harassment.” Another staff member told us they also felt well supported around managing reasonable adjustments. They added, “I have to say they have been very accommodating around this.” However, feedback from some staff highlighted less positive experiences around a lack of support and understanding for a need of workplace adjustments and felt they were not always listened to.

The provider had policies in place to promote workforce equality, diversity, and inclusion. Staff had opportunities through supervision and team meetings to share their experiences and raise any concerns. We shared the feedback with the provider who told us the new manager was working to ensure staff felt supported and since they had started, felt they had a positive impact on the staff team.

In general, staff told us they were aware of their responsibilities to support them in their role. This included an induction and completing shadowing shifts before they started. Staff told us members of the management team also carried out checks, which included feedback about areas for improvement. A staff member said, “We get feedback at the end of the month about how we write in the daily logs. Once they check, they make us aware of any issues and how we can make improvements.” Staff were also positive about how information was shared with them by the management team and felt it helped them to meet people’s needs. As there had been recent management changes, not all staff were able to fully comment about the registered manager as they felt he had not been in the role long enough but felt they had settled in well. The provider acknowledged the concerns where members of the senior management team had not identified the issues we found during the inspection.

The provider did not always have clear and effective governance systems in place to monitor the service and identify areas of improvement. There were delays in records being made available to us and we found evidence of falsified records. This meant we could not always be assured of the completeness of the records we reviewed. Whilst there were quality assurance processes in place, auditing systems for people’s medicines and financial transactions were inconsistent across the 4 schemes. Areas of concern we had identified as part of our assessment had not been picked up by the provider. This included gaps within people’s care and medicines records, people’s daily logs and staff recruitment processes. Systems in place for supporting people to manage their finances were not robust and we were not assured the provider had a clear oversight of this level of support being provided. We shared our concerns with the provider who acknowledged the shortfalls. They told us they had been made aware of this from recent local authority monitoring visits and were working across the schemes to identify areas of improvement and staff competencies. We were also told after the site visits the registered manager had resigned and the provider had recruited a new manager.

Whilst people had opportunities to provide feedback via quality assurance surveys and spot checks, people and their relatives had not always been fully involved in aspects about their care planning and the level of care they received. The local authority also received the same feedback from people when they carried out their monitoring visits. A person said, “I don’t know about a care plan, I think I have a care plan, but not sure where it is. I don’t know what it consists of though but feel the staff understand my needs.”

The provider responded to the findings of fraudulent activity and apologised to both us and the local authority, highlighting they were deeply disappointed to hear this and were proactive in following it up immediately once they had been made aware. A member of the senior management team added, “Integrity amongst our staff teams is fundamental to good service management and delivery. Expectations around honesty and transparency and working together are reflected in policies, procedures and training and these underpin how we anticipate staff will behave and practice. Most concerning is that you found fraudulent record keeping at a senior management level, as have the local authority. We do not condone falsification of records at any level but managers especially should be beyond reproach. We wish to reach a position where people can trust that we are telling them the truth.”

The provider had not always been open and transparent with all relevant stakeholders and external professionals. Our inspection had been triggered by concerns raised by the local authority, who identified similar concerns to our findings. The local authority had also highlighted concerns around openness and transparency and had also been given falsified documents. As highlighted in the safe section of this report, due to these concerns, along with their initial findings, the local authority suspended placements within the 4 schemes until they had assurances improvements could be made. However, after further monitoring visits and regular meetings with the provider, the local authority took the decision to terminate the contract with the provider. The provider felt there was a strained relationship with the local authority and they confirmed they would be ceasing their support. The provider told us although there was a contractual dispute with the local authority, they would be fully committed to the transition process to ensure the safety of people within the schemes.

Staff and leaders were not always open and transparent in their collaboration with us and other relevant external stakeholders and agencies. Other than being given falsified documents, information was not always shared with the relevant partners. Where staff had raised concerns with management about a person’s deterioration in health in one scheme, we found this had not been passed onto the relevant professionals, despite being told it had been reported to the local authority on multiple occasions. Staff and leaders had not always engaged with people and external stakeholders to share learning that resulted in continuous improvements to the service. For example, a safeguarding investigation from March 2024 had only been followed up and resolved with the person involved until after the inspection.

Staff told us they were happy with the level of training they had which helped them with continuous learning to support them in their role. Another care worker told us the feedback from spot checks and refresher training had helped them to feel more confident. The provider agreed there were shortfalls across the services that had impacted their ability to make certain improvements. However, since being made aware of the concerns, they told us they had worked hard to understand the reasons and impacts of these issues and were taking actions to address them.

Although there were policies in place, there were inconsistencies in how learning took place across the schemes to ensure repeat incidents were reduced and improvements were made. When incidents occurred, members of the management team did not always encourage and ensure reflection and learning was carried out. This had resulted in negative outcomes for people. Further to this, with changes in management and gaps in staff meetings across the schemes, this had impacted how information and learning was shared with the staff team. Where information was being shared via WhatsApp group messages, it was not always being updated within people’s care records. The head of quality and compliance told us after the inspection on 1 August 2024 they had taken on board the feedback from the inspection and local authority monitoring visits and highlighted the lessons to be learned had been shared across all the provider’s services to alert staff to potential issues that might need to be reviewed. We saw this was specifically related to medicines management and managing people’s finances.