Nestor Primecare Services Limited

Further education and skills inspection report

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Nestor Primecare Services Limited Employer

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Overall effectiveness Inadequate Effectiveness of leadership and management Inadequate Apprenticeships Inadequate

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Quality of teaching, learning and assessment Inadequate

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Personal development, behaviour and welfare Inadequate

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Overall effectiveness at previous inspection Requires improvement

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Summary of key findings

 Leaders and managers have demonstrated an abject failure to challenge themselves and their teams to deliver high outcomes, despite having opted for reducing the number of apprentices in learning.  The lack of effective quality assurance mechanisms has prevented leaders and managers from understanding and rectifying the key weaknesses of the provision.  The governance function is weak and has not supported managers to improve; it has not held them accountable for the delivery of the apprenticeship programme.  Safeguarding arrangements are ineffective at ensuring that all learners are protected and are well equipped to protect their clients.  Teaching, learning and assessment are weak; they do not support apprentices to progress well and to acquire new occupational skills and knowledge.  Apprentices do not develop their English and mathematics skills sufficiently; they are not able to apply these skills well to their job roles.

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Summary of key findings

 Leaders and managers have not identified and rectified the differences in achievement by different groups of apprentices.  Apprentices receive poor information, advice and guidance about the next steps in their careers, thus impeding their chances to improve their career and employment prospects.

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Summary of key findings

The provider has the following strengths

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Summary of key findings

 The inspection team found no key strengths.

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Information about the provider

 Nestor Primecare Services Limited, purchased two years ago by the Aurelius investment group, now trades as Allied Healthcare. It is one of the country’s largest providers of domiciliary healthcare staff with over 80 branches nationwide. The company holds contracts with Clinical Commissioning Groups (CCGs) in the geographical areas within which it operates.  The company employs around 10,000 people, including care and support staff and registered nurses. Apprentices account for 125 of the company’s employees. At the time of the inspection, approximately a quarter of the apprentices were on a learning break. Almost all of the 95 apprentices in learning are studying programmes in health and social care, with just over half at intermediate level, and the remainder at advanced level. A further four apprentices are studying administration and business management programmes.

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What does the provider need to do to improve further?

 Immediately implement a comprehensive review of the effectiveness of the existing safeguarding arrangements, ensuring that all weak processes are swiftly strengthened, paying particular attention to the urgent need to raise staff’s and learners’ awareness of the dangers of extremism and radicalisation.  Urgently devise a development plan aimed at delivering a successful apprenticeship programme that: – focuses on drastically improving the number of apprentices – including those from different groups – who stay on the programme, their rate of progress, and standard of achievement – supports the effective acquisition of new knowledge and occupational skills, including the development of apprentices’ English and mathematics skills.  Ensure that those exercising the role of governance are sufficiently knowledgeable about apprenticeships so that they can offer managers the necessary support and challenge to

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What does the provider need to do to improve further?

improve the provision.  Fully develop comprehensive quality assurance processes that inform the leaders’ and managers’ evaluation of their provision and lead to clear and discernible improvements in all the stages of a learner’s journey.  Radically develop the quality of teaching, learning and assessment practice by: – improving the planning of learning by considering the apprentices’ prior knowledge and skills – strengthening questioning techniques to extend and deepen apprentices’ knowledge.  Improve the information, advice and guidance that apprentices receive, so that they can make informed choices about the next steps in their careers.

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Effectiveness of leadership and management Inadequate

 Leaders and managers have failed to direct their teams towards an ambitious and unequivocal objective to improve the quality of teaching, learning and assessment and the outcomes that apprentices attain. Following on from the previous inspection, the provider reduced the number of apprentices on the programme, to focus on relaunching an improved model for delivering apprenticeships.  Some 18 months later, managers at all levels remain unclear and undecided as to how to provide the apprenticeship programme in the near future. In the meantime, and amidst a lack of strategic purpose, the retention of apprentices on the programme remains low. The quality of the provision has declined further and is now inadequate.  Managers set woefully low expectations for their assessors and these, in return, fail to motivate apprentices to complete their learning programme on time and to a high standard. Complacent and unambitious managers do not set assessors sufficiently

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Effectiveness of leadership and management Inadequate

challenging targets to ensure the rapid progress of the already reduced number of apprentices on programme. At present, only a third of apprentices are on target to achieve their framework on time.  Performance management of staff is ineffective at ensuring that apprentices’ outcomes are of the highest quality. Managers have not ensured that performance targets appropriately link to business improvement or staff development needs. Leaders do not monitor the quality of the agreed staff performance plans. As a result, they are not able to measure how these support improvements in teaching, learning and assessment practice.  Managers do not have a clear strategy to develop the quality of all aspects of the ‘learning journey’ that apprentices undertake. Apprentices with additional learning needs do not receive support with their learning. Those who already have a qualification in English and mathematics at level 2 do not develop these skills further.

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Effectiveness of leadership and management Inadequate

 Leaders and managers have failed to devise and implement effective quality assurance processes to support the improvement of teaching, learning and assessment. The quality of the observations of teaching, learning and assessment has improved. However, the agreed development plans for staff have not resulted in better learning sessions for apprentices.  The leaders’ and managers’ evaluation of the provision is not well founded on the evidence gathered through the provider’s quality assurance systems. Managers do not have an accurate understanding of the strengths and weaknesses of the provision. As a result, they are not tackling areas of concern quickly enough. For example, they do not challenge themselves sufficiently by setting demanding targets in their improvement plans to retain apprentices on the programme or to close the gap in the achievement of different groups.

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The governance of the provider

 The governance of the apprenticeship programme is poor.  Those exercising the governance function do not have access to sufficient or accurate information to enable them to hold managers to account for the performance of the apprenticeships.  Senior managers in the governance role recognise that they do not have the necessary knowledge and expertise to support and challenge the relevant managers to deliver a high-quality learning experience.

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Safeguarding

 The arrangements for safeguarding are not effective.  Leaders and managers have overlooked the importance of ensuring that effective mechanisms are in place to look after the safety of their apprentices. For example, they are unclear as to who in the organisation requires a Disclosure and Barring System (DBS) check. They have not been sufficiently prompt in ensuring that all leaders have undertaken the required safeguarding training.  Leaders and managers do not gather enough information to determine how effectively apprentices are being protected. As a consequence, they fail to test whether their safeguarding expectations are being delivered by the arrangements they have in place. For example, the safeguarding confidential line is insufficiently responsive to support learners well.  Leaders and managers have been particularly slow in implementing the provider’s ‘Prevent’ strategy, including the delivery of training to staff and apprentices. Assessors do

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Safeguarding

not provide apprentices with enough knowledge to enable them to keep themselves, and the clients in their care, safe from the dangers of radicalisation.

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Quality of teaching, learning and assessment Inadequate

 Assessors do not have high enough expectations of apprentices and, as a consequence, the large majority of apprentices do not make the progress of which they are capable.  Teaching and learning are weak. Assessors do not use information on the apprentices’ starting points to plan learning. As a result, learning sessions do not have a clear purpose and focus solely on signing off qualification units. Sessions do not lead to apprentices gaining new knowledge and skills that they can apply to improve their care practice.  Assessors do not use effective questioning techniques to help apprentices develop their knowledge and reflective skills. Apprentices do not receive additional questions from their assessors to help them to apply the theory they have learned to their job roles.  Assessment practice is insufficiently rigorous. In too many cases, assessors wrongfully accept and sign off, as valid and complete, work which is incorrect, or of a poor standard.

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Quality of teaching, learning and assessment Inadequate

For example, an apprentice described a sprained ankle as an example of a localised infection requiring antibiotics.

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Quality of teaching, learning and assessment Inadequate

 Following on from assessment, apprentices do not obtain feedback that helps them to understand what they need to do to improve. Written feedback does not support the most able apprentices to deepen their knowledge of the care sector.  The learning targets set by assessors are not precise or challenging enough to help apprentices make good progress and complete their qualification in the planned timeframe. Targets in progress reviews lack detail. They fail to ensure that apprentices acquire new vocational knowledge and develop their English and mathematics skills.  The learning resources available to apprentices are of insufficiently high quality. Almost all rely mainly on the handouts and workbooks their assessors supply. Apprentices do not receive encouragement to use reputable and professional websites such as the Care Quality Commission (CQC) and National Health Service (NHS) for their research activities.

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Quality of teaching, learning and assessment Inadequate

This fails to prepare them well for further higher-level study where independent learning skills are required.  Apprentices’ on- and off-the-job training is not integrated sufficiently well to ensure that they benefit from all the learning they undertake and apply it to their caring roles. Employers are insufficiently involved in apprentices’ reviews and the choosing of optional units. They fail to ensure that apprentices are making good progress and gaining the skills required for their current job role and future progression and promotion.  Apprentices’ development of English and mathematics skills is too slow. The large majority of those identified as needing additional support do not complete their functional skills qualification in the planned time. Apprentices undertake activities that solely concentrate on passing their tests. The correction of spelling, grammar and punctuation within apprentices’ work is insufficient. Assessors often model poor sentence construction

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Quality of teaching, learning and assessment Inadequate

within their feedback.  Apprentices’ understanding of safeguarding is weak. They have a poor understanding of the essential safeguarding knowledge to support clients and to keep themselves safe when working alone or, when reporting safeguarding concerns.

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Personal development, behaviour and welfare Inadequate

 Apprentices do not prioritise their learning; too often they miss appointments with assessors and/or do not complete their work on time. As a result, many apprentices have long periods of time when they do not submit their work and are not in contact with their assessor for training, assessments or reviews of progress.  Apprentices do not improve their mathematics and English skills sufficiently. Portfolios of work contain many grammatical errors that go uncorrected by assessors. Apprentices’ work does not demonstrate how they are applying their mathematics skills to their jobs. Fundamental errors in the use of English mean that apprentices’ explanations are often unclear, for example when writing care plans.  Apprentices’ understanding of e-safety is superficial. They have little understanding of how data protection applies to their job roles, for example how to destroy rotas containing patients’ address details when these are no longer needed. Apprentices do not

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Personal development, behaviour and welfare Inadequate

understand the risks of radicalisation and extremism, both for themselves and for the clients in their care, who are vulnerable by the nature of their health conditions.

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Personal development, behaviour and welfare Inadequate

 In too many cases, the standards of apprentices’ work are not good enough. Advanced apprentices do not demonstrate in their work a full understanding of the topic being assessed. In too many cases, their answers are factually incorrect. For example, apprentices entered inaccurate information on how to spot when a client might be suffering a stroke.  Apprentices who have self-identified an additional learning need, or demonstrate significant barriers to learning, such as dyslexia or dyspraxia, have not received any formal assessment or support from specialised agencies. Assessors do not identify or agree the necessary support or resetting of targets to meet the personal difficulties and challenges experienced by apprentices. This is particularly applicable to the considerable proportion of existing apprentices who have taken a break from learning.  Apprentices do not have any opportunities to undertake any enrichment activities, other

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Personal development, behaviour and welfare Inadequate

than the mandatory training they receive as employees or additional units that relate to their work role. Too often, assessors introduce these elements at an inappropriate time, for example when there are still significant amounts of work to do in order to complete the basic programme.  Apprentices receive poor information, advice and guidance. Assessors do not provide effective guidance on what apprentices could do after completing their framework, other than the possibility of moving to a higher-level apprenticeship. This is currently not available within Nestor. Where apprentices have career aspirations such as nursing, they are unaware of whether they are taking enough units to progress successfully.  Most apprentices have a basic understanding of fundamental British values, particularly about respect for others, and of how they can apply this to their work roles, for example respecting clients’ wishes around medication. However, assessors do not have the

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Personal development, behaviour and welfare Inadequate

necessary knowledge to develop apprentices’ awareness of these values further.  Apprentices demonstrate appropriate levels of confidence, as expected from staff working with clients in the care sector.

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Outcomes for learners Inadequate

 The declining trend in the rate of achievement continued in 2015/16 when only a minority of apprentices completed their framework. Just a third of them did so within the planned time. That year, the majority of apprentices left the programme without having completed their apprenticeship.  According to the provider’s own data, the percentage of apprentices who remained on programme last year improved slightly, but this was still too low. Only half of these went on to complete successfully. The proportion of apprentices who achieved last year within the planned end date remains unacceptably low.  Apprentices do not develop their skills further during their learning programme. The few apprentices who were exempt from doing an English and or mathematics functional skills qualification did not improve these skills. Only a few apprentices over the last three years have achieved a functional skills qualification at a higher level than the one required by

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Outcomes for learners Inadequate

their framework. Almost no apprentices took an additional qualification last year.  In the last two years, a small minority of the advanced apprentices have progressed from an intermediate apprenticeship.  Differences in achievement rates by different groups of apprentices exist. The gap in achievement between White apprentices and those from a minority ethnic background has widened over the last two years. Furthermore, apprentices’ rates of achievement vary according to their geographical areas. In particular, in the East of England fewer than half of the apprentices achieved their framework last year.  Although the large majority of apprentices passed their English and mathematics functional skills tests first time last year, they are not developing these skills sufficiently well, and are unsuccessful at applying them well in their job roles.  The large majority of apprentices are making slow progress. The proportion of

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Outcomes for learners Inadequate

apprentices who have passed their planned end date or are at risk of not achieving in time is too high. Approximately, only one out of every three apprentices is on target to achieve on time.

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Provider details

Approximate number of all learners over the previous full contract year Principal/CEO Mr Luca Warnke

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Provider information at the time of the inspection

Main course or learning programme level Level 1 or below Level 2 Level 3 Level 4 or above Total number of learners (excluding apprenticeships) 16–18 19+ 16–18 19+ 16–18 19+ 16–18 19+

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Provider information at the time of the inspection

- - - - - - - - Number of apprentices by apprenticeship level and age Intermediate Advanced Higher

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Provider information at the time of the inspection

16–18 19+ 16–18 19+ 16–18 19+ 1 60 - 32 - 2 Number of traineeships 16–19 19+ Total - - - Number of learners aged 14 to -

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Provider information at the time of the inspection

Number of learners for which the provider receives high- needs funding -

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Provider information at the time of the inspection

At the time of inspection, the provider contracts with the following main subcontractors: -

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Information about this inspection

The inspection team was assisted by the learning and development manager, as nominee. Inspectors took account of the provider's most recent self-assessment report and development plans, and the previous inspection report. Inspectors used interviews, telephone calls and online portfolios to gather the views of learners and employers; these views are reflected within the report. They observed learning sessions, assessments and progress reviews. The inspection took into account all relevant provision at the provider.

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Inspection team

Maria Navarro, lead inspector Her Majesty's Inspector

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Inspection team

Tracey Zimmerman Her Majesty’s Inspector

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Inspection team

Kathryn Townsley Ofsted Inspector guidance 'Raising concerns and making a complaint about Ofsted', which is available from Ofsted's website: www.gov.uk/government/publications/complaints-about-ofsted . If you would like Ofsted to send you a copy of the guidance, please telephone 0300 123 4234, or email enquiries@ofsted.gov.uk .

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Inspection team

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Inspection team

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Inspection team

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Inspection team

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Inspection team

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Inspection team

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Inspection team

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