PI Care

About the service

PI Care is a domiciliary care agency providing personal care and support to young people living in their own houses, flats and specialist housing. The service provides support to children and young people aged 4-18 years who have a learning disability, autistic people or people with mental health needs. It is also registered to provide support to adults who have a learning disability, autistic people or people with mental health needs.

At the time of our inspection, 3 people were receiving the regulated activity of personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Right Support:

Relatives told us their family members had choice and control and staff knew them as individuals, although some relative’s experience was less positive.

Staff supported people to make decisions where possible. Staff communicated with people in ways that met their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff worked with families to meet people’s best interests. The policies and systems in the service supported this practice.

Staff received training about how to support people when they experienced periods of distress. People’s freedoms were restricted only if there was no alternative.

Staff worked with other organisations to ensure people received the care, support and treatment they required. We received a wide range of feedback from external stakeholders which is reflected in the report.

Staff supported people with their medicines to ensure their needs were met. Improvements had been made to ensure medicines were monitored and managed safely.

Right Care:

Concerns had been raised before the inspection about staff knowledge and experience to work effectively with people with complex needs. The provider had been supported to provide additional specialist training to ensure staff were skilled and delivered good quality support.

Concerns had been raised before the inspection that people were not always protected from the risk of harm and abuse. Professionals told us this had begun to improve recently. Policies and training were in place, and staff were clear about what could constitute abuse and what they should do to help keep a person safe.

Staff protected people and respected their privacy and dignity. Most relatives told us their family member’s preferences and views were respected. Some professionals felt staff needed additional training and skills to meet the complex needs of individuals using the service.

Staff told us they understood and responded to people’s individual needs. They were able to explain their role in respect of individual people and clearly knew them well. Staff we spoke to had a clear understanding of the risks faced by the people they supported.

Right Culture:

We received a very wide range of views about the organisation, standards, staff and managers. Terms used ranged from ‘awful’ to ‘amazing’. We have endeavoured to reflect this range and balance our judgement in the report.

The managers and staff we spoke to were committed to upholding the organisation’s values to support people effectively. There had been recent changes to the management structure to strengthen leadership and improve outcomes for people.

People’s families were involved in planning, service provision and reviews. They were encouraged to share their views and the management team were well known by families. The provider worked closely with a wide range of other organisations to improve people’s quality of life.

We received mixed feedback about the provider’s communication, although most professionals who commented noted that this had improved recently.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 November 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We inspected this service due to an increase in concerns raised by professionals about the service. This included concerns about the knowledge and skills of staff, management oversight and the safety and wellbeing of the people being supported.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for PI Care on our website at www.cqc.org.uk.

Recommendations

We have made recommendations in relation to embedding robust governance and performance systems and continuing to develop quality assurance arrangements at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The provider supports people with complex care needs including learning disabilities, mental health and autistic people. They also act as a staff agency providing staff to residential settings for young people, which does not fall into the scope of regulation with the Care Quality Commission.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection the agency was supporting four young people. Only one young person was receiving the regulated activity of personal care.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/ or who are autistic.

People’s experience of using this service and what we found

Right Support

There were sufficient staff supporting the person. Staff had received training and ongoing support from the clinical lead and the providers. The provider worked with the person’s family to ensure a consistent team was in place and this was led by a clinical lead.

Staff supported and identified what was important to the person including their aspirations and goals. The person was supported to make decisions about how they wanted to be supported. Staff had received training in the individual ways the person communicated. Staff encouraged the person to learn new skills and take part in daily activities of their choice, ensuring their safety and that of others.

The service worked with the person and other stakeholders to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Right Care

The person did not always receive safe care because they medicines were not managed safely. Not all staff had undergone a thorough recruitment process to ensure all checks were in place before they started working with people.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff had received training to support people where they experienced periods of distress. The approach was based on the model of positive behaviour support.

Right Culture

Some improvements were needed to the governance arrangements to ensure the provider had oversight of the running of the service and the care that people received. There was a lack of care plan, medicine, recruitment and service delivery audits to demonstrate that people received safe, effective care that was responsive to their needs. Whilst they had good oversight of the one person’s care, as the service grows these systems need to be implemented and embedded to ensure ongoing compliance.

The provider had failed to notify us of incidents and loss of data when they transferred to a new information technology system. We have recommended the provider contacts the Information Commissioners Office to discuss the loss of staff records. We have recommended the provider maintains a log of concerns to enable them to review for any themes and to monitor actions to address the concerns and the outcome. This was because there was no record of the concerns shared with the provider in relation to menu planning for the person.

Staff were reviewing and monitoring the quality of support provided to the person, involving them, their families and other professionals. Weekly meetings with health and social care professionals were in place to ensure review the care and make adjustments as required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

This service was registered with us on 09 August 2021 and this is the first inspection.

Why we inspected

This was a planned inspection to provide the service with a rating.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to recruitment of staff, the safe management of medicines, ensuring robust government arrangements and the reporting of notifications that the provider must inform us about at this inspection. We have recommended the provider contacts the Information Commissioners Office to discuss the loss of staff records.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.