PLL Care Services

PLL Care Services is a domiciliary care agency that provides personal care to people in their own homes.

The service provides care to older people, people with a learning disability and/or autistic people, people living with mental health needs, dementia and physical disabilities.

Not everyone who used the service received personal care. Care Quality Commission (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 our inspection the service was providing care to 169 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

Robust safeguarding procedures were not embedded into practice. Concerns had not always been reported to the local authority as required and systems were not reviewed to minimise the risk of them happening again. Care plans and risk assessments did not always contain relevant, up to date information within them or were not available. Risks to people's safety were not always identified or mitigated. Therefore, staff did not always have the information required to provide safe and effective care and in relation to people’s specific health conditions.

People did not always receive their medicines safely and referrals to health care professionals were not made in a timely manner.

People were not supported to safely manage their medicines and did not always have access to their medicines. Topical medicines such as creams were not always documented adequately to ensure staff knew about these creams or where to apply them, and missed medicines were not always followed up by the provider.

People were not always supported by staff who had been safely recruited. Recruitment information contained contradictory start dates. The provider completed police checks but could not always evidence they had gained references for staff prior to them starting work.

Documents indicated that staff received an induction before working with people. However, we received mixed reviews from staff about their training.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: Care was not person-centred and did not promote people's dignity, privacy and human rights. Care plans were not person-centred and did not always contain information which would support staff to know the person they were supporting. Spot checks evidenced that people were not always treated with dignity. People and relatives were not always involved in reviewing of care needs.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives.

Effective quality assurance measures were not embedded to ensure a culture of continuous improvement. Audits and spot checks of staff competence had not been completed routinely and accidents and incidents were not reviewed to minimise the risk of them happening again. The provider did not share information in an accurate or transparent manner. Numerous discrepancies were found between information given by the provider and details obtained from records, staff and other professionals. Discrepancies included basic details such as the number of people supported, how people's care was funded and how many staff were employed. The provider had not notified CQC of safeguarding concerns as required by their registration. Feedback from people regarding the quality of the care they received was not regularly sought. Staff meetings were not used as a forum to share ideas and learning but as a way for the provider to share instructions. Staff did not receive regular supervisions to support them in their roles.

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

Why we inspected

The inspection was prompted in part due to concerns received about safety of the service. These concerns were around up to date and accurate records and assessments not being in place. There were also concerns about the effectiveness of the management in relation to governance by ensuring the service was safe and of a high quality. A decision was made for us to inspect and examine those risks.

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

You can see what action we have asked the provider to take at the end of this full report.

We asked the provider to provide an action plan following serious concerns found during the inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to person centred care, safe care and treatment, good governance, staffing and fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the service was Good overall however we found the provider did not always ensure statutory notifications were submitted and their record keeping around safeguarding concerns needed improving. There were a number of quality assurance processes in place and provider was in the process of addressing areas for improvement such as consistency of care and punctuality.

People knew how to complain and how to contact the office. Some people told us where they had raised concerns changes have been made and some people felt their feedback was not always promptly considered.

There was a registered manager in post who was also one of the directors and owners of the company. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were safe with staff. There were sufficient staff to meet people's needs. The provider followed safe recruitment processes. Staff knew how to protect people and how to alert senior staff and external organisations if they had safeguarding concerns. Risk assessments around people’s well-being and their environment were carried out. People received their medicines as prescribed.

People's needs were assessed prior to commencement of the service to ensure staff were able to meet their needs. Staff received ongoing training to carry out their roles and they told us they had supervisions. People were supported to meet their nutritional needs and access health services as required. Staff worked well within designated geographical areas and within the team.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the staff at the service supported this practice. People’s rights to make own decisions were respected.

The service was caring and staff supported people in a compassionate way. People's privacy and dignity was protected. People were supported to be as independent as possible. The service was responsive and people told us the support they had met their needs. People and their relatives where appropriate were involved in care planning.

People knew who the registered manager was and how to contact the office if needed. People’s views were sought via surveys and spot checks of staff. The service worked with a number of external social and health professionals.