PLL Care Services

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 one breach of the legal regulations. During our last inspection we found there was a breach of good governance. The provider had not made enough improvement and were still in breach of this regulation. We found their oversight and management of the service and governance and records systems remained ineffective. Leaders were not inclusive at all levels, systems and processes for people to speak up without fear of consequence was not embedded. Systems to monitor and improve quality and to monitor and mitigate risks had not always been implemented effectively. Systems and processes for improving quality were not effective at monitoring and improving the quality of service. Staff felt some improvement had been made but were not able to elaborate on any changes that had taken place in order to improve the service.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We asked staff about the management of the service. Staff told us they felt supported by the manager, however we also heard ‘At the moment,’ when asked if the manager was approachable.

At our last inspection of the service, we found ineffective oversight at management and provider level. Management and leadership of the service remained ineffective. During the assessment through discussions with the Registered Manager, staff and reviewing documentation, we found leaders were not inclusive at all levels and did not always understand the context in which care treatment and support embodies the culture and value of the workforce. There was not a clear demarcation of roles within the leadership team to ensure it was always clear who was responsible for overseeing and managing delegated tasks in the service. We could not always see where the Registered Manager had taken action or what their role was in managing the day to day running of the service. Leaders were not communicating honestly and effectively. We found staff had sometimes lacked direction and guidance. This had resulted in a lack of consistent work and approach. As a result, some people had not received the right care and treatment when their needs changed. A lack of management oversight had led to risks for people using the service. Although policies and procedures state the Registered Manager is responsible for a lot of checks and audits, we could not always see these had been completed by the Registered Manager. This was a continued breach of good governance.

Staff told us they were worried they would lose their jobs if they spoke up. We heard “If staff go to the management to complain,[it’s met negatively] and it’s not good to report to intimidation.” Staff were concerned if the service took on more clients like they previously had then management would behave the way they used. Staff told us they felt able to raise concerns at team meetings.

The provider had a whistleblowing policy in place which detailed who to contact. However, staff we spoke to did not always feel a positive culture had been fostered to allow people to speak up without consequence of losing their employment. The service carried out a staff survey which received little response. One of the outcomes was for management to express with staff the survey is anonymous to encourage more staff to participate.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff we spoke to felt their concerns would be actioned by the office staff when reporting issues around care, however felt that the way they were treated by management had seen little improvements.

Systems to monitor and improve quality and to monitor and mitigate risks had not always been implemented effectively. This meant complaints, accidents, incidents, and other adverse events had not always been investigated or responded to completely. There were significant shortfalls in many of the records viewed. This placed people at risk of receiving unsafe care or care which did not meet their needs. The provider was not meeting all standards of good quality care including assessment and planning of risks and care needs, providing personalised care and support and deploying staff to meet people's needs. There were risks relating to medicines management and people's health and wellbeing. Therefore, people did not always receive good quality or safe care. There had been a lack of governance oversight, and this meant some people had experienced poor outcomes and not had the care they needed in a timely way. The systems in place to ensure risks relating to people’s care and support were assessed and mitigated were not robust. For example audits in place did not identify inconsistences found during the assessment around, audits being in place was reflective of the service, actions following audits, training, missed medicines and lessons learned. The service was not following their auditing of medication policy and procedure which detailed audits should be carried out monthly and include an action needed within a target date. Medication administration record audits were not always carried out monthly and did not contain target dates or completion dates. This resulted in no action being taken in order to ensure people were receiving their medicines safely in a timely manner. The provider had not made enough improvement and were still in breach of good governance.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff felt some improvement had been made since the previous inspection, there had been some improvement with support, and lessons had been learned, but were not always able to elaborate on what this meant. Staff were not able to elaborate on any changes that had taken place in order to improve the service.

The provider was not using learning to make improvements required at the service. They had not taken sufficient action since our last inspection to meet breaches in regulations were identified. The systems and processes for improving quality had not always been effective, they were not established or operated effectively to ensure compliance with regulations by assessing, monitoring and improving quality of service. Audits had not identified problems, were not robust enough and improvements were still needed. People were placed at risk by risks which had not been identified or mitigated. For example, the way their medicines and health were being managed, There was not always an accurate, complete records of care and treatment provided to people and decisions taken how staff were deployed and how their care was planned. The provider had not made enough improvement and were still in breach of good governance.