PCAS Kent Ltd

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation to person centred care and need for consent.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had not assessed people’s needs consistently and effectively. People’s weights were not always well managed where the need had been identified. One person’s care plan detailed a Waterlow assessment had been completed and identified the person as at high risk of developing pressure sores. However there was no weight recorded in their care plan and it was not clear how they assessed a Waterlow score of 15 or what action staff should take to support the person in relation to their weight. The Waterlow score is a tool used in healthcare, particularly in nursing, to assess a patient's risk of developing pressure ulcers or bedsores, which incorporates a person’s weight to evaluate the risk. The person was at risk of their pressure care not being assessed accurately for their needs, which could lead to an increased risk of pressure sores.

Another person’s care plan detailed their body mass index (BMI) was in the obese category. However, there were no weights recorded to clarify this or how staff were to support the person with their weight management. BMI is a measure of body fat based on weight and height that is used to assess whether someone is underweight, healthy weight, over weight or obese. The person was at risk of not getting the right support to maintain a healthy weight.

Care and support plans were not always reflective of people’s currents support needs. For example, one person’s mobility had changed and they were now cared for in bed, but their support plan still stated they moved about with an aid. This meant staff did not have the most accurate information and the person was at risk of not being supported appropriately.

The provider had not effectively incorporated best practice guidance, such as The REACH standards. The REACH standards are a set of 9 standards to ensure people with a learning disability and/or autistic people are supported to live how they choose, with the same rights as other citizens. Standard 1 refers to the person being able to choose who they live with, we found this was not always the case and people could not always choose who they lived with. Staff we spoke with confirmed that people did not always have a choice who they lived with. One staff member told us, “PCAS have some work to do around the Reach Standards. At the moment, I do feel as though this is very business run.”

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not always ensure people’s capacity was fully assessed when required and that best interest decisions took place in line with the Mental Capacity Act 2005 requirements. One person had a monitor in their bedroom due to them having epilepsy. However, a best interest meeting had not taken place to ensure this was the least restrictive support option.

Following the inspection, the provider took action to review the monitor that was in place and submit a DoLs application. Deprivation of Liberty Safeguards (DoLS) are a set of legal rules that protect people who lack the mental capacity to make decisions about their care and treatment in hospitals or care homes.