PCAS Kent Ltd

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of the legal regulation(s) in relation to governance at the service.

This service scored 32 (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 did not have systems in place to identify a closed culture. Staff told us communication from senior leaders was poor, particularly around decisions being made about people moving into services. For example, staff told us, “I think communication is a major issue’.

The provider had not consistently adopted their values to ensure people received care that was person centred and in a way they chose. For example, one of the providers commitments was to carry out regular checks to monitor the service. However, we found that regular checks and audits were not used consistently or effectively.

We received consistent feedback from staff about a poor culture within the service and the provider not being supportive. “The culture is not brilliant here” and “There is a closed culture here, there is a lack of communication.”

A closed culture can lead to harm, including abuse and neglect, due to the lack of transparency, open communication and external scrutiny. Whilst the provider told us they had recently started work on rectifying this, staff fed back there had been no improvements and it was too early to see any progress.

Senior leaders did not lead by example by modelling inclusive behaviours. Staff told us they were not included in in decisions that affected them and the people they supported on a day-to-day basis. One staff member told us, “I don’t think they [leaders] include people in the right way, there are decisions we do not know about that directly affect us, and the people we support’”

Senior leaders were not alert to examples of poor culture that affected the quality of people’s care and could have a detrimental impact on staff. For example, leaders had not ensured people had thorough assessments prior to moving into a service to ensure their compatibility with other people in the house.

The provider had not followed the principles of Right support, right care, right culture (RSRCRC). The RSRCRC outlines that 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. The provider had not ensured people were supported to consistently make choices, particularly regarding who they lived with. In one service, two people moved in on an emergency basis. However, the provider had not ensured that the people who already lived in the service had been able to give their input and choice.

Leaders did not actively promote staff empowerment to drive improvement. Although there was a staff forum, staff were not confident that their voices will be heard. One staff member told us, “You can speak up but I don’t know you’re listened to or supported.”

There was not a culture that encouraged staff to speak up, where individuals (including external whistleblowers) felt safe to raise concerns and were actively supported without fear of negative consequences. One staff member told us, “I don’t feel supported, I am worried about the repercussions if I speak up.”

Staff told us they have shared their concerns around the placements of people and the lack of involvement from people themselves and staff. Staff told us these concerns were not acted upon by the provider. One person told us, “There is no transparency from the top [leaders], we are almost fearful that something might happen if we spoke up.” The provider told us they had started to address the concerns staff had regarding communication from leaders, however this was in the early stages of being review by providers.

The provider did not always take action to continually review and improve the culture of the organisation, particularly in the context of inclusion. Inductions and shadowing for staff were very rigid and shadowing hours were not extended if the need was identified, particularly for staff that had not worked in health and social care before. We received mixed feedback from staff, one person told us, “I don’t feel the senior leaders are inclusive.” However, some staff also told us, “I would say equality and diversity are considered by the provider.” Staff completed training around equality and diversity.

Governance processes were not effective to identify the significant concerns we found. The registered manager carried out audits to assess the service. However, where it had been recorded the service was ‘compliant’ we found evidence that this was not the case. For example, a governance audit completed by the manager detailed 100% compliance, which included that all accidents and incidents were recorded, investigated and lessons learned were shared. However, we identified multiple incidents that had not been actioned accordingly.

The provider had not ensured staff had completed the relevant training needed to support people safely. For example, there were gaps in training around positive behaviour support and staff told us they needed more training and support in this area.

The provider did not implement relevant or mandatory quality frameworks, recognised standards, best practices or equivalents to improve equity in experience and outcomes for people using services and tackle known inequalities. For example, the provider had not ensured they fully implemented the REACH standards and RSRCRC.

The provider did not consistently work in partnership with key organisations to support care provision, service development and joined-up care. For example, the provider had not ensured people were always able to have autonomy and control over their care when it was shared between PCAS and another provider.

The provider told us the local authorities had the final say on where people live however there was no joined up working to ensure the services identified were suitable for people or their choice if they were able to make one. The provider had not fully assessed the compatibility of people and worked with the local authorities to ensure this was considered.

However, within other areas of the service staff had worked in partnership with other organisations. For example, staff worked well with community nurses to ensure on person had their medicines administered.

The provider did not have effective processes to consistently ensure that lessons were learnt and improvements implemented. There was not sufficient oversight of incidents and accidents and lessons learnt were not always shared with staff to ensure changes and improvements could be made to people’s care and support.

Staff were not supported to prioritise time to develop their skills. Staff told us that hours had been cut and they no longer had enough hours to ensure their day-to-day work was complete.

The provider failed to improve on their previous rating of requires improvement. At the last inspection on 31 August 2022, we identified concerns in the Safe and Well led domains. During this assessment, we identified these concerns had not been effectively addressed since the last inspection and there were further concerns around safe care and treatment and good governance.