PCAS Kent Ltd

On this page

• 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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Assessments had been undertaken before people’s care and support packages started. Assessment processes considered people’s holistic needs, including their physical health, mental wellbeing, personal care requirements, communication needs, risks and support to access the community. This helped ensure care and support were tailored to people's individual needs, preferences and circumstances. The management team told us these were reviewed monthly. We observed these had mostly been reviewed monthly. The provider had developed a new referral documentation file for supported living. This provided detailed information, in an easy-to-read format for people wishing to have care and support from PCAS. It provided helpful guidance about sharing a house, moving home, rules, feelings, support and things to remember. It also showed that people were asked their preferences about where they would like to live such as in a town, the countryside, near the sea, in a flat, a house or a bungalow, their own place or a shared property. People were asked about their preferences of staff, what they might need help with, how often they needed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People made choices about their food and drinks. People were supported to plan their meals, manage their budget, food shop and to prepare and cook their meals. Each person had different skills and abilities, and support was tailored to their needs. Some people needed more help than others. A property had height adjustable work surfaces which enabled a person with a physical disability to be involved with preparing and cooking their meals. People said, “I am making dinner tonight. I am making sausages and mash. We take it in turns to cook”, “Today I am having a picnic in the garden with [person] we went to [supermarket] to buy the bits; rolls, cheese, ham, coleslaw, crisps, scotch egg and bananas. I help cook the dinner” and “Staff help do the cooking. I do chopping. I do the food shopping. We have a menu, today is ham egg and chips.”

Care and support plans showed that some people had goals and aspirations and showed how people had been supported to achieve their goals such as taking holidays. A person told us, “Next month I am going on holiday to Skegness, with my sister and family.” A relative said, “She went for the weekend in a caravan she enjoyed it, really nice things they do. They took her to have her nails done and nice things.” Staff told us how they were supporting people to achieve goals and exploring ways in which people could have a holiday, when they had health needs which were met by community nursing teams.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider told us that they shared information about health concerns with relevant healthcare professionals and with relatives. We observed this taking place during the assessment and records showed this had happened. The provider had a clear process to escalate health concerns within a timely manner. People’s care and support plans included hospital passports. Staff worked with health professionals to ensure people got the care and support they needed. A person said, “I had a hospital passport which I took into hospital, we have changed it and added the office numbers and [manager’s] number too. [A manager] was told I had gone to hospital, the staff and [person I live with] came to see me in hospital.”

A relative had written to the provider to state, ‘I feel very satisfied that all the staff are working together to provide [Person] the professional care that she needs, as a family we are very happy.’ A health and social care professional told us, “Through conversations during reviews and visits staff have been able to provide through and robust oversight of people’s needs particularly in relation to any health changes, these have been supported with actions and questions requesting signposting in specific cases such as diabetes management.”

A staff member told us, “Our care plans contain the medical history and details that are important to their care. We understand if we need to take them to family friends or hospital appointment. We learn everything about challenging behaviours. What their likes and dislikes are. I feel that it does help us to get to know them but spending time and shadowing is much better way of us getting to know how to support the person.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported with their health needs. People told us they were supported with their healthcare. Some people had regular visits from community nurses to help manage their health conditions such as diabetes. People said, “The staff call the doctor, staff help me at the appointment, we go by taxi”, “I went to the doctor last week, I don’t know when last saw dentist, I clean my teeth myself”, “I talked to the staff when I was pain, I had bad stomach pains and went to Maidstone hospital, then had patient transport to Pembury hospital. I had scans and I feel much better now” and “[Staff member] has been fighting to get me a dentist, I have now got one in Chatham, I have an opticians.”

The management team told us, people were not routinely supported to monitor their weight. A member of the management team said, “We only record weight if it is medically needed. If staff see physically that there are changes in people’s appearance, we would refer them to their GP and seek medical advice.” A staff member said, “We have really good working relationships with other agencies and the GP, and the options are really good.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. Staff told us they had handovers from staff working with people and communication was improved since we last assessed the service. A staff member said, “Staff do handovers between shifts, we use [electronic care planning system] to handover info and we have a house WhatsApp. Service users have not got a log in [to the electronic care planning system] and can’t see the care plan and records. When I do care reviews I sit with service users and go through the plan and we read it together and review it.”

Whilst we were visiting some people in their home, we observed staff ask a person if they wanted to take part in an event. The person voiced they would like to be involved and staff said that they would meet with the person and others to plan the event. The person told us excitedly,

“I love a planning meeting.” Staff praised the person for being very organised and good at planning.

A health and social care professional said, “The care provider has been actively engaging with external professionals, including [person’s] GP, a Learning Disability nurse, and specialists from the Kent Association for the Blind. The local SaLT (speech and language therapist) team has also been involved. [Person] has up-to-date SaLT guidelines in place, which staff follow and there have been no recorded choking incidents.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We found that the service had not always worked within the principles of the Mental Capacity Act (MCA).

Mental capacity assessments did not follow good practice guidance and the MCA code of practice. These had become tick box exercises to move a process on in electronic care planning system. It was clear that some assessments were better than others, but there was a lack of understanding in the recording and evidencing of decisions taken. There was no evidence any other people were involved in best interest decisions other than the staff member completing the assessment form. We discussed this with the management team who told us that MCA and DoLS (Deprivation of Liberty Safeguards) training had been developed and an external trainer was delivering this face-to-face training to the staff team at the time of the assessment. The provider also commissioned the trainer to provide enhanced MCA and DoLS training to senior staff and the management team as they were the individuals responsible for carrying out these assessments.

During our visits to people in their homes, we observed staff asking people for consent and respecting people’s decisions. A relative told us, “They do talk to him and encourage and advise him. They talk to him where he wants to go etc. They understand him and he understands them using his iPad.” A health and social care professional told us, “We have seen significant improvement in how documentation has improved and interactions between staff and people we support, the logs reflect that people are involved and offered choices and have showed us where support is declined or amended according to needs.” A relative said, “[Person] makes simple decisions, they ask if he wants to go to a show and they show him things and let him decide and food choices. DoLS was placed 2 years ago, if he left environment, they couldn’t stop him leaving, he is at risk, they initiated it for his safety and their reassurance. On day to day, I let the care agency look after him, I trust them wholeheartedly.”