PCAS Kent Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had implemented a new system for reviewing and tracking accidents and incidents as well as medicines errors/incidents. They also reviewed all records related to people displaying distressed behaviour. Operational managers carried out initial investigations and took actions at the time of incidents and then the senior management team reviewed all the data, reviewing actions and identifying learning, additional actions and trends. This enabled the whole management team to have greater oversight of what was happening across the service. However, we found some actions to address concerns (that had been reported through an incident form) had not always been taken in a timely manner. For example, a risk assessment in relation to a person had not been updated and reviewed to include additional information for staff about what action they should take if the person became distressed and ran away from staff during visits to the local community.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was a clear process for new referrals and assessments were completed prior to decisions being made about whether the service could meet people’s needs. Transition arrangements were in place so that people who were wanting to move to a shared property could view the property, meet people, spend time socialising and make an informed decision about the move. People already living in the property were also involved in deciding who could move into their home. A person told us, “I came to visit the house, see my room and then met the ladies for a cup of tea.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People were safe and were protected from harm. Staff were aware of the whistle blowing policy and told us they always had access to all policies. We observed interactions between staff and people during our visit. We saw safe practice whilst enabling people to maintain their routines and independence.

Staff had received safeguarding training. Staff understood their responsibilities to report a safeguarding concern. A staff member said, “I have had safeguarding [training], and I would report abuse if it was happening. I would go to my line manger first and it would be raised higher."

Relatives told us their loved ones were safe. A relative said, “She is very safe and looked after so well.” A person said, “I feel safe in my surroundings.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. Community DoLS (Deprivation of Liberty Safeguards) refers to care settings outside of hospitals and care homes, such as supported living or a person's own home. If someone lacks the mental capacity to consent and requires continuous supervision or restricted freedom to stay safe, this must be legally authorised by the Court of Protection. We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The provider evidenced that community DoLS applications had been applied for when required by service.

The provider did not always work well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, we found some risk assessments needed to be more robust. For example, detailing the risks of running for 1 person and how staff can safely support them. Risk assessments for people with epilepsy were not very detailed to ensure staff had guidance with supporting in the shower. A person’s epilepsy risk assessment was long and detailed but missed some key factors, such as why staff should remain with them during baths/showers. It was a known risk that temperature changes affected the person and sometimes caused seizures. The risk assessment did not provide additional information relating to these signs and triggers. Another person’s care records had no risk assessment in place for using a wheelchair and no guide in place to direct staff on how to transfer the person safely using moving and handling equipment. After the assessment site visits, the management team took action to address this. The provider also put in place additional training and support relating to risk assessments for staff who were responsible for creating these.

Personal emergency evacuation plans (PEEPs) were in place, but these did not clearly detail people’s support needs if they required to be evacuated in an emergency. A person told us, “The doors close when the fire alarm goes off, if there was a fire I would sit in the chair and don’t move.” We spoke with the management team who told us they had just started a review of fire evacuation at each of the supported living properties and changes were being planned.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff supported people to report maintenance issues to their landlords to ensure people’s homes were safe. People given clear info about their tenancies and The REACH standards were embedded in easy-to-read information. The REACH standards are a set of voluntary standards that introduce the fundamental principles of support for living.

People told us. “[Landlord] are in charge of cutting grass, cleaning windows outside and they do repairs. We have a QR code to scan when we need a repair” and “If I have a problem with the house, we have a man come to fix it, we had someone to check the fire doors and fire alarm in place.”

The provider made sure there were enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.Staff had regular supervision meetings, induction was a mixture of training and shadowing experienced staff to gain confidence and experience. The training matrix showed that most staff had completed mandatory training. The provider had a training schedule of online and face to face training which was tailored to staff in all roles. The provider had employed experts by experience (some of whom used the PCAS Kent service) to co-facilitate Oliver McGowan training to staff. Staff feedback about the training was positive.

Staff had been safely recruited. All required checks had been carried out, and documents were all in date. The information helps employers make safer recruitment decisions.

Staffing rotas showed that staff were deployed to work with people to meet their assessed needs, some people required support 24 hours a day, some people only needed care and support at key times. When we visited some of the houses where people lived, we observed there appeared to be enough staff to meet people’s needs. People were provided information about who would be supporting them. Staff knew people well.

People told, “Staff come and support me, I like the staff”, “We have a [staffing] rota on the wall in the kitchen”; “The staff are here all day every day”, “I like all the staff” and “I know the staff and they are good.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

People were supported to keep their homes clean. Some people were independent with this, and other people needed some support, guidance or encouragement. People told us, “I enjoy tidying my room, I have help to clean it”, “I did my washing today and changed my bed, it is out on the line and the airer” and “I do washing up, and clean my bedroom and bring my washing downstairs. Night staff do cleaning in the main house. I do dusting and hoovering.”

We visited a number of people in their homes in Gravesend, Maidstone, Ashford and the Isle of Sheppey. We observed people had been supported to keep their homes clean. Staff had access to plenty of PPE (Personal protective equipment) to keep them and people they supported safe. A health and social care professional who visited people in their own homes said, “The home always appears clean, tidy and well maintained.” A relative told us, “I go in the front room it’s clean and tidy and his room is, and washing always on, his bed is clean.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. However, medicines for 1 person did not tally, we counted these with staff and checked the records and found that the person had not always had their medicine. Some people’s medicines care plans did not list the medicines they were prescribed and why. Some PRN (as and when required) medicines were listed on the medicines administration record (MAR) at timed intervals, rather than being given as and when required. The provider had been working to improve medicines practice across the service and had developed a training course, support and staff competency assessments. Staff were in the process of completing this. The provider had also worked to introduce a standardised set of medicines forms and templates to help ensure consistency.

Most people’s medicines records showed people had their medicines as prescribed. People were supported to manage their own medicines when they had capacity to do so.

A person said, “I self-medicate, I order the medicines in the NHS app (they showed us how they did this by logging in to the app on their phone) and I pick up the medicines.” Other people told us, “I am independent and take my own medicines” and “Staff remind me when to take my tablet medication, staff help me if I have a headache.”