Plus Point Care 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.

This is the first assessment for service. This key question has been rated 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 legal regulation 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 demonstrate culture and values based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

There were concerns with the provider’s transparency and engagement during the assessment. We did not receive all documentation requested in the timescales given. The provider did not engage and make the necessary improvements identified on this assessment. This meant we could not be assured the provider’s priority was providing safe and high-quality care.

People and their relatives were provided with a service user guide about what to expect from their care. However, the core principles outlined in this guide were not always adhered to. The principles outlined in the guide included collaborative working and a 24-hour service for people, their families and social services. During the assessment, a lack of timely communication and delegation meant the contact details for Plus Point Care Ltd, for people, their relatives and stakeholders was not available. This demonstrated the lack of collaborative working or provision of communication, which was against the principles of Plus Point Care Ltd.

Whilst the staff were given an employee handbook to direct them to the aims and objectives of Plus Point Care Ltd, which in turn directed the intended culture of the service. As we identified the provider did not consistently lead by example, so we were not assured the cultural aims had been achieved.

The provider, who was also the registered manager, did not deliver care, treatment and support, with credibility, openness and honestly.

The provider failed to meet the requirement for all registered health and social care providers to ensure staff were adequately trained on how to support and interact with autistic people and people with a learning disability. This demonstrated they either did not understand the requirements and recommendations for staff upskilling, or the provider had decided not to take this action.

The provider did not proactively address their own learning and development needs around supporting autistic people and people with a learning disability. The provider said they had been unable to access the complete training package they had preferred to use, but they had no plans to address their lack of training. This meant people were not supported by a provider who had achieved the required level for supporting autistic people or people with a learning disability.

Risks were not always professionally managed, and the provider’s lack of openness gave concern about the lack of their capability. When specific risks were identified and discussed, the provider exhibited reluctance to discuss the risks in an open way. A person had demonstrated they were at risk of falls, however the provider, who had not put a necessary risk assessment in place, then denied the person had had a fall, despite us seeing in the recent falls audit the person was recorded as having had a fall.

There was no evidence of succession planning. There were no senior staff, or staff who had been upskilled to take on leadership roles if these were required. This meant consistent capable leadership could not be guaranteed.

The provider governance processes did not support a positive culture to enable speaking up and ensuring their voices would be heard.

Whilst there was a comprehensive complaints, suggestions and compliments policy in place, people or their relatives told us they had not all had a copy of this. The policy itself also stated a copy would be available on the website, but this was not the case. The lack of availability of the policy was an example of poor governance, and suggested policy and processes recorded had not reliably been followed. It also prevented all people from being able to speak up if they had concerns.

People and their relatives told us they knew who the registered manager was and said they were approachable. One relative said, “[The registered manager] is very friendly on the phone and said if there were any problems to give [the registered manager] a ring.”

Staff told us they knew the whistleblowing processes at Plus Point Care Ltd. Whistleblowing is when an employee challenges actions by anyone working for the provider. The employee handbook outlined the steps staff would need to take to escalate their concerns. Staff told us they had not had to blow the whistle on poor care, but would be able should it be required, and felt provider was approachable.

The provider did not demonstrate they always worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Whilst the employee handbook noted the importance of equal opportunities, including staff recruitment, we were unable to be assured of non-biased recruitment due to an absence of an interview record for all staff.

Staff awareness of equality, diversity and human rights was not evidenced. Training records showed staff had not all completed the appropriate training or had their understanding assessed at a supervision – as not all staff had been recorded as completing a supervision. This meant the provider could not be assured staff were able to establish an inclusive culture amongst the staff team.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Whilst staff told us they felt supported by management when they needed guidance or help, they were not aware of what action to take if the registered manager was not available. The provider did not have sufficient mitigation in place, for the risk associated with having a small leadership team. During our assessment an unexpected lack of management presence coupled with a lack of robust arrangements for this situation meant the business was unable to proceed safely. Two different business continuity plans were provided during the assessment, neither gave assurance that in an emergency, care would have continued safely. Staff were not aware of what would happen if the manager was not present – this included not knowing who would have oversight of rotas. Staff also told us other than the registered manager there was no staff who would be able to complete the ongoing competency assessments for staff or have oversight of required training needs.

The provider told us call attendance had been monitored in ‘real time’, but there was no contingency if the registered manager was not available. This meant we were not assured of oversight of care calls was sufficient and action would be taken in the event of a staff member not attending a care call.

Governance systems were ineffective. Audits showed necessary action which had been identified was not always achieved. For example, an audit of medicine administration repeatedly showed staff had not completed all necessary tasks. As this was identified on a number of records, and over a long period of time, insufficient action had been taken by the provider to rectify the issue. This lack of action meant people were placed at ongoing risk.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

Partnership working was not effective due to the provider’s lack of engagement. Opportunities had been given to the provider to work with stakeholders to develop their service to ensure people’s care was the best it could be. Stakeholders told us at times the provider had fought against collaborative working, whilst others told us the provider had been difficult to engage with.

Information requested during this assessment was not provided in a timely way. There were inadequate assurances from the provider following an informal request for information about the provider’s actions to ensure required improvements were made. The provider failed to share both required information and records, and their learning and required improvements were not evidenced.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Whilst staff told us they felt they had all the learning they required, training records showed they had not received all necessary learning. Without this basic foundation, there had been no assurance continuous learning would be achieved.

The provider’s annual report submitted to CQC reported lots of creative ways they had provided people with positive outcomes. However, the provider was unable to evidence this had been implemented. An example of this is the report stated, ‘The registered manager and Communication and Accessibility Lead collaborate directly to review feedback, analyse trends, and implement necessary, appropriate changes to enhance our overall communication practice. Documenting and Supporting Individual Needs’. The provider told us there was no communication and accessibility lead and they were both these roles. In addition, the report stated there was a list of organisations who could support people with their communication needs; however, the provider did not produce this when asked. The lack of adequate support for people with communication needs which we had been told was in place, meant we were not assured all people’s needs were addressed, and therefore able to access the same care and quality of life that other people achieved.