PHH Care 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.

This is the first assessment for this service. This key question has been rated requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 always ensure people's care and treatment were effective. Systems for assessing, recording and reviewing people's health, care, and wellbeing were not always sufficiently robust.

Care records lacked person-specific guidance relating to catheter care. Information available did not provide clear guidance about the individual's needs, known risks or the support required to maintain their health and wellbeing.

One person's records did not fully reflect their current needs, however, staff were able to explain the person's routines, preferences and support requirements. Although staff demonstrated a good understanding of the people they supported, this information was not always reflected within people’s care records.

This meant there was a risk that important information could be lost or inconsistently applied, particularly where care was being delivered by different staff members.

Several risk assessments contained clear information about people's needs, triggers, actions to reduce risks, supporting staff to respond appropriately and maintain people’s safety and wellbeing. However, this was not consistent across the service.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans did not always contain the information required to support people safely with specialist healthcare needs. One person was receiving nutrition via a percutaneous endoscopic gastrostomy [PEG], the care plan instructed staff to follow a prescribed feeding plan, however, this was not available within the care records. As a result, staff provided inconsistent support. Audits had not identified the inconsistencies in the persons care, or the need for robust guidance.

Guidance in place for the effective management of PEG care lacked important information about equipment, how to clean and maintain equipment, and side effects staff should monitor. Supporting guidance for the management of trapped air was not in place, despite this being observed as a risk by senior staff during a spot check.

Records instructed staff to use a strict aseptic technique, however, there was no accompanying guidance explaining what this involved or how it should be implemented in practice.

Following the inspection, the provider took action to ensure that they contacted the relevant professionals and obtained the necessary information and guidance.

The provider did not always work well across teams and services to support people.

The provider worked with healthcare professionals involved in people's care and staff described occasions when they sought advice and support from external services. However, records did not always demonstrate that assessments, risks and changes in people's needs had been consistently documented and shared.

Care plans and risk assessments were not always up to date and, in some cases, contained incomplete or conflicting information. This reduced assurance that staff had access to important information about people’s needs.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control.

People and their relatives spoke positively about the support they received. Staff were able to describe how they encouraged people to remain as independent as possible and tailored support to meet their individual needs and preferences.

Staff understood people's preferences and routines and worked with them to maintain their wellbeing. Daily records documented how staff encouraged people to participate in decisions about their care and adapted support in response to their needs.

Although shortfalls in care planning and documentation were found, there was evidence that staff knew people well and were providing support aimed at maintaining their health, wellbeing and independence.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive, consistent, or that they met both clinical expectations and the expectations of people themselves.

Records relating to skin integrity were not always sufficiently detailed to support effective monitoring of outcomes, as monitoring or review of body maps was not in place. Body maps relating to a person's pressure sore were not in place. Body maps in place, did not record important information such as the size and location of wounds, the date they were identified, or the suspected cause.

Staff did not always have access to clear and consistent information to support effective care. Care records lacked clear guidance regarding repositioning, despite records indicating repositioning was required to alleviate discomfort and reduce the risk of further skin deterioration.

Despite these shortfalls, some staff provided attentive care and took action to promote people's comfort and wellbeing. Records demonstrated staff supported people with repositioning, recording using pillows to support posture and relieve pressure.

However, this guidance was not available within the person’s care planning or risk assessment and was not consistently carried out by all staff.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Relatives spoke positively about the way staff involved people in decisions about their care. One relative told us, “They always ask if it's OK if they help [person].”

Staff told us, they had completed dementia training and were able to describe how they supported people living with dementia. However, staff were unable to demonstrate a clear understanding of the Mental Capacity Act (MCA) or explain how the principles of the MCA influenced their day-to-day practice.

Despite these shortfalls, staff routinely sought consent and respected people's choices when providing care and support. Staff respected people's preferences and involved them in decisions about their daily care and support.