PHH Care 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.

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

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

of avoidable harm.

The service was in breach of legal regulation in relation to safe care and treatment and the ways people’s medicines were managed.

This service scored 50 (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 promote a proactive and positive culture of safety. Systems in place to identify, review and embed learning following incidents were not always effective.

The provider documented how they responded to people’s needs following incidents, for example, increasing care and support for people, and providing staff debriefs, however, records did not always evidence effective oversight of incidents or actions taken to learn from incidents.

Incident forms were not consistently completed to support investigation and follow-up of concerns, limiting the provider’s ability to identify themes, trends and opportunities for learning. Where incidents had been recorded, actions were not always clearly documented, it was not always evident whether additional guidance or control measures had been implemented to reduce the risk of recurrence.

Staff demonstrated an understanding of how to escalate concerns. Staff described processes for reporting concerns and sharing information following incidents. One staff member told us, “If an incident happens, lines of reporting have been helpful. We try and update the care plan as often as we can, but things change quickly, so when we go to [people’s] homes, we report changes to the line manager.”

The provider worked with people and healthcare partners to establish and maintain systems of care intended to ensure people received safe and coordinated support.

Care and support was planned and organised with people and, where appropriate, in partnership with professionals and others involved in their care.

Staff worked with relevant professionals, to support safe pathways of care and continuity when people's needs changed or when they accessed other services.

Whilst staff demonstrated knowledge of people's current needs and described effective communication with external professionals, people’s care plans did not always reflect changes in people's circumstances.

The provider's safeguarding systems were not always sufficiently robust to ensure concerns were consistently recognised, reported, investigated and notified to the Commission where required. The provider did not always share concerns quickly and appropriately.

Safeguarding processes were not always effective. The provider did not always recognise and escalate potential safeguarding concerns. For example, a person had alleged they had been harmed by a member of staff, this had not been identified or raised as a safeguarding concern. This meant opportunities to investigate concerns and reduce the risk of future harm may have been missed.

Safeguarding incidents had not been notified to the Care Quality Commission (CQC). The registered manager was not aware that safeguarding concerns met the threshold for a statutory notification.

Staff told us, they would report concerns to their line managers and were confident their line manager would take appropriate action, however, staff were not always clear about who they could escalate safeguarding matters to beyond their immediate manager.

People told us, they felt safe and staff were able to describe the actions they would take to respond to safety concerns. One staff member told us, “If I get in and they [person] have been on the floor, I check around to make sure the environment is safe, then put a call through to 999 and inform the office about it.”

The provider did not always work effectively with people to assess, monitor and manage risks. Staff did not always have access to the information required to provide care that was safe, supportive and reflective of people's individual needs.

Some risk assessments clearly identified the risk, including appropriate control measures, however, some risk assessments lacked sufficient detail or guidance for staff to reduce risks and keep people safe.

Risks to people's health, safety and wellbeing were not always adequately identified, assessed or reviewed. Risk assessments were not always up to date or relevant to the person's current needs. For example, 1 person was assessed as self-administering their medicines. Important medicines the person was taking, were missing from the assessment, and daily notes documented staff were administering their medicines. The risk assessment had been reviewed following an audit, however, it had not been updated to reflect the person’s current support needs for staff to manage the risk safely.

This meant people were at risk of receiving inconsistent care and support, as staff did not always have access to accurate and up-to-date information about how to safely meet their needs.

The provider did not always effectively identify, assess and manage risks associated with the care environment or equipment used to support people's care.

Systems were not always in place to ensure equipment, facilities and technology supported the delivery of safe care.

Equipment used to support people was not always documented within care plans and there were no supporting risk assessments. For example, 1 person experienced harm when using equipment, staff responded appropriately following the incident, and the provider contacted professionals who attended and carried out an assessment. This assessment had not been included within the persons care planning. The provider had not documented the rationale for the use of the equipment, assessed the risk, or included guidance outlining the control measures required to keep the person safe.

The provider did not always ensure there were enough suitably qualified, competent, skilled and experienced staff to meet people's needs safely.

Systems to ensure staff had received training and competency assessments was not always effective. Not all staff had completed training or had been deemed as competent in the relevant training required to people they were supporting. For example, staff supported a person who required oxygen therapy, staff had not received oxygen training. Staff told us, they would not know what action to take if concerns arose relating to oxygen use.

Not all staff had completed mandatory training relevant to their role, and several staff were not included on the provider's training matrix. Staff were providing stoma care without the relevant training. The provider carried out a competency assessment for a member of staff relating to Percutaneous Endoscopic Gastrostomy [PEG] care despite the member of staff not having completed the training. This had not been identified through the provider's governance processes.

Several staff had completed training with previous care providers, although the provider completed competency assessments staff had not always completed the service's own mandatory training programme. The provider had identified outstanding training, however, there was limited evidence that timely action had been taken to address the issues identified. Following the inspection the provider told us, they had begun prioritising this area and had started taking action to improve training compliance and oversight.

Some staff described feeling supported and spoke positively about training available. One staff member said, “I feel supported. I have had several trainings, in house, at the office. We have a dedicated trainer who carries out medication training for staff and the PEG training, and they come and watch us carry out care.” However, we also heard, “I haven't got a lot of training since I've been in the company, but online training, the basic one. I have in person training but would like more.” This feedback reflected the inconsistencies identified through our review of training and competency records.

The provider assessed and managed the risk of infection and had processes in place to reduce the risk of infections spreading. Staff had access to personal protective equipment [PPE] and people told us, staff used this appropriately when providing care and support.

People spoke positively about infection prevention practices within the service. People told us, staff wore PPE when delivering care, which helped to protect them from the risk of infection.

Staff demonstrated an understanding of the importance of infection prevention and control and described using PPE in line with the provider's procedures.

The provider did not always ensure medicines were managed safely or in a way that fully met people's needs, preferences and assessed capacities. Systems for the recording, administration and monitoring of medicines were not always robust, placing people at risk of unsafe medicines management.

People's involvement in planning and managing their medicines was not always clearly documented. The provider had not ensured there was sufficient guidance to support staff in following safe medicines practices.

Medicines Administration Records [MARs] were not consistently in place. Staff recorded the administration of medicines in daily notes or in some cases on separate recording sheets rather than using formal MAR documentation, documented times within the daily records, and the recording sheets did not always match.

Records relating to medicines prescribed for pain relief were not always complete. Protocols for medicines prescribed on an 'as required' [PRN] basis were not comprehensive. PRN protocols lacked clear information about why medicines were prescribed and the circumstances in which they should be administered.

Records relating to topical medicines were incomplete. Topical creams were not consistently referenced within skin integrity assessments, body maps or MAR records. This meant the provider could not be assured topical medicines were being applied safely and as prescribed.

The absence of complete MAR documentation and clear medicines guidance increased the risk of medicines errors and reduced the provider's ability to effectively monitor medicines administration.