PHH 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 this service. This key question has been rated requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 61 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff meetings were used to communicate key information, discuss service developments and guidance on who to contact for support or to escalate concerns.

The provider had systems in place to monitor the quality of the service, including audits of care records. Where shortfalls were identified, these were discussed with staff to reinforce expectations and promote improvements in practice.

Audits had identified concerns regarding the accuracy and consistency of care notes, including entries containing dates and times which did not always correspond with the care provided. The provider had recognised these issues and had taken action to address them through monitoring and discussion with staff.

The provider had leaders who were approachable. Staff spoke positively about their line managers and described a culture where concerns could be raised and acted upon.

Staff gave examples of receiving timely support from managers when concerns about people's wellbeing arose. One member of staff told us, “Our line managers are always at the ready. Where there are concerns about people, they act and report it to the district nurses and will go out and see the [person]. I feel like something will be done.”

Staff generally told us, they felt supported in their roles. One staff member said, “Care coordinator, they sometimes check on you. I feel supported in my role.” Another member of staff said, “I believe they [managers] do their best. She's [registered manager] has been quite supportive all this time, she's always supportive.”

Whilst staff were complimentary about the support they received from leaders, some of the shortfalls identified through audits, staff feedback and our inspection had not been addressed in a timely manner. Although leaders were approachable and committed to supporting staff, governance and oversight arrangements were not always sufficiently effective in ensuring identified improvements were embedded into practice.

The provider fostered an open culture where staff were encouraged to contribute their views and participate in discussions about the service. However, the provider did not always evidence how they acted on staff concerns.

Staff told us, they were given opportunities to share feedback and felt able to speak up during meetings, however some staff did not always feel staff were able to speak up, staff told us “General meetings we attend, they do ask us to participate. I feel staff don't respond like they should, I don't know why.”

The provider gathered staff feedback through surveys and engagement activities. Survey results identified areas that were important to staff, including recognition for their work, additional training opportunities, and regular welfare check-ins. Action plans clearly identified the improvements required; however, there was limited evidence these actions had been implemented.

This meant that although mechanisms were in place for staff to share their views, the provider did not always demonstrate how feedback was translated into meaningful action. As a result, opportunities to further strengthen staff engagement and promote a culture where staff felt fully valued and listened to were sometimes missed.

The provider valued diversity within its workforce and sought to promote an inclusive culture where staff were supported to develop their skills and progress within their roles.

Staff spoke positively about further opportunities for learning, training and professional development.

Staff told us, they were provided with opportunities to access further education to support their development. This demonstrated the provider recognised the importance of investing in its workforce.

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

Governance systems were not always effective in identifying and managing risks. There were significant shortfalls relating to medicines management, including the absence of Medicines Administration Records [MAR]. Medicines audits identified a number of improvements required, however, audits had not identified wider issues, including a lack of complete documentation. This had not been identified through the provider's governance and auditing processes.

Oversight of care planning was limited. Although managers told us, care plans were reviewed, there was no documented audit trail to evidence these checks had taken place. As a result, a number of issues within care plans and risk assessments had not been identified or addressed. This included inconsistent information, missing assessments and gaps in guidance available to staff.

Action plans in place identified actions required to ensure people were safe, however, updates required to people’s information was not completed, and actions were not always allocated to people, with a completion date.

There was a lack of clarity regarding roles and responsibilities when discussing incident management. Records did not always demonstrate clear ownership of actions following incidents or evidence that learning had been effectively reviewed and embedded into practice.

Gaps in training and oversight of training had been identified by the provider, however there was limited action to ensure staff were effectively trained and oversight in place was correct. The provider completed monthly audits of daily care notes. These had identified shortfalls regarding the quality of recording and poor notetaking, which were discussed with staff through training and team meetings.

Following the inspection, the manager told us, they would ensure they took appropriate action to address the issues identified.

The provider understood the importance of working with other professionals and agencies to support people and improve outcomes.

Staff worked in partnership with a range of healthcare professionals, including district nurses, palliative care teams and other specialist services, to ensure people received appropriate support when their needs changed.

Information received from healthcare professionals was shared with staff through group communication systems and recorded on the provider's electronic care planning system. However, this information was not always reflected within people's formal care plans.

The provider did not always demonstrate a culture of continuous learning, improvement and innovation. Systems were not always effective in ensuring learning was appropriately embedded into practice or consistently used to improve outcomes for people.

Staff told us, they received feedback regarding concerns they had raised and were kept informed of actions taken.

The provider maintained a safeguarding log, however, records did not consistently demonstrate what lessons had been learned following safeguarding concerns or how this learning had been shared with staff. This meant the provider could not always demonstrate that learning from incidents and safeguarding concerns had been fully embedded into practice to improve the safety and quality of care.

Actions relating to incidents were not consistently completed. For example, incident investigations recorded that care plans and risk assessments should be reviewed following events; however, these reviews had not always been undertaken.