Pinnacle Care Professionals 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

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

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The provider logged accidents and incidents, as well as near misses, and we saw the registered manager reviewed these to identify any themes and trends. Any areas of concern, or good practice, were highlighted and shared with the wider staff team to promote improved ways of working. The registered manager had also introduced a weekly learning point to support with continuous learning and development within the team, for example focus on a specific policy or identified actions from an audit.

Continued learning through consideration and reflection on when things went well and when incidents and near misses occurred and actively highlighting areas of positive practice and areas for development with the team was embedded. This supported on going good practice which improved the safety of people using the service.

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.

The provider completed a robust assessment of people’s needs, preferences and wishes with people prior to care commencing, they also included relatives and external professionals where appropriate to do so to ensure they had a clear understanding of people’s holistic needs. The registered manager explained the process and told us, “There’s lots of communication, what they [the individual] or family want to do and manage themselves, so we provide care without treading on toes, and being respectful.” People and relatives gave us examples of how the provider worked with them. One relative said, “[Name] had a full assessment, a big meeting to discuss everything at the beginning and we stipulated no male carers and no tattoos, and they have stayed with that all the time.”

Carrying out a full assessment and ongoing reviews with people, and involving relatives and external professionals, made sure people received continuity of care which was monitored and provided safely.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus 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 always shared concerns quickly and appropriately.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

Mental capacity assessments had consistently been completed with people, capacity was fully considered including fluctuating capacity, and the appropriate documentation was in place. This was supported by the providers policy and procedure.

People and relatives we spoke with felt they and loved ones were supported by a dedicated staff team, including the management team, who worked in a way that always prioritised people’s safety. One person who required support with mobility told us, “I am very safe, they [staff] all know what they are doing and I trust them”. The sentiment about feeling safe and having confidence in staff was echoed by everyone we spoke with, and staff understood what made individual people feel safe including effectively supporting people with feelings of anxiety.

We saw exceptional examples of the staff team engaging effectively with healthcare partners to protect people from harm. For example, proactively working with an occupational therapist to get additional equipment and handrails to support someone to mobilise safely.

Staff were trained and knowledgeable on safeguarding processes including reporting issues to external teams for example, the local authority and CQC.

The combination of these ways of working meant people were consistently supported to remain, and feel, safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and relatives told us they were fully involved in the management of risk and that staff had a good understanding of measures to ensure people’s safety. The registered manager was able to give us clear examples of how people were supported with risk issues without impacting their autonomy. One of the examples explained how staff supported a person living with dementia who wanders to remain safe whilst still supporting their independence by identifying the route the person took, locating them and gently encouraging them to return home. We saw risks were assessed and mitigation was in place which kept people safe

This approach meant people were supported to remain safe but still do the things that were important to them.

The provider detected and controlled potential risks in the care environment. They made sure equipment and facilities supported the delivery of safe care.

Before beginning care the provider completed an environmental risk assessment with people at their home, this included consideration of all aspects of any internal and external risks to people and staff including, external lighting, whether there were any trip hazards, appliance safety and fire risks. The registered manager told us, “We recommend they [people] get a home fire check for example for a person on oxygen, we’ve arranged it for some people. We do online referrals with people’s consent and make the arrangements, and the fire department contact the person or families….we need to have all the information to be able to deal with whatever comes up.”

Where risks had been identified we saw risk assessments and risk reduction measures were implemented and this was clearly documented in people’s care plans. This ensured people and the staff supporting them were safe.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked well together to provide safe care that met people’s individual needs and had clear contingency plans to ensure staff absence was covered so people continued to receive their care and support.

Staff were recruited safely using robust recruitment process and completing the relevant checks. They received a full induction, shadowing with experienced staff, comprehensive training which included bespoke training from external professionals engaged by the provider and regular competency assessments. We spoke with people who had been supported by staff who had received person specific training relevant to them, one person said, “The staff who attend my calls are friendly, well presented, trained to a high standard and provide the client centred care I was promised.” Staff practice was regularly monitored through unannounced spot checks completed by the management team and they received regular supervision. Staff showed us the pocket guide the registered manager had created for staff to use for on the spot guidance and told us about a challenging situation when supporting someone at the end of their life and using the guide. They said, “[We weren’t sure who to phone first] So we read that [pocket guide] and it was really helpful. [It tells you] what we do in this situation or that, the pocketbooks are really good and it [information] is just right there.”

The registered manager spoke about securing the right people for the staff team and upskilling them to provide the best possible care and raise standards in the sector. They said, “My plan is to get the right people and work hard to support them to get retention. If people move on, they move and deliver better care because they’ve been here, so their expectations drive improvements elsewhere, it’s not about hoarding knowledge it’s about sharing it.”

People and relatives supported that staff were skilled and well trained. One person said, “Every one of them [staff] knows what they are doing, every one, and they always ask me what I want.”

When completing an assessment for a new person the registered manager ensured all the necessary training was in place or implemented additional training to ensure people received the exact support they required. We saw numerous examples of where the registered manager had developed links with external professionals, for example a stoma nurse, to support with the delivery of safe support through specialist staff training.

Ensuring they recruited the right people and provided staff with a full induction, training and ongoing support and guidance meant people received safe care from competent staff that met their specific needs. People echoed this through their feedback and said they felt ‘reassured’ and benefitted emotionally and physically from being supported by staff that were competent and well versed in their individual care and support needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider ensured staff had the right training, personal protective equipment (PPE) and clear policy guidance and care plans to manage and control the risk of infection. Staff ensured they used effective handwashing, which was assessed during spot checks, as well as task appropriate PPE. Staff ensured any equipment was effectively cleaned and any clinical items were carefully stored to keep them hygienically clean.

People’s care plans identified the support they needed with maintaining their home environment as well as support with their personal care and clothing.

These measures supported to decrease the risk of infection to people and effectively manage any current infections safely.

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.

We saw as required medicines records were not always clearly documented providing a clear reason for administration and outcome but there were no indicators that this had resulted in unsafe practice. We spoke with the registered manager about this at the time and saw audit evidence that this issue had already been identified and was promptly addressed with staff.

Administration, ordering where required, support with emergency treatment prescriptions and oversight of staff practice was well managed. People supported with medicines felt this was safely managed, one relative told us, “The carers give them their medication and keep an eye on reordering, they watch it all the time. [Relative] is so safe”.

Staff had received training on safe medicines management, and their competency was assessed by the management team as well as part of spot checks. This meant people received safe support with medicines to maintain their health and wellbeing.