Archived: Penkz Limited

People’s experience of using this service:

At the last inspection of 4 March 2020, we found breaches of Regulation 10 (Dignity and respect), Regulation 16 (Receiving and acting on complaints) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we identified that improvements had been made to the benefit of people using the service and the service was no longer in breach.

People who used the service had been treated with dignity and respect. They and their relatives told us that they felt safe when attended to by care staff.

People had been protected from abuse. Care staff had received training on how to safeguard people and were aware of the procedure to follow if they suspected that people were subject to, or at risk of abuse.

People were protected from potential risks. Risks to people’s health and wellbeing had been assessed. Risk assessments contained guidance for staff on minimising risks to people.

People received their medicines as prescribed. Care staff had received medicines administration training and knew how to administer medicines safely.

Care staff were safely recruited, and essential pre-employment checks had been carried out. There were sufficient staff to enable the service to provide quality care.

People received person-centred care and care staff carried out their duties in accordance with agreed care plans. People had been consulted regarding the care provided and regular reviews of care had been carried out.

The service had arrangements for responding to complaints. People were aware of the complaints' procedure. The records indicated that complaints had been promptly responded to.

The service was well managed. Management monitored the quality of the services provided via checks and audits. These checks and audits were comprehensive, and deficiencies had been rectified. The service worked closely with health and social care professionals to meet the needs of people. There was a written action plan for improving the service.

Rating at last inspection:

The last rating for the service was Requires Improvement (published on 28 April 2020).

Why we inspected:

We undertook this focused inspection as we had concerns regarding the service, and we wanted to check that people were well cared for. The inspection was prompted in part due to concerns received during and following the last inspection about the reliability of the service and the safety of people who used the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led. The ratings from the previous comprehensive inspection for the key question not looked at on this occasion was used in calculating the overall rating at this inspection. The overall rating for the service is now Good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Penkz Limited on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor the service through the information we receive. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Not all people who used the service had been treated with dignity and respect at all times. Some staff were not gentle in their approach and behaved in an unpleasant manner towards people and their relatives.

Some people and their relatives did not always receive person-centred care as staff did not always arrive on time or stayed the agreed duration. In some instances, staff rushed to complete their jobs.

Some people’s complaints were not effectively responded to. Although there was a record of complaints made, these did not clearly indicate if the complaints had been promptly responded to.

Some aspects of the service were not well managed. Management monitored the quality of the services provided via checks and audits. These checks and audits were however, not sufficiently comprehensive and did not always rectify deficiencies noted.

People had been consulted regarding the care provided and a recent satisfaction survey had been carried out. However, the written action plan in response to concerns expressed had not yet been completed.

There were arrangements to protect people from potential risks. Risks to people’s health and wellbeing had been assessed. Risk assessments contained guidance for staff on minimising risks to people.

There were arrangements to protect people from abuse. Staff had received training on how to safeguard people and were aware of the procedure to follow if they suspected that people were subject to, or at risk of abuse.

People received their medicines as prescribed. Staff had received medicines administration training and knew how to administer medicines safely.

Staff were safely recruited, and essential pre-employment checks had been carried out. They had received appropriate training and support to ensure that they were able to carry out their duties. The registered manager and senior staff carried out regular supervision sessions, annual appraisals and spot checks.

The healthcare needs of people had been assessed and staff worked closely with healthcare professionals to meet the needs of people.

Staff encouraged people to have a healthy diet where this was part of their contracted responsibilities. They were aware that if there were significant fluctuations in people’s weight, they should alert their manager, relatives and professionals involved.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for the service was Good (published on 7 September 2017).

Why we inspected:

This was a scheduled planned comprehensive inspection.

Enforcement:

We found three breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014 in relation to person-centred care and Good governance.

Follow up:

We will continue to monitor the service through the information we receive. If we receive any concerning information we may inspect sooner.

At our previous comprehensive inspection on 13 and 14 July 2016 we rated the service as “Requires Improvement”. We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The registered provider had not ensured that medicine administration charts (MAR) were properly completed. This may put people at risk. At this inspection we noted that audits and checks had been carried out to ensure that they were properly completed. Where there were unexplained gaps, follow up action had been taken. The service had a policy and procedure for the administration of medicines and care workers had been provided with training.

The second breach was in respect of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing. The provider had failed to provide adequate supervision and all essential training for care workers. This placed people at risk of not receiving appropriate care from care workers who were well supported. At this inspection we noted that care workers had been provided with supervision. This consisted of a mixture of individual supervision and group supervision. However, the group supervisions were not clearly specified in care workers supervision records. We have therefore recommended that this be done.

The third breach was in respect of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Receiving and acting on complaints. The provider failed to establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints. This means that concerns some people had were not being responded to. At this inspection there was evidence that complaints had been appropriately dealt with.

The fourth breach was in respect of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. The provider did not have adequate scrutiny and quality monitoring of the service. This may put people at risk of harm or of not receiving appropriate care. At this inspection we noted that the service had the necessary checks and audits for ensuring quality care.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People who used the service and their representatives stated that people had been well treated and people were safe with their care workers. The service had a safeguarding adults policy and care workers had received training in safeguarding people. Potential risks to people were assessed and guidance provided to care workers for minimising these risks. The service had an infection control policy and gloves and aprons were available for care workers. People who used the service and their relatives informed us that care workers observed hygienic practices.

The care records of one person did not contain a risk assessment. The registered manager stated that this was kept at the home of the person concerned. He also stated that this person’s contract was due to be terminated. We recommend that all copies of risk assessments of people be kept in the office so that care workers and senior staff in the office are fully informed regarding potential risks to people and care workers.

We examined the recruitment records. The records indicated that care workers had been carefully recruited. Care workers had received appropriate training to ensure that they had the skills and knowledge to care for people. Care workers said there was a good staff team and the registered manager and senior staff were approachable.

People and their representatives informed us that they mostly got on well with their regular care workers. They stated that their care workers did what was agreed. Care plans were prepared with the involvement of people and their representatives. Reviews of care and telephone monitoring had been carried out to ensure that the care provided was relevant. Two people we spoke with were not satisfied with the services provided. We were able to raise some of the points with the registered manager who responded promptly.

Two social care professionals informed us that they had no concerns regarding the care provided to their clients. Spot checks had been carried out on care workers to ensure they were carrying out their duties. Visits had been made by the care co-ordinator to people to discuss their care and obtain feedback from them or their relatives. A satisfaction survey had been carried out recently and there was an action plan following the findings.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People who used the service and their representatives stated that people had been well treated and people were safe with their care workers. The service had a safeguarding adults policy and care workers had received training in safeguarding people. Potential risks to people were assessed and guidance provided to care workers for minimising these risks. The service had an infection control policy and gloves and aprons were available for care workers. People who used the service and their relatives informed us that care workers observed hygienic practices.

The service had a policy and procedure for the administration of medicines and care workers had been provided with training. We however, noted that there were unexplained gaps in three medicine administration charts (MAR) and there was no documented evidence of regular audits on the administration of medicines. This deficiency places people at risk and we have made a requirement in this report in respect of this.

We examined the recruitment records. The records indicated that care workers had been carefully recruited. Care workers had received appropriate training to ensure that they had the skills and knowledge to care for people. Care workers said there was a good staff team and the registered manager and senior staff were approachable. We however, noted that staff supervision was irregular and there were long gaps in between sessions and not all staff had received annual appraisals. These deficiencies indicated that care workers were not receiving regular support and opportunities to discuss issues related to their work. Some staff had not received all the required training. The registered manager informed us that these would be provided.

People and their representatives informed us that they mostly got on well with their regular care workers. They stated that their care workers did what was agreed. Care plans were prepared with the involvement of people and their representatives. Reviews of care and telephone monitoring had been carried out to ensure that the care provided was relevant. We however, noted that not all complaints had been promptly responded to and one complaint letter was not dated. Two people we spoke with also made complaints regarding some aspects of their care. The registered manager responded promptly and investigated the complaints.

Social and healthcare professionals informed us that the care needs of people had been met and the service kept them informed of progress. Spot checks had been carried out on care staff to ensure they were carrying out their duties. Visits had been made by the care co-ordinator to people to discuss their care and obtain feedback from them or their relatives. A satisfaction survey had been carried out recently and there was an action plan following the findings. Two social care professionals informed us that the service was addressing deficiencies identified. We however, noted that the service did not have adequate quality assurance measures in place. There was insufficient documented evidence of audits and checks and action taken to address deficiencies. Comprehensive audits and checks are needed in areas such as supervision arrangements, complaints, spot checks, staff logging in arrangements, arrangements for medicines, care documentation, policies and procedures. This deficiency may place people at risk of receiving inadequate care and we have made a requirement in respect of this.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report