Peartreelifecare Limited

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. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained 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.
 

This service scored 53 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

The provider had some systems to support learning from incidents, but these were not consistently effective. Managers described how learning was shared through team meetings, handovers and staff newsletters, and we saw evidence of daily handovers and management meetings. However, safeguarding records did not consistently capture lessons learnt or outcomes, which limited the provider’s ability to demonstrate how learning was embedded into practice. Audits and care plan reviews had not identified several of the issues found during this assessment, including gaps in care planning and medicines practice. This reduced assurance that learning was routinely used to improve safety and quality across 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 had effective systems in place to support safe pathways and transitions. Pre-assessments were completed before care packages started, and managers told us they only accepted new packages when enough trained staff were available. We saw evidence of communication with hospitals and other professionals before and following discharge. Relatives told us that meet-and-greet visits and shadowing were used to support transitions, including from children’s services, which helped people feel safe and supported when care started.
 

The provider had appropriate safeguarding arrangements in place, and staff demonstrated a good understanding of safeguarding responsibilities. Safeguarding training had been completed, policies were available, and the registered manager understood their responsibilities under the Duty of Candour. Notifications were submitted to the Care Quality Commission as required. However, safeguarding logs were not always completed fully and did not consistently record lessons learnt or outcomes, which limited oversight. People and relatives shared both positive experiences and concerns, including examples where safeguarding action had been taken
 

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
Appropriate risk assessments were in place, including for falls and oxygen use. Staff understood people’s needs and risks and could describe how they supported people safely. However, people were not always involved in managing their risks. For example, people and relatives told us they were not involved in care planning and reviews were not always consistent. Some relatives told us they relied on checking care tasks themselves to ensure risks were managed safely. This meant we were not assured that people were always fully involved in decisions about risk.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
The provider had environmental risk assessments in place, but these were not always complete. Some assessments did not clearly record whether smoke alarms were present, who was responsible for testing them, or how often checks were carried out. This limited assurance that environmental risks were fully monitored. However, there were no immediate safety concerns identified during visits, and staff were aware of environmental risks within people’s homes
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.
The provider had mostly safe staffing arrangements. Recruitment gaps had been identified and explored; however, we identified some gaps in employment history that required further input. Staff received supervision, appraisal and spot checks. We saw evidence of a training matrix and clinical competencies, including for percutaneous endoscopic gastrostomy feeding (PEG), non-invasive ventilation and suctioning. The provider ensured staff were trained before supporting people with complex needs. However, some relatives reported concerns about staff skills, turnover and consistency, which reduced assurance that staffing arrangements always met people’s needs safely.

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 had systems in place to manage infection risks. Staff had completed infection prevention and control training, policies were available, and staff told us there was an adequate supply of personal protective equipment (PPE). We observed staff using PPE appropriately and wearing suitable clothing. However, some relatives raised concerns about cross-contamination and inconsistent practice in the past which had now been resolved, and we were assured adequate changes had been made. This indicates that infection control procedures were not always applied consistently in people’s homes however improvements have been made.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.
Medicines were not consistently managed safely. Most medicines were administered as prescribed. However, guidance for medicines given via feeding tubes was not always followed, and there was no recorded evidence to confirm contact with prescribers where concerns had been raised. As-required medicine (PRN) protocols were in place, however, some lacked clear review dates and guidance on when to seek medical advice. Relatives also raised concerns about medicines not always being administered or observed.