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We are carrying out a review of quality at PCHCS. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 28 June 2019

This inspection took place between 18 September and 25 October 2018. We visited the provider’s office on 18 September and between 19 September and 16 October, we carried out telephone interviews with people who used the service, their relatives and staff. On 23 October, we received further information of concern about the service, so carried out a second visit to the provider’s office. The was an announced inspection, although the second visit to the office on 25 October was unannounced.

We last carried out an inspection at this service in April 2016 and the service was rated ‘Good’ overall, with a rating of ‘Requires Improvement’ in the ‘Well Led’ domain. This was because we identified concerns in relation to late care calls and how the provider monitored the quality of the service provided. At this inspection we found that these issues continued to be a significant concern. In addition, we identified concerns in relation to how the provider identified and managed risks to people, poor quality care planning and delivery, poor quality training, poor record keeping and complaints management. Much of the feedback from people and staff regarding the quality of the care and support was poor, and showed that changes were not being implemented or embedded within acceptable timescales. As a result, the service has been rated inadequate. This inspection identified multiple breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

PCHCS is a domiciliary care service providing personal care and support to people in their own homes. At the time of our inspection, the service was providing care to 18 people.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People did not receive their care visits on time, and care visits were frequently cut shorter than the allocated time. This meant that people were placed at risk of neglect, medicines not being administered at the correct intervals and not having their care needs attended to within a reasonable time. The service had a system for monitoring their calls and identifying persistent issues that required improvement but it had not been used effectively.

People had care plans and risk assessments in place but these were poor in quality and lacked sufficiently up-to-date, relevant and personalised information to enable staff to carry out their care effectively. There were concerns in relation to people having consented to the care provided and the provider’s understanding of the Mental Capacity Act 2005 was poor. People were asked for their views through surveys and quality monitoring calls but issues identified were not resolved. People had mixed views as to whether they felt cared for and were treated with dignity and respect.

Staff recruited to the service did not always have suitable references in place, and there were gaps in employment histories which had not been accounted for.

Staff training was inadequate and left staff to provide care to people for which they had not been fully trained. Their competency was not assessed to ensure they were able to provide this care safely to people.

Understanding of how to protect people from harm and how to report incidents of concern was insufficient throughout all levels of staffing. This had led to a significant increase in investigations into incidents by the local authority.

People did not always feel confident that complaints would be resolved, and expressed concerns that the management were not always respons

Inspection areas

Safe

Inadequate

Updated 28 June 2019

The service was not safe.

People did not always receive care on time, and calls were frequently late or shortened.

Risk assessments were not always completed and appropriate action taken to mitigate people�s exposure to the risk of harm was not recorded.

People�s medicines were not managed safely.

The provider did not use information from when things went wrong to make lasting improvements to the service.

Recruitment checks were not always fully completed to ensure a robust recruitment process was in place.

Effective

Inadequate

Updated 28 June 2019

The service was not effective.

Staff did not receive training of a sufficient quality to meet the needs of people they supported.

Understanding of the Mental Capacity Act 2005 was insufficient.

People were not always supported to have enough to eat and drink of an acceptable quality, when this was part of their planned care.

The service did not ensure that people�s healthcare needs were met.

Caring

Inadequate

Updated 28 June 2019

The service was not caring.

Some individual staff were kind, but others were not.

The service was not organised around the needs of people and they were often left waiting for care or receiving care that was hurried and late.

People did not have sufficient choice about how their care was delivered.

People were not always treated with dignity and respect.

Responsive

Inadequate

Updated 28 June 2019

The service was not responsive.

Care plans contained insufficient information in relation to people�s individual needs

People did not always receive their funded amount of care hours or care at the time it was needed.

Care Plans did not include information about people�s wishes for their end of their life.

Complaints were not handled effectively and the provider did not keep accurate logs of complaints.

Well-led

Inadequate

Updated 28 June 2019

The service was not well-led.

There was insufficient provider oversight of all aspects of the service.

Action was not taken to address shortfalls in care provided, or to manage care visits effectively.

Staff Practice was not monitored effectively.

Action was not taken to resolve concerns raised by people and their relatives.

Records were insufficient, inaccurate or contradictory.

People were not always confident that they would always receive a response from the office when they raised concerns.

The provider did not work proactively with other agencies to ensure a good quality service was provided.

Notifications of reportable incidents were not made as required by law.