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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 carried out on 18 September 2018

During a routine inspection

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 carried out on 28 April 2016

During a routine inspection

We carried out an announced inspection on 28 April 2016. Between this date and 20 May 2016, we spoke with people who used the service and members of staff by telephone.

The service provides personal care to adults with a variety of care needs in their own homes. Some of the 18 people being supported by the service at the time of the inspection were living with dementia. The service is also registered to provide treatments for people with drug and alcohol addictions, but this was dormant at the time of the inspection.

There was a registered manager in post. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm and suitable equipment was in place so that people were supported safely. People’s medicines were being managed safely.

The provider had safe recruitment processes in place and they had sufficient numbers of staff to support people safely. Staff had received regular supervision and support, and they had been trained to meet people’s individual needs.

Staff understood their roles and responsibilities to seek people’s consent prior to care being provided. Where people did not have capacity to consent to their care or make decisions about some aspects of their care, this had been managed in line with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported by kind, caring and respectful staff. They were supported to make choices about how they wanted to be supported. People’s health and wellbeing was promoted, and they were supported to access other health and care services when required.

People’s needs had been assessed and their care plans took account of their individual needs, preferences, and choices. They enjoyed good relationships with staff who provided companionship at each visit. The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service and their relatives, and they acted on the comments received to improve the quality of the service.

Some people were not happy that staff were sometimes late for their visits and that they had not always been informed that they would be late. The provider’s quality monitoring processes needed improving so that they had robust systems to evidence what actions they had taken to make continuous improvements.