Kent PBS Service

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of legal regulation in relation to person centred care and dignity and respect.

This service scored 30 (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 treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not treat colleagues from other organisations with kindness and respect.

People were placed in situations that were profoundly undignified and unsafe through poor leadership and governance, and some relatives and professionals had noted a significant decline in people’s welfare since moving to the service. Multiple relatives told us their loved one’s personal hygiene had declined, and they were often unengaged and not supported to develop life skills.

Staff did not consistently monitor or respond to concerns on people’s health and wellbeing. We saw where a professional had raised the weight loss of a person the service had failed to implement regular monitoring to review any increases or losses. Another person who had an increased weight gain, contrary to guidance in their care plan and despite their care plan describing the importance of offering healthier choices, there was no evidence this was happening. A further person would frequently not wash for weeks at a time, with no clear plan of how that would be supported or evidence of self-neglect being followed up on.

Although we received some positive feedback about individual members of staff, we also received feedback that staff would spend significant amounts of time not engaging with people or using their personal phones.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

There was a lack of consideration to what support people required to meet their physical and social needs and promote their ongoing wellbeing. The provider failed to continually review people’s needs and update care planning documents to set out how their own staff should promote people to have a positive quality of life. A significant proportion of care planning documents were outdated. For example, one person’s activities care plan stated it would be updated when they moved into the service, despite this happening more than a year ago. People’s care plans documented had plans to support them take part in activities such as shopping or swimming which stated they would be updated after people had done this for the first time, but they had not been despite these activities taking place regularly.

Relatives and stakeholders raised concerns that though people had previously taken part in varied activities prior to moving to the service, however now spent significant amounts of time in bed or unengaged. The activities provided were not always as meaningful as they could be, for example one person often went for long drives without leaving the car. However, this was due to car drives formulating part of their PBS plan.

However, we did see some positive examples, such as one person who had been supported to go on holiday for the first time in many years. They had also recently attended a concert for a favourite band which had been a long-time ambition.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

We saw poor evidence of how the provider promoted people’s independence. People did not always have access to parts of their own home with no clear rationale for why this was the case. For example, the care notes for some people described them as needing to request access to activities cupboards.Where people requested privacy and time for themselves, we saw that was respected, however people spent significant amounts of time in their rooms and often made choices that placed them at risk of harm. There was no guidance or evidence that staff were supporting people in these circumstances to offer healthier or meaningful choices to improve their quality of life.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We identified significant concerns with how the provider and staff recognised that people were in distress or pain, and may need their prescribed medication to ensure their wellbeing. There had been significant incidents of self-injurious behaviour or distress which resulted in harm coming to people and staff, but “as needed” medications such as paracetamol or medications to reduce distress had not been consistently offered. This risked prolonging people’s distress or discomfort and made further incidents of harm more likely. Recognising signs that people needed their medication was especially important where people could not communicate verbally, however this was not happening.

We were concerned that staff could not respond appropriately to people’s needs and identified a poor level of knowledge around how staff would respond to health concerns such as choking, constipation, or instances of extreme distress.

The provider did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

Staff were placed at significant risk of harm through instances of physical aggression, however leaders had not identified that unsafe medication management practices and staff knowledge further increased this risk. Staff were placed in situations where they experienced regular verbal or racial abuse and there was a lack of clear guidance on how staff should respond to this. There were systems to gather feedback from staff on their experience such as surveys. Although the most survey had a very low response rate, the provider had taken action to understand why this might be the case. The provider failed to invest in their own workforce and ensure they had the training they needed to deliver a safe level of care.