Archived: Pinnacle Brit

Pinnacle Brit provides personal care and support to older people and people with disabilities living in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. At the time of our inspection, all 14 people received personal care.

People’s experience of using this service and what we found

As in the last 3inspections, risks associated with people’s care were not being managed safely. The provider did not have robust systems in place to ensure staff attended the care call and stayed for the full length of the call. Medicines were not being managed in a safe way.

Staff training and supervision were not effective in ensuring good quality of care or identifying and addressing shortfalls. People were not always supported to have maximum choice and control of their lives.

People's independence was impacted as staff were not always advising them when they were going to be late. People and their families did not always have input into their preferred call times which they fed back impacted on their lives.

As from the previous inspection, there was a lack of personalisation and detailed guidance for staff specific to each person's needs. There was a lack of detailed information on people's preferences, their likes and dislikes and life histories and staff confirmed to us they did not know this information. There was a lack of evidence of robust investigation into the complaints or actions taken to make the necessary improvements. People and relatives were not always confident complaints would be addressed.

There remained a lack of robust systems in place to monitor the delivery of care and this impacted on the care people received. The provider had failed to ensure there were robust systems in place where staff either arrived late for a call or did not stay for the full length of the call. Audits taking place were not identifying or preventing issues occurring or continuing at the service. The provider failed to have effective systems in place to gain feedback from people, relatives and staff about the quality of care.

People fed back staff were not always adhering to infection prevention controls. We also found staff were not always recording how much people had eaten and drunk. We have made recommendations around both areas.

There were people and relatives that fed back they had developed good relationships with their regular carers. We saw external professionals were contacted where staff had a concern about a person’s health.

Rating at last inspection

The last rating for this service was inadequate (published 29 September 2022) and there were multiple breaches of regulation. At this inspection, we found the provider remained in breach of regulations. The service remains rated as inadequate overall. This service remains in Special Measures

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to risks associated with people's care, and the management of medicines. We identified breaches in relation to the deployment of staff and lack of robust training and supervision. We identified breaches in relation to care not being planned and provided around people's needs and wishes and there was a lack of robust oversight of the quality of care and responding and acting on complaints.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service remains 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Pinnacle Brit provides personal care and support to older people and people with disabilities living in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. At the time of our inspection all 24 people supported by the service received personal care.

People’s experience of using this service and what we found

The risks associated with people’s care were not always managed in a safe way. This included the provider not knowing whether staff had attended calls, poor management of medicines and risks associated with people’s care not mitigated. People were not protected from the risk of neglect as staff were not always attending calls when required. Staff were frequently not staying for the full length of the call which was impacting on care.

An assessment of people’s needs was not always undertaken when their health changed. People and relatives did not always feel staff were competent to deliver care. The supervisions staff received were not always effective in identifying and addressing shortfalls. Although we saw health care professional were consulted this was not always undertaken in a timely way. People were not always supported to have maximum choice and control of their lives.

People were not always treated in caring or respectful way although people and relatives fed back that some staff were kind and considerate. People’s independence was impacted as staff were not always advising them when they were going to be late. People and their families did not always have input into their preferred call times which they fed back impacted on their lives.

Whilst we found improvements in the information in some people’s care plans there remained a lack of personalisation and detailed guidance for staff specific to each person's needs. There was a lack of detailed information on people’s preferences, their likes and dislikes and life histories. There was a lack of evidence in people’s care notes that staff were providing the care detailed in people’s daily care planners. There was a lack of robust investigation into the complaints or actions taken to make the necessary improvements.

There was a lack of robust systems in place to monitor the delivery of care and this impacted on the care that people received. The provider had failed to ensure there were robust systems in place where staff either arrived late for a call or failed to attend a call. Audits taking place were not identifying or preventing issues occurring or continuing at the service. The provider failed to have effective systems in place to gain feedback from people, relatives and staff about the quality of care.

Rating at last inspection and update

The last rating for this service was inadequate (published11 January 2022) and there were multiple breaches of regulation. We imposed conditions to the providers registration relating to the governance and oversight. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 11 January 2022. During this inspection the provider demonstrated that improvements have not been made. The service remains rated as inadequate overall. This service remains in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. We have reported our concerns to the Local Authority safeguarding team. The provider has not taken action to mitigate risks to people.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risks associated with people’s care, safeguarding people against neglect and the management of medicines. We identified breaches in relation to care not being planned and provided around people’s needs and wishes and there was a lack of robust oversight of the quality of care and responding and acting on complaints.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Pinnacle Brit provides personal care and support to older people and people with disabilities living in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. At the time of our inspection all 40 people supported by the service received personal care.

People’s experience of using this service and what we found

People's medicines were not being managed in a safe way which put people at risk. Staff were not trained or assessed as safe to administer medicines to people. Accidents and incidents were not always reported, and actions were not always taken to reduce reoccurrence of them.

Good infection control was not always being followed and assessments of the risks associated with people were not always assessed. The provider had not ensured that there was sufficient organisation of the staff rotas and we found that staff were at times late for calls and did not always stay for the duration of the call.

The provider and staff were not following procedures that related to safeguarding people from the risk of abuse or neglect. The recruitment of staff was not robust which put people at risk. Staff were not sufficiently trained or supervised to ensure that they were competent to carry out their role. There was a lack of understanding of the Mental Capacity Act and its principles. Where people's capacity to make specific decisions was in doubt there was no assessments undertaken by the provider.

Prior to people receiving care there was a lack of assessment of their needs. People's care was not provided in a consistent way. Care plans lacked detail and guidance for staff and information about people's backgrounds, interests and things that were important to them. Where people were being cared for at the end of their lives there was no care planning in place around this.

Where people and relatives complained about their care, this was not recorded, and insufficient actions were taking place to address their complaints. There were no systems in place to assess the quality of the care being provided. Notifications that are required to be sent to the CQC were not always being done.

There were people and relatives that told us that they felt safe with staff and there were some relatives that felt staff developed good relationships with their loved ones. Staff fed back they felt supported by the leadership.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 24 December 2020) and there were three breaches of regulation. We only looked at the Safe, Responsive and Well-Led domains at this inspection as we had concerns around these areas. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we looked at all of the domains and we found improvements had not been made and the provider remained in breach of regulations and further regulations had been breached.

Why we inspected

The inspection was prompted in part due to concerns received about the care and support people received and the way the service was managed. We decided to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive, and Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinnacle Brit on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risks related to lack of robust systems in place to ensure staff arrived at the call and stayed for the duration, safe care being provided to people, and lack of detailed care planning. Breaches were also in relation to staff training and supervision of staff, a lack of understanding of the Mental Capacity Act (MCA) and the lack of robust provider and management quality assurance at this inspection

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect in six months and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Pinnacle Brit is a domiciliary care agency. It is registered to provide personal care to both younger and older people, some with disabilities and dementia living in their own homes. At the time of our inspection the service was providing care to 37 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Where there were risks to people’s safety and wellbeing, most of these, but not all, had been assessed. However, risk assessments did not always include a risk management plan or guidance for staff to follow to help ensure they understood the person’s condition and knew how to meet their needs.

Whilst we found some important guidance for staff was missing, people's care plans set out the care tasks they required help with, and these contained some personalised information about people and their preferences for how they liked to be supported.

There were systems and protocols in place to monitor the quality of the service provided. However, feedback from people and relatives was sometimes negative about time keeping, length of time spent during the call and consistency of care workers. The provider had recently installed an electronic system to monitor care workers attendance at calls, but more time was required for the new system to embed and become fully effective.

Notwithstanding the above, we also received some positive feedback from people and their relatives about the service, and people told us they generally felt safe and well cared for.

The provider undertook spot checks, visits to people and sought feedback from them and their relatives. They addressed concerns and worked with the staff team to develop the service. People and staff knew how to raise any concerns they had with the registered manager and felt they would be listened to.

The registered manager and senior staff were responsive to and worked in partnership with health and social care professionals for people's’ well-being.

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

This service was registered with us on 13 February 2020 and this was the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the care and support people received and the way the service was managed. We decided to inspect and examine those risks. This focused inspection which included the key questions of safe, responsive and well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to person centred care, safe care and treatment and good governance at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.