Protective Care Group Limited

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• 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

Systems were in place to protect people from the risk of harm and abuse. Staff used various strategies to support people to make decisions about their lives and manage their personal risks. Risk assessments and care records were completed to provide staff with the information they needed to promote people's safety, independence and health and well-being. There was a culture of learning from incidents and gaining support from key health care professionals. We assessed that the provider was delivering care using best practice for supporting people with a learning disability and autistim. Comprehensive recruitment and training systems were used to ensure people were supported by competent staff who were of good character. The provider had an effective approach to assess and manage people's medicines and prevent the spread of infection.

This service scored 72 (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 promoted a culture of learning through reflection and structured conversations with staff. Systems were in place for accidents and incidents to be reported, recorded and reviewed by the registered manager and relevant funding authorities. Actions had been taken when shortfalls had been identified in the management of incidents. For example, further record/report training had been delivered when it had been identified that incident reports had not fully reflected the events leading up to, during and after the incidents. Appraisal of the incident reports by the registered manager demonstrated that additional training had been embedded in staff practices.

Staff we spoke with told us there was a positive learning culture and that staff were supported after any incidents. Staff felt there was an open and transparent culture across the service and they could confidently raise concerns Staff were given opportunities to debrief, identify good practice and areas that needed further improvement to help prevent future incidents. One staff member said "After an incident we debrief with staff and [managers name]. They come in next day and debriefs everyone, we look at what happened, make sure everyone is ok. " The registered manager encouraged staff and people to raise concerns and the local regional managers and seniors were accessible and provided support and direction as required. They stated they had seen an improvement in the management and recording of incidents.

Relatives were assured that any accidents or incidents relating to their family member where investigated thoroughly and reflected on. They felt communication from the service was good and they were involved in any decision making or changes to the way people were supported. Relatives felt staff and managers listened to their concerns to help achieve positive outcomes for people.

Most staff reported that they had the information and knowledge they needed to help people transfer into the service smoothly. Two staff reported there was good partnership working with families and professionals. The registered manager emphasised the importance of working with people with complex needs and their families to understand people's needs, backgrounds and preference to ensure safe transitions into the service. People's possible and ongoing risks when transferring in and out of the service were identified and planned for to ensure continuity of care. Staff and managers said they had developed a good working relationships with key professionals to ensure people's needs were known and reveiwed as needed.

Processes and policies were designed to ensure information about people's needs were effectively communicated between key partners to help people to smoothly transitioned in and out of the service. For one person, a robust transition framework had been established which identified the person's communication and emotional needs when moving into their new home. Prior to the move, the person's risk and possible strategies were discussed with all key partners including their family to support and prepare the person for their new home and way of living. This way of working was underpinned by evidence based best practice for people with a learning disability and/or autism

Relatives were assured that managers and staff worked with them and relevant health and social care professionals to ensure there were safe systems of care when people moved into the service. They said staff monitored people's ongoing needs and raised any concerns in a timely manner to the appropriate professionals.

We attempted to contact the provider's partners who were involved in people’s care journey to establish if the provider had maintained safe systems of care which was managed and monitored safely. We did not receive any feedback from the provider's partners, however other evidence categories assured the commission that the provider actively engaged with relevant professionals to seek support in a timely manner and implemented their recommendations.

The provider had effective safeguarding processes in place to ensure people live a life of their choice which was free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. We raised with the registered manager that the provider's safeguarding related policies would benefit from having the contact details of all the funding local authorities who commissioned the service. This would ensure staff had the contact details of the appropriate funding authority, if they needed to raise safeguarding concern. The registered manager stated as part of their governance improvement plans, they would be reviewing all of the provider's policies. The provider had ensured staff had been trained in safeguarding children and adults and were aware of their role to report concerns quickly. Two designated safeguarding leads within the service helped to support staff and manage safeguarding concerns.

Staff received safeguarding training and were confident in recognising and reporting abuse and they knew how to apply it. They were aware of the provider’s safeguarding policies and procedures which were reinforced during team meetings and supervisions. Staff were confident that managers would investigate any concerns and inform the appropriate agencies.

Relatives were assured that their family members were safe living in their home and were supported by staff who were kind and trained to support people with complex needs. They felt the approach of staff was person-centred and tailored to meet the individual needs of people.

Staff had the information they needed to support and manage people who receive the regulated activity of personal care to safely manage their risks. Staff confirmed people's care records and risk assessments were reviewed regularly to enable a balance approach to support people to live a life of their choice and free from unwarranted restrictions. The strategies used to support people in a consistent and safe manner were assessed and continually reviewed. Staff said people's care records helped them to identify and report any emerging risks such as changes in people’s emotional well-being. Staff were aware of the personalised strategies required to support people to help them regulate their emotions and behaviours.

Systems were in place to assess, monitor, review and manage people's risks safely. People’s care plan included ways to identify changes in their well-being and emotions and how to avoid or minimise the need for restricting their freedom. The provider's systems including staff training and policies supported a proportionate and lawful approach when imposing restrictions on people. The values and policies of the service were underpinned with the practice of only using 'as required ' medicines and restraint as the last resort. Effective open debriefing and communication systems were used after each incident or changes in people's needs. This ensured people and staff were supported as needed and information about people's changing needs and strategies to support them were shared. The provider stated they were committed to be open and transparent and informed stakeholders of people's incidents and risk management plans. The provider's policies underpinned by best practice guidance in supporting people to live a fulfilled life of their choice and to consider people's diverse needs and human rights at all times.

A relative said staff knew people well and were aware of events and situations which may result in their family member becoming distressed. They explained staff had recognised that they [the relative] were the 'expert' in their family member and had approached them for advice on how best to support their family member to move into their new home. They said, "They [the staff] listened to me, I gave them what they wanted to know, how to progress it, they planned it, and it worked well." The relative was assured staff had a balanced approach in assessing people's risks but also helped people to progress and respect their choices. People were supported to maintain their physical health and well-being. Where changes in people's needs were identified, appropriate referrals were made to health services in a timely manner.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives were assured that people were supported with enough staff who had been safely recruited and had the skills to support their family member.

At our last inspection the provider had failed to safely recruit new staff. This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvement had been made at this assessment and the provider was no longer in breach of regulation 19. Since our last inspection the provider had reveiwed and enhanced their human resources and recruitment systems to ensure staff were safely vetted before they supported people. Training systems were in place to monitor the training needs of staff. Staff received regular supervisions, however records did not always demonstrate outcomes of support meetings and it was not clear if development and support outcomes had been actioned. The registered manager acknowledged our feedback and started to resource line management supervision training for key staff members.

Staff reported that they had been safely recruited and inducted in their role to support people. Staff felt supported and trained in their role and were given opportunities to further develop. They had received regular supervisions and felt they could approach senior staff and leaders if they had any concerns. Enough staff had been recruited to provide an established and consistent team to support people. However, not all staff were confident in the provider's systems to manage unplanned staff absences; as this had occasionally put pressure on staff to stay on shift until another staff member could deployed to cover the shift.

Relatives confirmed staff adhered to good infection control practices. Appropriate personal protective equipment was available and worn when supporting people with their personal hygiene needs.

Staff told us they had access to personal protective equipment and wore it in line with best practices. Staff had been trained in safe infection control practices and had access to the provider's infection control policies. The registered manager stated they were committed to prevent and maintain good infection control across the service and reduce the risk of the spread of infection.

We reviewed the provider's infection control policies and found they did not always reflect current government guidance. The provider's infection control audits had not been fully embedded in each household to ensure the cleanliness of people's homes was maintained and monitored. We found no impact on people as staff supported people safely to reduce the risk of spread of infection. The registered manager was responsive to our feedback and agreed to review all infection control policies and to fully implement the provider's infection control audits to ensure staff had the guidance they needed to prevent and manage an infection outbreak.

The management and administration of people's medicines were monitored by people's staff team and the regional manager to ensure people received their medicines as prescribed. External scrutiny systems had been used to support the registered manager to monitor the management of people's medicines. Whilst we found no impact on people; we identified that the processes to record people's prescriptions and daily stock balance on medicines charts needed to be strengthened to help prevent medicines errors. The registered manager was responsive to our feedback and immediately addressed our concerns with the staff teams and regional managers. The provider was committed to reduce the need for people to receive excessive and inappropriate medicines. They understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured that people’s medicines were reviewed by prescribers in line with these principles.

Relatives confirmed people received their prescribed medicines as required and had no concerns about the management of people's medicines.

Staff told us they had received medicines management training before they started to administer people's medicines. They were confident in safe medicines management practices and the recording of people's medicines. Staff confirmed 'as required' protocols and medicines records were in place to direct staff in the personalised management of people's medicines. The administration of 'as required' medicines were considered as part of incidents reviews and debriefs.