PLL Care Services

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified three breaches of the legal regulations. During our last inspection we found there was a breach of person centred care, and safe care and treatment. The provider had not made enough improvement and were still in breach of these regulations and were in further breach of consent to care and treatment. The systems and processes in place did not always ensure people’s care plans and assessments were up to date. Risk assessments did not allow for safe effective care, and people were not receiving the full time specified within their care plan. Staff were not given sufficient personalised, proactive guidance on how to support people. The provider did not follow guidance around best practice for people with limited capacity. However, people’s relatives felt communication with the office had improved.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke with told us they receive calls from the office to check on things. Some people told us they had received a thorough assessment before care started. However, people also told us that the service did not always take peoples preferences into account when designing and or delivering care. One relative of someone using the service told us “In the meeting it was really what they wanted to put in.”

Staff felt some positive changes around assessing people’s needs had been implemented. Staff we spoke to felt peoples care plans contained the information they needed. However, when care was discussed in further detail, aspects of what staff informed us about was not included within care plans or assessments.

Although some improvements had been made around information available within care plans, the systems and processes did not always ensure people’s care plans and assessments were up to date. Whilst assessments considered a range of needs and contained some helpful information that was personalised, this was often lost in extraneous, out of date, and at times, inaccurate information that masked the key information staff needed to understand how to meet people’s needs. People were not receiving the full time specified within their care plan, and risks were not consistently identified. People who were diabetic had no guidance, care plans or risk assessments in place about preparing appropriate food. People who required hoisting had no guidance. Information had been copied from other care plans, not relevant to individuals. Documentation around people’s impairments, equipment, continence, medicines, communication needs, personal care and risks were inconsistent and did not contain guidance for staff to assess people needs. For 1 person who required support with seizures, their behaviour care plan detailed behaviours that were consistent with having a seizure. The provider had not recognised this. This did not allow for safe effective care. Staff were not being given sufficient personalised, proactive guidance on how to support people in a meaningful way. This placed people at risk of not receiving effective care and was a continued breach of person centred care and safe care and treatment.

People were involved in care planning, “They [office] ring me up to check what is going on and if I need to change things, they do that quite often.” However, we heard “We do the care planning meetings, but I do still find them a bit pushy about things though.”

Staff told us how they best supported people and knew what was important and mattered to them. However, staff were not always aware of best legislation and good practice when asked questions about how they would support people with specific needs.

The provider did not deliver care in line with national guidance and evidence-based practice. For example, risk assessments were not in place for people who had choking risks, bedrails, and equipment. Records were not updated consistently and contained conflicting information. For 1 person water temperature was not being recorded, and their fluids were not being recorded as detailed within the care plan. People who required support to manage their catheter had no supporting documentation. For people who had Waterlow assessments in place, there was no strategy or guidance for staff to manage this risk. There was limited guidance or information available for staff to know how to best support people who were unable to verbalise their needs. 1 person was at increased risk of choking, there was no risk assessment in place, speech and language therapy assessments or guidance for staff to follow. Training records did not evidence all staff had received training for nutrition and hydration. This placed some people at increased risk of choking. This placed people at risk of not receiving evidence-based care and treatment and was a continued breach of safe care and treatment.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People’s relatives told us they felt involved in peoples care, people had choice. We heard “They [relative] get to choose what they want to do in the day, if they don’t want breakfast till 10 o’clock, that’s fine, they choose their own meals and get a choice of what they do in the day.”

Staff were aware of their responsibilities to protect people’s rights, obtain consent for care and treatment and how to support people to express their choices. However, staff felt further training around dementia care would be useful. The Registered Managers understanding of their role and responsibility regarding consent and people’s ability to consent was not consistent with legislative guidance.

The provider had clear policies and procedures in place which detailed how to support and assess capacity, including the requirement for a mandatory checklist from the Mental Capacity Act (MCA). However, we were not assured these were being used. People using the service had no best interests’ decisions or capacity assessments in place. Care notes detailed consent had been obtained, however there was no explanation about how this was gained. Care plans did not document people’s capacity and ability to consent. We did not always see evidence in place for relatives to consent on behalf of people. Documentation in place for Lasting Power of Attorney (LPA) was not sufficient. The service’s auditing process stated all people had capacity assessments in place, however we did not see any evidence of this. This placed people at risk of not receiving effective care and was a breach of consent to care and treatment.