PLL Care Services

On this page

• 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

We identified two breaches of the legal regulations. During our last inspection, we found there was a breach of safe care and treatment and fit and proper persons employed. The provider had not made enough improvement and were still in breach of these regulations. Staff did not always know how to report concerns externally and did not consistently protect people from abuse and improper treatment. The provider did not always identify allegations of abuse or make referrals in line with policy. The provider did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were incomplete and did not include risks we identified during our assessment. People did not always have sufficient care plans to guide safe practice. Not all staff were trained to provide safe care and did not have the relevant employment checks in place. Medicines were not always managed safely. However, there were enough staff to ensure people’s safety and meet the people’s needs. People’s relatives felt their loved ones were safe.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives felt their loves ones were safe. One relative stated “Oh [relative] is safe with them and they [carers] are very clean and tidy” and, “I am sure [relative] is safe with them, they all seem to know what to do.” However, we could not be assured that people received safe care due to staff not having access to correct up to date information about peoples risks and needs.

Staff were aware of safeguarding risks associated with people’s care. However, not all staff were able to demonstrate how they would keep people safe. Staff reported concerns to the registered manager but felt concerns could be taken personally. The safeguarding policy did not include all local authorities that the provider worked with, and guidance was not always on clear on what action staff could take when raising a safeguarding. Not all staff knew how they would report concerns externally.

Not all staff had received training in relation to safeguarding adults from abuse. Safeguarding processes and policies were not always followed. We found CQC were not always notified by the service where referrals had been made by services. The provider had not always contacted the safeguarding team or taken appropriate action following allegations of abuse.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 we spoke to felt there were enough well-trained staff, and communication around late visits was good.

Staff confirmed they had attended refresher courses, or watched videos of how to use equipment, followed by demonstrations during people’s visits. Staff we spoke to felt there were enough staff available to support the number of people using the service. However, staff were concerned if the service took on more clients “[The Registered Manager] would behave the way they used to.” Staff were concerned about their current working hours and welfare.

Not all staff were trained to carry out care. The services training matrix did not contain all the relevant training required to support people using the service. Recruitment procedures were not operated effectively to ensure persons employed met the conditions in Schedule 3 of the Health and Social Care Act 2008. This states certain information must be obtained in respect of people employed. Required recruitment checks such as DBS referrals and references were not available or had been made some time after employment. The Registered Manger told us, some staff had remained on a 20-hour part time contract and had obtained a sponsorship licence from other providers. There was no information in place regarding part time working, staff were working over the 20 hours and were not aware the service no longer had a sponsorship license.

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

People felt their relatives’ medicines were managed well by the service. We heard “They do the medicines and that’s all fine, I really have no worries, they have been spot on.” However, we also heard “They do the medicines alright” and “The only time it was missed was a couple of weeks ago when some pills were left in the bottom.” This was not documented within the services incidents or accidents. There was limited oversight available to monitor missed medicines or action taken.

Staff felt confident administering and supporting people with their medicines. Staff felt they had enough training to carry out administration of medicines.

Medicines were not always managed safely. The provider had medication administration and auditing policies and procedures in place. However, we were not assured this was always followed. Medication Administration Record (MAR) charts were not updated to reflect guidance from the GP. People were not always given medicine as prescribed. Staff confirmed they followed medicine directions from family and the service around PRNs [medicine taken when required] rather than as intended. PRN medicines were given daily, daily notes did not record why PRN medicine was required. Guidance was not in place for people who required PRN to support psychological wellbeing. People were given, and not given medicines at the direction of family. People were given medicines which were prescribed for others, not the intended person. Staff told us they administered pain relief to people without a MAR chart in place. Where new medicines were prescribed, these had not always been added to the MAR chart. People missed medicines because of this. There was no information about when to give lifesaving medicines, and what seizure activity requires seizure medication, staff were not always aware of when to give these medicines. This placed people at risk of not receiving their medicines or receiving them unsafely and was a continued breach of safe care and treatment.