Prudent Domiciliary Care Limited (PBG)

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found a breach of legal regulation in good governance. The provider recently recognised significant issues with planning and delivery of the care visits, but they failed to implement effective contingency plans to minimise risks to people. The governance systems used in the service did not always enable the provider to have a good oversight of the quality and safety of people’s care after the service started supporting increased numbers of people in the local communities and the issues were recognised. The provider’s systems failed to address the improvement needs effectively. The governance systems in the service were under review at the time of the assessment. Staff and management team shared a common vision and values for the service, but people’s actual experience was different as it was affected by the shortfalls around quality and timeliness of their care. The service had a registered manager and management team which were supporting the care staff team. Staff told us the management were overall approachable, but communication was not always responded to timely which could be improved.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although staff and leaders could explain the vision and values of how the service should operate to provide quality care, this was not always reflected in day-to-day operations of the service. People and their representatives told us about their negative experience when communicating with the senior staff and lack of response from the provider when they had raised concerns. Staff told us they had regular opportunities to communicate with the management, but there was work to be done on improving the responsiveness of that communication. For example, staff told us they did not always receive a response from the office when they contacted for help and support.

The provider had clearly identified vision and values, but these were not always reflected in people’s experience of care provided by the service. There were systems in place to communicate regularly with staff and to discuss team culture, but identified issues affecting people’s quality of care were not remedied in a timely way.

Leaders of the service failed to effectively investigate and address issues with care visits planning, people’s feedback about their negative experiences and staff feedback about challenges they came across. This impacted on people’s experience of their care and support and put them at risk of receiving poor care. Staff told us overall the senior staff were supportive and available when they needed them but there were some issues with communication. Staff commented, “Sometimes yes (the management team respond to a call), sometimes no. Sometimes when you really need someone in the office you can’t get through. You sent a message and sometimes they don’t get back, sometimes they do”, “They are approachable in the office, sometimes they don’t have time. Sometimes they tell you they will call you, and they don’t” and “The office staff are supportive. If I phone them, they always respond.”, “We have an emergency contact. [The management team] will let us know what to do (if support is needed by staff).”

The provider had systems and processes in place for staff to seek support from managers when out in the community, supporting people. However, these systems were not always effective in addressing issues affecting people’s care promptly and supporting staff to be able to recognise and address such concerns. There was an out of hours on call system in place and office staff were available for care staff within the working hours. The management team visited people’s homes when care was provided to observe staff practice. The office was open for staff to visit and discuss any support or resources needs. There were systems and processes to support staff around their employment and any personal circumstances. However, staff told us they did not always receive response from the service’s office when they needed support. People and their representatives told us their concerns and queries were not always addressed by the management and sometimes they were not happy with the manner which the management communicated with them.

Some staff felt comfortable raising concerns or suggestions, but others commented their concerns and views were not always listened to and issues they had raised had not been resolved impacting on their ability to provide safe and timely care to people. People and their relatives told us they did not always feel heard when they spoke up and raised concerns.

The provider had a whistleblowing policy in place and guidance for staff on how to raise any concerns. However, not all staff and people feedback around issues and challenges affecting the safety and quality of their care was listened to effectively, for example around issue with timings of the care visits.

Some staff were concerned about how the provider allocated workloads and supported them to be able to fulfil their rosters. Other staff told us they felt the provider was respecting equality, diversity of its workforce and created inclusive working environment. One staff member commented, “My colleagues are amazing people, really caring, respectful to everyone. We come from different places, different races and we have different clients. The company has equal opportunities policy and they do not tolerate any (discriminatory) comments and behaviour. They always protect their carers.”

The provider’s systems and processes to ensure staff’s equality and diversity rights were protected and supported during roster management, care provision and within staff support mechanisms were not always used effectively. For example, staff told us their roster allocation was unmanageable at times and this had not been resolved despite them raising issues with the management. The registered manager could explain how they ensured the recruitment, staff management and training was undertaken to avoid discrimination and to support equal opportunities for all staff.

Governance was inadequate. Although the registered manager and senior staff were aware of some challenges and issues which needed addressing in the service, there was a delay in the management team realising the extent of the issues around rostering. The actions taken to address these shortfalls were not effective which impacted on the quality of people’s care. Senior staff we spoke with was not always aware of the significance of the shortfalls and risks to people. For example, we were told there were no complaints or unresolved challenges around care visits timings and the quality of the care provided. The planned review of governance systems to improve management oversight was not implemented at the time of the assessment.

The provider had governance systems and processes in place, but they were not effective in recognising and addressing shortfalls in the service in a timely way which made them inadequate. For example, although staff training was monitored, there was limited assurance on how multiple gaps in training for some staff were being addressed by the provider. Care visits times were monitored but there was a lack of structured approach to identifying and actioning any issues and their impact on people. The provider had identified issues with care visits lateness. Although some action was taken to improve care visit timeliness and rostering, this was not yet fully completed, so people’s care was still negatively affected. The shortfalls in governance put people at risk of receiving substandard care and at the risk of avoidable harm if their care was not effectively meeting their needs. This was a breach of regulation in good governance.

People and their relatives told us overall staff worked in partnership with them to plan and organise people’s care and staff would support people to contact healthcare or social care services when needed for better coordination of their care. However, we were also told that some aspects of people’s care were negatively affected by the shortfalls in roster planning and implementation, for example, around ensuring people’s care was provided as agreed, any changes were effectively managed and escalated or in relation to transitions in care.

Staff told us they knew when to report any changes to the office and senior staff would take action to support people to access other health and social care services or to communicate with people’s relatives when needed. Senior staff knew how to prepare and submit referrals to the local healthcare and social care services. However, the communication issues with the office raised by staff, as well as delays and inconsistencies in care visits and roster management put people at risk of these processes being delayed impacting on their experience of their care. The registered manager explained how they established and maintained links with local health and social care services. However, we received feedback of not all issues being flagged with relevant partners where needed to ensure people had positive experience of their care.

The local social services were not made aware by the provider of the shortfalls in care provision as required prior to the assessment. The provider and registered manager had not shared the risks and challenges relating to people’s care, and had continued to accept new packages despite knowing they were not meeting the needs of the people they currently supported.

The provider had systems and process in place around involving people’s representatives in care provision and planning, seeking feedback from them and working with local partners but these were not used effectively. The initial assessment process was used by senior staff to assess people’s care needs and gather relevant information from partners before the service started to support the individual. However, people and their representatives told us their wishes, preferences and requests were not always considered and followed in how they received their care. Senior staff were aware of how to make referrals to other services and people’s records showed this was completed when required, for example, people were referred to occupational health or community nursing services.

Staff told us the roster planning improvements had not yet been fully implemented and the responsiveness of communication between staff team and management team could be better. However, staff also commented some improvements were underway. One staff member said, “It improves every day, whenever you raise concerns, it improves (further) every day.” However, not all required improvements were actioned timely and effectively, so people’s experience of their care continued to be negatively affected. Despite the provider’s assurances on actions taken to address the identified at the time of the site visit shortfalls, we continued to receive concerns about the service in relation to the same issues, such as inconsistencies in care visits and poor communication.

The provider was aware of some of the shortfalls in the service quality and safety but failed to take effective and timely action to ensure people received good and safe care at the time of the assessment. Improvement priorities were broadly discussed in staff meetings. However, there was a lack of structured approach to action planning with clear allocations of tasks, timeframes being identified for completion of the actions and ongoing monitoring of the effectiveness of improvements being implemented. The contingency plans in place were not fully and effectively addressing shortfalls to minimise impact on people.