Pacific Care Services Limited

On this page

• 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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question requires improvement. At this inspection, the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. One staff member said,” The culture of the service is supportive and open. There is a strong emphasis on teamwork and maintaining high standards of care. If there is ever a problem, I feel comfortable discussing it with my management team. They never judge me and always listen to my concerns. They work with me to resolve any issues in a constructive and supportive manner. I truly appreciate this agency.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness and honesty.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Partners had experienced an open and helpful approach from the provider when requesting any updates regarding concerns or incidents. The culture was open, and the registered manager welcomed suggestions.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff with a range of backgrounds and needs were well supported by a leadership team who understood the benefits and challenges of supporting a demographic of people for whom English was not their first language.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. The registered manager and nominated individual were open about the journey they had been on to improve the service. They were able to demonstrate a range of these improvements. There was an improved schedule of quality assurance systems in place to support the management team review and assess the service delivery. This included auditing medication, infection control, care plans, health and safety and accidents and incidents. Staff felt included and well supported on this journey. Auditing still required improvement. Whilst the registered manager and deputy had a good grasp on any immediate and emerging issues, they were not yet in a routine of analysing across incidents for trends and patterns. The registered manager recognised this and was committed to implementing a more effective system to suitably assess, monitor and improve of the quality of the service.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. One professional told us they had worked closely with the agency with a person who required frequent hospital admissions. They said,” I have always dealt with [manager], and they have always been very supportive and proactive in ensuring timely discharges back home for this client. [Manager] has also liaised with the wards to get updates so they can restart the client’s care package preventing the client remaining in hospital any longer than is required.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. They actively contributed to safe, effective practice and research.