Personal Assistant Services North achieved an overall Good rating at its July 2019 inspection, with strengths in person-centred care, staff commitment, and multi-agency working for people with learning disabilities. The Well-Led domain was rated Requires Improvement due to weak governance systems, absent medicine audits, a failure to notify CQC of one safeguarding incident, and no end-of-life care planning.
Concerns (6)
critical
Incident learning
: “We found one safeguarding incident had occurred in the service which we had not been notified of. The service had notified other relevant parties but had omitted to notify us.”
moderateGovernance: “improvements, and actions from the audits, did not feed in to an overall action plan for the service. This meant it was hard to establish and monitor what actions needed to take place, by who, and when.”
moderateMedication management: “Audits of medicines were not regularly taking place... The service was not regularly carrying out competency checks.”
minorEnd-of-life care: “The service had not discussed or planned for end of life care. There were no records of people's wishes and views on this subject.”
minorRecord keeping: “systems did not easily support the 'live' updating of care plans as two separate paper copies...were being used and this increased the risk of potential errors.”
minorStaffing levels: “Recent changes within the staff team meant at times the service had to use agency staff...some staff felt at times this had placed an additional pressure on them.”
Strengths
· Staff were kind, caring and committed, many having worked at the service for several years ensuring continuity for people with learning disabilities.
· Staff worked proactively with health and social care professionals including occupational therapists and nurses to deliver best-practice support.
· People received highly personalised, person-centred care with regularly updated care plans and tailored communication strategies.
· Strong safeguarding culture with staff empowered to report concerns directly to the Local Authority.
· Service promoted independence, community engagement, and social inclusion in line with Registering the Right Support principles.
Quality-Statement breakdown (22)
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough; supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships; support to follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Continuous learning and improving care; working in partnership with othersGood
Independence Matters C.I.C. Personal Assistant Services North was rated Good across all five key questions at its announced inspection on 26 September 2016. The single area requiring improvement was the absence of completed mental capacity assessments, though the provider had recently created a policy and was taking action to address this.
Concerns (1)
moderateConsent / capacity: “in the absence of mental capacity assessments, it was not clear how the level of people's mental capacity was assessed or how they were supported in making decisions.”
Strengths
· Comprehensive pre-employment checks ensuring only suitable staff were employed
· Sufficient staffing levels with effective matching of staff skills and personalities to individual people's needs
· Staff were well trained, including mandatory and person-specific training, with mentoring and shadowing for new starters
· Regular supervision (at least three-monthly) and annual appraisals in place for all staff
· Detailed, person-centred care plans providing clear guidance to ensure consistent care