Prudent Domiciliary Care Limited (PBG)

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

At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We found there had been improvements around the management of risk, but we still found some concerns. We found 2 continued breaches of regulation around the management of risk and staff not always attending calls at a time when people needed.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they would feel confident staff would manage incidents well. However, we found lessons were not always learnt to continually identify and embed good practice. Staff were able to describe how they supported people when they had incidents. However, where incidents were recorded, there was a lack analysis and evidence of any learning from these. For example, where people had fallen, there was no information on whether a falls risk assessment had taken place as a result and or what guidance staff had been given to reduce further risks.

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.

People were protected from the risk of abuse and neglect. People told us they felt safe and well cared for by staff. Relatives said they felt assured by the staff attending to their loved ones. Comments included, “I feel very safe, the way they approach and talk to you” and “I feel safe they have given [family member] a nice wash.” The manager was now investigating all allegations of abuse and reporting to the local authority. However, there was a lack of information on the outcomes of the investigations, or any lessons learned from these. Staff understood what they needed to do to protect people from the risk of abuse. Staff received safeguarding training and there was a whistleblowing policy that staff could access.

The provider and registered manager did not always work well with people to understand and manage risks. Where risk assessments were in place for people, these at times lacked detailed guidance for staff on how best to manage the risk. For example, 1 person’s risk around choking had increased yet there was limited guidance for staff on to best to support them. Where people’s health conditions were recorded, the guidance on this was generic and not specific to the person or how this affected them. Where people were at risk of malnutrition and dehydration, staff were not always recording how much people had eaten or drunk. People however felt staff understood the risks associated with their care. Staff told us they understood how to manage people’s care in a safe way. Staff described how they would assist people with moving and handling, how to reduce the risk of people developing pressure sores and how to assist people at risk of choking. One member of staff told us, “Sometimes we have bedbound clients, when we notice sores we will clean it, apply [cream], let the family member know, let office know, record and arrange the community nurse to come out.”

The service did not always assess for potential risks in people’s homes. Where people smoked, there was a lack of guidance for staff on how to reduce the risks associated with this. The registered manager told us they had taken action to address this. However, we did see other environmental risk assessments were undertaken to prevent the risks of trips and falls.

The service did not work together well to provide care that met people’s individual needs. Although people and their relatives told us staff would always attend their call and would stay for the duration, they had concerns around the timing of the care calls. They told us the timings of calls would change frequently so they did not always know day to day when staff were due. Comments included, “The only thing we find difficult is the different times, half eight or nearly ten in the morning and it does regulate your life” and “They don’t turn up on time and if you’ve got an appointment and they’re running late you miss it.” We saw from the electronic call monitoring there were no missed calls however we saw the arrival times of calls would frequently change. This meant people would not always be able to plan their day effectively. The service did not always make sure there were enough qualified, skilled and experienced staff. Whilst we saw staff had received all of their induction, mandatory training and supervisions, staff fed back the inductions could be improved upon. One member of staff told us, “[The induction] could be more in depth.” People told us newly recruited staff could receive more training. The provider operated effective and safe recruitment practices when employing new staff.

The service did not always assess or manage the risk of infection. People and relatives told us that not all staff attending their calls would wear appropriate personal protective equipment (PPE). One relative said, “[Member of staff] doesn’t bother with an apron.” This placed people at risk of infections. Other people and relatives said staff always adhered to good infection control. One person told us, “They [staff] wash their hands before they start and when they finish.” All staff had received training in infection control and staff had sufficient PPE. There were sufficient additional stocks of PPE in the office for staff. One member of staff said, “We did online and face to face training, how to wash hands, sanitise hands if you have to, also infection prevention.”

Whilst people told us, where needed, they were supported with their medicines, we found the management of medicines was not as robust as needed. We found staff were not always recording when they had prompted people to take their medicines. The registered manager took action to address this. There was also some guidance missing for staff on how staff needed to support people with medicines including times people needed their medicine. Staff told us they received training on administering medicines and were saw they were competency assessed to do so.