P & E Care Limited was rated Requires Improvement overall, with a breach of Regulation 12 due to inadequate risk assessments and insufficient guidance for staff on managing identified risks, including PRN medicines. Whilst the service demonstrated strengths in staffing, safeguarding, staff training, caring practice and responsiveness, governance systems failed to identify key gaps in risk documentation, undermining the safety and well-led ratings.
Concerns (4)
criticalCare planning: “risks to people were not always adequately assessed and there was not always detailed guidance in place for staff on how they should manage identified risk safely”
moderateMedication management: “there was no guidance for staff on the circumstances in which administration may be required, the maximum dose, or the frequency at which the medicine could be safely administered”
moderateGovernance: “the provider's audits had not identified the issues we found at this inspection in regard to information that was missing from one person's environmental risk assessment”
moderateRecord keeping: “action was not always promptly taken to ensure people's care plans and risk assessments were updated where their conditions had deteriorated”
Strengths
· Sufficient staff deployed to meet people's needs with adequate travel time between visits
· Safe recruitment practices followed including DBS checks, references and right to work verification
· Staff received safeguarding training and were aware of whistleblowing procedures
· Regular staff supervision, annual appraisals and mandatory training including Care Certificate for new staff
· People treated with dignity, respect and kindness; privacy maintained during personal care
Quality-Statement breakdown (21)
safe: Risk assessment and managementRequires improvement
safe: Medicines managementRequires improvement
safe: Staffing levels and visit timingsGood
safe: Safe recruitment practicesGood
safe: SafeguardingGood
safe: Infection controlGood
safe: Incident and accident managementGood
effective: Staff induction, training and supervisionGood
effective: Mental Capacity Act compliance and consentGood
effective: Nutrition and hydration supportGood
effective: Healthcare access and multi-agency workingGood
caring: Kindness and compassionGood
caring: Dignity, privacy and respectGood
caring: Involvement in care decisions and independenceGood
responsive: Person-centred care planningGood
responsive: Complaints handlingGood
responsive: Cultural and accessibility needsGood
well-led: Governance and audit effectivenessRequires improvement
well-led: Leadership and management cultureGood
well-led: People's feedback and quality assuranceGood
well-led: Regulatory compliance and notificationsGood
P & E Care Limited, a domiciliary care service in Bromley, was rated Requires Improvement overall at its first inspection in June 2017, with Safe and Well-Led requiring improvement due to gaps in medicines administration records, inadequate travel-time rostering, poor out-of-hours call logging, and audit failures to detect the medicines recording issue. Effective, Caring, and Responsive were all rated Good, reflecting well-trained, respectful staff, person-centred care plans, and a responsive complaints process.
Concerns (5)
moderateMedication management: “medicines administration record (MAR) and medicines care plans did not include information about this prescribed medicine, the dose required and the frequency of administration.”
moderateRecord keeping: “provider had not kept records to monitor the nature of out of hour's calls to see if there was any pattern and to improve the quality of the services people received.”
moderateGovernance: “provider's quality audit had not picked the concerns we identified in relation to one person being administered a weekly pain relief patches by staff member.”
moderateMissed or late visits: “office staff had not always allowed enough time for staff to travel between calls when taking into consideration the distance between two home visits, the mode of transport.”
minorGovernance: “no communication record to show that the office staff had informed people when staff were running late to their scheduled home visits and this required improvement.”
Strengths
· People and relatives felt safe with staff and reported staff treated them well
· Satisfactory DBS and background checks carried out before staff started working
· Staff completed safeguarding training and understood how to report concerns
· Risk assessments completed for every person and regularly reviewed
· Accidents and incidents system in place to reduce recurrence
P & E Care Limited improved from Requires Improvement to Good overall at this July 2019 inspection, having remediated previous breaches around risk assessment and governance audits. All five key questions were rated Good, with people reporting safe, person-centred care delivered by consistent, well-supported staff.
Strengths
· Risks comprehensively assessed with clear staff guidance; previous breach of Regulation 12 fully remediated.
· Medicines managed safely with PRN guidance on MARs and competency-assessed staff.
· Sufficient staffing with no missed visits reported; safe recruitment practices followed.
· Staff supported through induction, Care Certificate, regular supervision and annual appraisal.
· People involved in care planning; care plans person-centred and reflective of individual needs and preferences.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
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
caring: Person-centred care and involvement
Good
caring: Dignity, privacy and independenceGood
responsive: Care planning and reviewGood
responsive: Complaints handlingGood
well-led: Record keepingRequires improvement
well-led: Governance and audit effectivenessRequires improvement
well-led: Leadership and cultureGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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 control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Continuous learning and improving careGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood