Precious Homes Bedfordshire demonstrated meaningful improvements across all key questions since its July 2022 inspection, with the caring domain upgraded to Good, but the service remained rated Requires Improvement overall due to ongoing inconsistencies in person-centred care, staff communication skills, record keeping, and governance. No regulatory breaches were found at this inspection, though sustained consistent practice is required before further rating improvements can be achieved.
Concerns (8)
moderateCare planning: “there were still entries that lacked personalised information and read as a list of tasks carried out by staff”
moderatePerson-centred care: “Staff had identified potential goals for people however there was little evidence of people's involvement, progress, or measurable steps to achieve the goals.”
moderateCommunication with families: “mixed feedback about how the provider sought feedback from people and those important to them...Other people told us they were not asked for their feedback.”
moderateStaff training: “Further work was needed to ensure all staff had the skills to communicate with and understand people who had individual ways of communicating such as Makaton”
moderateGovernance: “there was a greater focus on policies and processes, rather than people's lived experience and quality of life...provider's audits still not fully match our inspection findings.”
moderateIncident learning: “staff were not consistently following one person's PBS plan; in terms of when to give medication to manage their distressed behaviours.”
moderateStaff competency: “we did not see any communication aids or signing being used with people during our visits, and daily records made little reference to these too.”
minorRecord keeping: “we found instances of language used by staff that still did not demonstrate best practice. For example, describing people's behaviour as 'aggressive'”
Strengths
· People received kind and compassionate care with positive, respectful interactions observed between staff and people during both unannounced visits.
· Significant improvements in dignity and respect; people's privacy was consistently upheld and environments were clean and well-maintained.
· Improvements in medicines management including enhanced staff knowledge of epilepsy and emergency medication administration.
· Infection prevention and control systems had improved with effective spot checks and cleaning rotas in place.
· Increased staff supervision and team meetings providing regular communication, problem solving and team working.
Quality-Statement breakdown (23)
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff working with other agencies; supporting people to live healthier lives and access healthcareRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
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
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to develop and maintain relationships; support to follow interests and take part in activitiesRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture; engaging and involving people, staff and the publicRequires improvement
well-led: Duty of candour; managers and staff understanding quality, performance, risks and regulatory requirementsGood
well-led: Working in partnership with othersRequires improvement
safe:Insufficient evidence to rateeffective:Insufficient evidence to rate
This targeted inspection of Precious Homes Bedfordshire followed a Warning Notice under Regulation 12 and found improvements across medicines management, infection control, incident recording, and healthcare access. Ratings remain unchanged from the previous 'Requires improvement' judgement as only specific areas of 'Safe' and 'Effective' were reviewed.
Concerns (3)
moderateIncident learning: “Some incidents had not been recorded at all, so there was no information to review and learn from.”
minorRecord keeping: “We did find some records that would have benefited from more detail however, other records showed the management team were making regular checks of incidents”
minorMedication management: “we did find some [PRN protocols] that would benefit from further detail to ensure consistency in how people's medicines were administered”
Strengths
· Action taken to ensure medicines were administered safely and as prescribed, including new personalised medication guidance for each person
· All staff observed wearing face masks correctly; cleaning rotas and spot checks introduced to maintain hygiene standards
· Regular medication audits introduced with follow-up actions and staff retraining after errors
· New health appointment spreadsheet developed to improve oversight of routine healthcare and screening
· Incidents being monitored more closely to identify learning opportunities and improve safety
Quality-Statement breakdown (4)
safe: Using medicines safelyInsufficient evidence to rate
safe: Preventing and controlling infectionInsufficient evidence to rate
safe: Learning lessons when things go wrongInsufficient evidence to rate
effective: Supporting people to live healthier lives, access healthcare services and supportInsufficient evidence to rate
Precious Homes Bedfordshire was downgraded from Good to Requires Improvement overall, with Well-led rated Inadequate due to widespread governance and leadership failings. Inspectors identified breaches across person-centred care, dignity, consent, safe care (medicines, infection control, lessons learnt), governance and staffing, resulting in two warning notices.
Concerns (17)
criticalMedication management: “Medicines were not always managed safely or administered as prescribed.”
criticalMedication management: “We saw medication in one person's flat at 3.30pm, which was due to be given at 2pm.”
criticalInfection control: “The service did not have effective infection, prevention and control measures to keep people safe.”
criticalInfection control: “we found an unacceptable level of dirt, including faeces, in one person's flat and on their duvet cover.”
criticalSafeguarding: “records showed there had been delays in some safeguarding concerns being reported in a timely way; both to us (CQC) and the local authority safeguarding team.”
criticalPerson-centred care: “People did not consistently receive care that supported their needs, aspirations, focused on their quality of life, and followed best practice.”
criticalConsent / capacity: “People were not consistently supported to make decisions in line with current legislation and guidance.”
criticalGovernance: “The provider's systems for checking the culture, quality and safety across the service were not sufficiently robust.”
criticalLeadership: “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
moderateIncident learning: “Gaps in records such as incident reports, showed missed opportunities to routinely learn lessons and improve safety across the service”
moderateCare planning: “Support plans did not contain sufficient guidance to ensure people consistently received personalised, proactive and co-ordinated support.”
moderateStaff training: “Training records we saw had lots of gaps for both new and refresher training.”
moderateStaff competency: “The service had enough staff, but they were not always appropriately skilled to meet people's needs and keep them safe.”
moderateSupervision / appraisal: “We also received mixed feedback about how regularly staff supervisions were carried out. We were unable to verify this information as the supervision matrix we saw was not up to date.”
moderateCommunication with families: “Staff could not effectively communicate with everyone using the service, because they did not have the right guidance and skills to understand some people's individual communication needs.”
moderateComplaints handling: “Records did not evidence how concerns and complaints were handled.”
moderateRecord keeping: “Some incidents had not been recorded at all, so there was no information to review and learn from.”
Strengths
· New manager recruited who was approachable and had started to make improvements
· Relatives and professionals felt people were kept safe from avoidable harm because staff knew them well
· Staff had training to recognise and report abuse and knew how to apply it
· Most people received support from the same staff providing consistency
· Positive interactions observed with staff providing reassurance and hugs to distressed individuals
Quality-Statement breakdown (23)
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience