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Inspection carried out on 22 August 2017

During a routine inspection

We inspected Premier Personal Care Limited on 22 August 2017. The service is a Domiciliary Care Agency (DCA) registered to provide personal care in people’s own homes. At the time of our inspection visit the service supported 48 people. The agency operated in Henley-on-Thames and surrounding villages.

At our last inspection on 25 May 2015 we found people's medicines were not always managed safely and risk assessments were not always complete or up to date. At this inspection we found the provider had addressed the concerns. We saw people had risk assessments where required and guidance was available to staff in how to manage these risks. People received their medicines as prescribed and we found the medicines records were completed when people were supported with taking their medicines. Medicine records were regularly audited.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had systems to monitor the quality of the service. They ensured that the feedback from people was sought and regular checks of staff working practices were completed. The team promoted open and transparent culture. There was a clear staffing structure in place and staff were clear on their roles and responsibilities.

People told us they were safe. People were supported by sufficient staff and had regular staff. The provider ensured safe recruitment practices were followed. Staff were aware of safeguarding and how to escalate any concern including how to whistle blow if required.

People were supported by staff that had received training relevant to their roles. Staff told us and records confirmed staff were regularly supported by their line manager.

People received support that met their needs. People’s care plans were current and reflected the level of assistance required on each visit. People were supported to meet their nutritional needs and access health professionals when required. People knew how to make a complaint but told us they had never needed to.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

People complimented the staff and told us staff were “pretty marvellous”, “very good’ and ‘polite”. People’s dignity and privacy were respected. Staff ensured people were supported to maintain their independence. Staff ensured people’s confidentiality and when they spoke about people they referred to people with respect.

Inspection carried out on 25 May 2016

During a routine inspection

We carried out an announced inspection on 25 May 2016.

Premier Personal Care is a domiciliary care service providing personal care support to people living in their own homes.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At an inspection in December 2014 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection the

provider sent us details of how they would meet their legal requirements relating to the three breaches.

At this inspection we found improvements had been made. Staff had received up dated training and there was a system in place to monitor staff to ensure they had the skills and knowledge to meet people's needs. Staff understood their responsibilities to identify and report concerns relating to the abuse of vulnerable people. Care plan reviews were carried out monthly to ensure they were up to date and reflected people's needs. However at this inspection we found people's medicines were not always managed safely and risk assessments were not always complete or up to date.

People were positive about the quality of the service and the caring approach of the care staff supporting them. People had developed meaningful relationships with care staff who knew them well. People knew who was coming to provide their support and received a weekly rota. There was a system in place to schedule and monitor calls and people told us they had not experienced any missed visits.

People knew how to make complaints and were confident to do so. Complaints were dealt with in line with the providers complaints policy.

Care staff were well supported by the management team and benefited from regular supervision and team meetings. There was an on call system that provided support for people and staff when the office was closed.

People were supported in line with the principles of the Mental Capacity Act 2005. However, records did not always follow the principles of the Act. People were included in the development of care plans and support was provided in the way they chose. People were positive about the flexibility of the service.

People's views on the service were sought through regular questionnaires and reviews. Feedback was used to improve the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the end of the full version of the report.

Inspection carried out on 9 December 2014

During a routine inspection

Premier Personal Care is a domiciliary care agency that provides care and support to people in their own homes. On the day of our visit there were approximately 61 people using the service. The agency provides support to people with a range of care needs, which include older people, people living with dementia and people with physical disabilities.

This inspection took place on 9 December 2014. The provider was given 48 hours’ that the inspection was going to take place. We gave this notice to ensure there would be senior management available at the service’s office to assist us in accessing information we required during the inspection.

At our previous inspection on 9 December 2013 the provider was meeting the requirements of the law in all the standards.

The registered manager has been registered since May 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they felt safe with the care they received. Staff demonstrated understanding of how to identify abuse and what they should if they suspected it had occurred. Staff administered medicines to people safely. However some staff had not received refresher training in safeguarding adults and medicines. The service carried out appropriate recruitment and criminal checks procedures. People said staff turned up to their homes on time. We have made a recommendation about environmental risk assessments.

The service did not always act in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity to make specific decisions, consent was sought by people not authorised to give it. There was no evidence to show the service had not applied the recent court ruling in regards to DoLS in their work practice. People received care and support from staff who received effective supervisions and appraisals. However, some staff had not undertaken relevant training and could not demonstrate how the MCA related to their job roles. People’s nutritional needs were met; staff demonstrated how they supported people who were malnourished to gain weight. This was also evidenced in care records. The service worked closely with health professionals to enable people to receive the support they required.

People gave mixed responses in regards to whether they had received a review of their care. Some people said this had occurred whilst others could not remember the last time took place. A review of care records showed care reviews did not occur on a regular basis for some people. People said the service was responsive to their needs and they know how to make a complaint if they had concerns. We saw complaints received were responded to appropriately.

Some quality assurance systems to monitor the quality of the service were not effective. For example, there was no evidence of care audits of care records to ensure information was factual and accurate. The service sought feedback from people, those who represented them and staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection carried out on 9 December 2013

During a routine inspection

We spoke with five people who told us they were happy with the service they received, they told us they found the staff to be "kind and respectful" and that they "can't find fault whatsoever". They told us they knew most of the staff by name and felt the staff knew them well which meant they had a "good relationship" with them. They told us they felt the staff were well trained and that they felt included in planning the care they received.

We spoke with staff who told us they always asked people what they would like before performing any care, they told us they felt the provider was a "good employer" and that they saw the same people each week, they told us they felt this meant that they gave people continuity of care which they felt was an important part of their job. Staff told us they felt the training was good and that the manager communicated well with them and listened to their viewpoint.

We saw the care plans for four people and saw that a wide variety of assessments were completed when planning care. We saw that safety and well being of people was paramount when planning care and saw risk assessments were performed that included personal care and the home environment. This meant that people were being cared for holistically and their independence was being promoted.

Inspection carried out on 21 December 2012

During a routine inspection

We telephoned four people who used the service and spoke to two family members of other service users. Everyone we spoke to said they were happy with their regular social care workers and gave us positive feedback about them. People told us their regular social care worker knew their needs well and how they liked things to be done. A person who used the services said "the team leaders are wonderful, and sort out any problems - they are really professional."

All the people we spoke to said that the agency arranged a replacement care worker when their regular care worker was away and almost all said that replacement care workers supplied were good. None of the people we spoke to, or their friends and families, said that they had ever had any concerns about the treatment they received from care workers. A service user told us "they definitely treat me with respect."