Primary Homecare Limited

Where they do receive personal care, we also consider any wider social care provided. At the time of inspection there were 99 people who used the service who received personal care. This agency also offers a rehabilitation service to people.

People’s experience of using this service and what we found

Primary Homecare Limited provides an exceptionally caring and responsive service. People and their relatives were extremely complimentary about their experience and would recommend the service to others. One person said, “They do so much so well. They’re efficient and very professional in what they do and they genuinely like to care.” One relative told us, “Oh God, yes I’d recommend them. It’s a godsend for us. [My family member] seems a lot happier.”

There were several special examples of where staff had gone the extra mile to ensure people received a tailor-made service. People’s life choices were respected including staff protecting people from being discriminated against, appreciating and championing diversity and ensuring people's privacy and dignity are central to their care. People told us their care workers were exceptionally caring and respectful. People were enabled to lead their best lives, as independently as possible on their terms.

The management team and staff worked in partnership with people, relatives and other professionals to achieve person-centred care and excellent outcomes for people. One professional said, “I have several customers that are supported by primary home care who are flexible and responsive to the customers’ needs and expectations". People said that they had a small group of staff that knew them, their situation and their support networks well. People received their care visits at the times they expected and for the length of time agreed.

People felt safe and trusted the staff that supported them, because staff were well trained and respectful. One person said, “They speak to me so nicely and listen to everything.”

Risks to people had been assessed and were managed safely. People's care records were re-assessed regularly and guided staff on how to assist people safely and encourage their independence.

Staff felt supported and valued in their role by the management team and there were enough staff appropriately recruited and employed to meet people’s needs.

People received their medication as prescribed and staff adhered to infection prevention and control procedures in line with legislative requirements and recognised best practice guidelines.

People's communication needs were detailed in their care plans. Care plans also detailed people's preferences of support, for example, gender of staff or preference of language if not English. Staff understood equality and diversity and ensured people's privacy and dignity was respected.

Staff understood the importance of gaining consent from people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives felt able to raise any issues with the staff and management team and were confident these would be addressed.

Systems to monitor the quality and safety of the service were in place. Care records were on an electronic system that had many functions and led to better management oversight and monitoring of service delivery. The provider was committed to providing high quality care and the service worked well in partnership with others to ensure the best outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Rating at the last inspection was outstanding. (Published 17 September 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service , which will help inform when we next inspect.

Primary Homecare Limited is a domiciliary care service, providing personal care to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, there were 161 people using the service.

People’s experience of using this service and what we found

People received an extremely responsive service which was tailor made to meet their needs and aspirations. There were systems to provide people with end of life care which met their needs and wishes. There was a complaints procedure in place and people’s concerns were promptly addressed.

The service was extremely well-led. Robust systems to monitor and assess the service provided helped the registered manager to identify where improvements were needed, and these were addressed quickly. People were asked for their views about the service and these consistently demonstrated a high level of satisfaction relating to the service they received. All staff spoken with were extremely passionate about providing high quality care to people.

People and relatives told us about how the care workers and other staff working in the service were caring and respectful. People were provided with a caring and compassionate service. People’s rights to independence, privacy and dignity were promoted and respected. People’s choices about the service were valued and used to plan their care.

Risks to people were assessed and mitigated, this included the risks of avoidable harm and abuse. Where people required assistance with their medicines, there were systems to provide this service safely. People’s care visits were completed as planned. Recruitment of care workers was done safely. Care workers were trained in infection control and the appropriate equipment was provided to reduce risks of cross infection. There were systems to learn from incidents and use the learning to drive improvement.

People were supported by care workers who were trained and supported to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people required support with their dietary needs, this was provided. Where required, people were supported to maintain good health. The service worked well with other professionals involved in people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Primary Homecare Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide personal care and is a domiciliary service. There were one hundred and fifty-seven people receiving support at the time of the inspection.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service was outstandingly well-led which was demonstrated by how the staff were supported and how well the service was organised to ensure people received high standards of care according to their assessed needs.

The care plans were person-centred written to clearly identify the support required alongside what the person could do for themselves.

All staff had attended training as part of their induction to the service designed to help them recognise abuse and know what actions to take to protect people as far as reasonably possible from actual or potential harm. Staff had a clear understanding of their roles and responsibilities, whether this was staff involved with providing direct support or those working to organise and support. People using the service were supported by a sufficient number of suitably experienced and knowledgeable staff to meet their needs. The manager carried out appropriate recruitment checks before staff began work with the service. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred. As part of the assessment process to determine if the service could meet the individual’s needs, people were asked about their preferences and choices and the support plans were written in a person-centred style.

The service had a medicines policy, staff had received training and systems were in place to manage medicines and people were supported to take their prescribed medicines safely. The service carried out an audit to determine that medicines were being managed safely.

People using the service experienced a service based upon their assessed support needs which was person-centred. The staff were knowledgeable about the people they supported. Individual goals were identified as the service employed occupational therapist alongside experienced care staff and sought the advice of other professionals to organise and deliver the care support.

Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 including best interest meetings. A best interests meeting may be needed where an adult (16+) lacks mental capacity to make significant decisions for themselves and needs others to make those decisions on their behalf.

Positive and caring relationships had been developed between the people using the service and staff supporting them. Staff responded to people’s needs in an empathic manner. People’s choices were respected as was their privacy and dignity. The care plans were written to take account of people’s needs and to promote and maintain independence. People were involved in the planning and reviewing of their care and support, as were family members with their permission. The service was focused upon a solution based approach and to achieve this aim.

The service had a clear set of values, positive culture and ethos which were understood by the staff as these were shared across the organisation in meetings and company literature. People and relatives we spoke with were positive about the service. Saying the important things of coming on time and staff clearly knowing what to do to support them were carried out without fuss and people could enjoy a laugh and a joke with the staff.

Staff were supported and supervised in their roles and had an annual appraisal to discuss their performance and career development. Part of the supervision process was for the service to carry out spot checks of the care delivery. The service also supported senior staff with mentors for their career development.

Staff supported people with their health care needs including where required monitoring of people’s food and fluid intake. The service reviewed people’s care to ensure the service continued to meet their needs and they worked with other professionals to that end.

The staff told us there was an open culture as the manager was approachable and enabled people who used the service to express their views. People were supported to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions about the service. The service had systems in place to check the quality of the support provided which included surveys to analyse people’s views who used the service.

We consider the service was outstandingly well-led. This was because the manager was an effective role model actively seeking the views of people using the service and other stakeholders as well as supporting the staff. A positive culture had been created where people felt confident to challenge and raise concerns. Also the service had worked with other services to welcome apprentices and also supported staff that were working for the service while embarking upon nurse training.

Staff management systems were in place to provide sufficient staff at the correct times to support people with the care and support they required. The service was provided over a large geographical area to some remote parts of the county and there was management support in place to support the staff delivering the direct support. People using the service were consulted about having the staff of the gender they wished to support them.

People using the service were confident any concerns they raised would be listened to and resolved professionally. This was because there were policies and procedures in place as well as management systems focussed upon delivering and developing quality services. Staff reported to the registered manager who in turn reported to the provider of the service. Senior managers were supported by mentors to help them to develop their skills and resolve management problems as they occurred.

The management systems in place we saw included audits of people’s view that used the service the views of staff and also checking upon the standards of service delivery such as spot checking that staff attended to people on time. The organisation is one of a learning culture where information gained is shared across the organisation for the benefit of the staff and people using the service.

Overall people spoken with gave positive feedback about the service they received. However we received mixed feedback about the timing of visits and the consistency of staff. The majority of people told us that their visits were fairly prompt, however one person commented, 'The timing we requested can be out by an hour'. Another person stated that, 'We have to wait up to an hour with some care workers, but not others'. Other comments included, 'They can come about ten to fifteen minutes late, but that's not a problem'. 'I have carers four times a day, on time, and it's very rare they're late'. 'If the rotas change, it can shift things a little but they do try and keep to times'.

People told us that most of the time the same staff visited. However one person commented, 'We don't get the same carers every day, and occasionally get new ones'. One person told us that they were, 'Not quite sure who's coming'. One person said, 'I've got to know the regular person who I have most of the time, however somebody else comes on a Monday, and there's no real telling who I have on a Monday, unless my regular carer tells me on a Sunday'. One person commented, 'I usually do know whose coming as you get a rota'.

People told us that they felt safe and relaxed with staff. We saw that people who used the service were well cared for by responsive and well led staff. We found that people received care and support according to their assessed needs. Where people did not have capacity to consent to their care we saw evidence that best interest meetings had been held, in accordance with the legal requirements of Mental Capacity Act (MCA) 2005.

We found that there were enough skilled and experienced staff to meet people's needs. Staff told us that they had received appropriate training and spoke knowledgably about the people they provided care and support to. Systems were in place to assess and monitor the quality of the service that people received.

We found that the service was meeting the personal, emotional and healthcare needs of people who used the service. Care plans had been reviewed and updated within the past six months and risk assessments were in place where a specific risk had been identified.

Families we spoke with told us that they felt that that their relative's privacy and dignity were respected by staff. They told us that staff knew how to communicate with individuals to ensure that they understood their wishes. All five people who used the service told us that they felt able to raise any concerns they had with staff and that they would respond appropriately.

Relatives we spoke with also told us that they knew how to complain. One person told us that, "Staff were very friendly, kind and caring and they knew how to care for me."

We saw that staff had been provided with the appropriate training and support to carry out their role effectively and safely. Staff told us that they found the manager to be supportive and approachable.

The service is regularly monitored and reviewed by the manager. There are systems in place that have ensured people who used the service have been consulted about the care received.