Archived: Priority Home Care

Priority Home Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults.At the time of our inspection there were 30 people receiving personal care from the service. There was a central office base in Ferndown.

Not everyone using Priority Home Care received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager in place. 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.

Quality monitoring systems in place were not robust or effective. We found that detailed findings during auditing were not recorded nor were actions required for improvements listed or timescales added. The service did not record improvement actions. This meant that areas for development might be missed or forgotten.

The service did not maintain accurate, complete and contemporaneous records in respect to each person. Information was not always recorded and care records were not all up to date.

The service assessed people’s communication needs and these were being met, but they were not recorded.

People were supported to make decisions. However, best interest decision meetings had not taken place in line with the Mental capacity Act for one person.

People were supported by staff who understood the risks they faced and valued their right to live full lives. Staff described individual risks and the measures that were in place to mitigate them. Risks had been assessed and safety measures were reflected in people care and support plans.

People and staff told us that they felt the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults.

Medicines were managed safely, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular training as well as training specific to their roles for example, nutrition and dementia.

Staff received regular supervisions and annual appraisals which were carried out by the registered manager.

People were supported to eat and drink enough whilst maintaining a healthy diet. Food and fluid intake was recorded for those who required monitoring for this.

People were supported to access healthcare services. We were told that health professionals visit people in their homes and that on occasion’s staff would support people to arrange outpatient appointments.

People told us that staff were caring. We observed positive interactions between the staff and people. People said they felt comfortable with staff supporting them and that staff treated them in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs although these were not clearly recorded in people’s plans. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected people’s needs in these.

Staff, people and families told us that they thought the management was good at Priority Home Care. We found that the management team promoted an open working environment and was flexible.

Staff were acknowledged by the registered manager for their hard work and commitment in their jobs. Staff told us this made them feel valued and that they were involved in developing the service.

This is the third consecutive time the service has been rated Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.

The service provides personal care to older people living in their own homes. At the time of our inspection there were 28 people receiving a service from the agency.

The service has a registered manager. 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.

Improvements had been made in the safe care and treatment of people. Management auditing systems were being researched but had not been implemented to monitor the quality and safety of the service and ensure that improvements made were being sustained.

Reviews of each person’s care had taken place and were risks had been identified actions had been put in place to minimise the risk of avoidable harm. People had been involved in decisions about how their risks were managed and had their freedoms and choices respected. Care workers told us that new care and support plans were helpful and gave them insight into people’s risks and medicines.

People felt their care was safe and were supported by care workers that had received training on how to recognise signs of abuse and the actions they needed to take if abuse was suspected. Staff had been recruited safely included checks to ensure they were suitable to work with vulnerable people. Staffing levels ensured that people received their agreed care calls including when the time of a visit was critical to meet a health or social need.

Medicines were administered and recorded safely. Information provided to care workers provided the details needed to ensure that topical creams were applied as prescribed. People were involved in decisions about how risks associated with their medicines were managed.

A quality assurance system was in place to gather feedback from people using the service and their families. Initial analysis had highlighted that improved communication was needed and the registered manager told us in response they would be introducing a monthly newsletter for people.

The management of the service was described as open and friendly. Staff felt included in the development of the service and felt their ideas were listened to and when necessary appropriate actions had been taken. Staff felt communication was good and included monthly informal meetings, formal minuted meetings and a monthly newsletter. Staff understood their roles and responsibilities and felt supported with decisions.

The service provides personal care to older people living in their own homes. At the time of our inspection there were 30 people receiving a service from the agency.

The service has a registered manager. 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.

People were at risk of not having their topical creams administered safely which meant they were not being protected from the risk of deteriorating skin or health conditions. Risks associated with some medicines such as instructions not to have alcohol had not been considered. People had assessments that highlighted risks they lived with such as skin damage or choking. They were not fully protected as care workers had not been provided with information on the actions they needed to take to reduce the risks in order to protect people from harm. Processes to report incidents that could cause harm to a person were not consistently reported. This meant that risk had not always been reviewed appropriately.

People were at risk of not receiving care specific to their individual needs as care and support plans did not contain enough information to support care workers in their role. Examples included people who needed support with communicating due to a dementia, poor eating habits, risk of choking and pressure care.

Auditing systems and processes were not in place to assess, monitor and ensure effective management oversight. This meant that risks in relation to medicine administration and the care and welfare of people had not been identified.

People and their families described the care as safe. People were supported by enough staff that had been trained to recognise signs of abuse and understood the actions they needed to take if abuse was suspected. Staff had been recruited safely which included obtaining previous employment references and a criminal record check to ensure they were suitable to work with vulnerable people. Staff received an induction and on-going training and support than enabled them to carry out their roles.

When any accidents, incidents or changes in people‘s care needs had been reported to the registered manager the appropriate actions had taken place such as referring to health professionals or organising a change of equipment. People were supported with access to healthcare when needed.

Care workers described communication and team work as good and felt kept informed of any changes to people’s care and support needs. Information was shared via a group text system, phone calls, monthly staff meetings and word of mouth. People told us that care workers understood their likes and preferences when providing care and support and that they felt involved in decisions about their care. A complaints process was in place and people felt if they needed to use it they would have been listened too. Staff were working within the principles of the Mental Capacity Act and understood how to support people to make their own decisions. When people had been assessed as not able to make certain decisions the correct processes were followed to ensure decisions were made in peoples best interest.

We observed a caring, friendly and relaxed relationship between people and the care workers. People had their communication and care needs understood and staff demonstrated a good knowledge of people, their life’s and interests. People told us that they felt their privacy, dignity and their need to maintain independence was respected.

Staff spoke positively about the organisation and valued the registered managers input with people. They told us they felt able to share ideas and concerns and gave examples of how this had led to better outcomes for people. They described how they felt appreciated and valued by the organisation. A quality assurance survey took place annually and provided feedback from people and their families. Feedback had been positive about the service. Information provided had been shared with staff and used to implement changes in practice.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe using the agency. They had confidence in their care workers and felt able to talk with the registered manager about any concerns. The agency had procedures in place to protect people from abuse and we found that, where there were concerns about people's welfare, these had been reported to appropriate agencies.

Staff received some training and support to carry out their work. We found that there was regular contact between the registered manager and staff which meant that staff felt supported. However, improvements were needed to ensure that all staff received regular supervision and appraisal and their work was monitored in a robust way.

The agency had some systems in place to monitor the quality of the service. However, they did not always use the information they obtained to make improvements across the service. This meant that shortfalls were identified during the inspection that could have been identified, and acted upon, by the agency themselves last year. Improvements were needed to ensure that effective action was always taken in response to concerns.

Records about people's care did not always contain appropriate or accurate information about their needs and how they should be met. This potentially put people at risk of not receiving appropriate support. Improvements were needed to ensure that records always contained enough information to guide staff and demonstrate how people's needs were being met.

We found that staff had been appropriately trained and were being given further training through a local college which includes safe medication administration.

The service supports staff through an on-call system should staff need to seek further advice from senior staff while supporting people in the community.

We found that the provider had taken action to improve staff recruitment procedures and protect people who used the service. They had undertaken appropriate checks on new staff to ensure they were suitable to work with vulnerable adults. They had also obtained information about some of their existing care workers that was missing at the time of our last inspection to ensure that they were compliant with the regulations.

We did not speak with people who used the service at this inspection. However, we spoke with people who used the service and some health and social care professionals who had contact with the agency at our last inspection in March 2013. People's views about the care they received were reflected in our last inspection report which was published in May 2013.

Although we received positive feedback from people who used the service, their relatives and professionals, the provider was not compliant with six regulations. Recruitment checks were not always carried out on staff before they started work and there were shortfalls in the training provided to staff to ensure they were safe and competent to provide care. The provider did not have systems in place to ensure people's capacity to make decisions and consent to their care was clearly recorded. An up to date policy on safeguarding adults from abuse was not available and specific training on abuse awareness had not been delivered to staff to ensure their full understanding of procedures. The provider had not followed their action plan to ensure they achieved compliance with the regulations following their last inspection and had failed to notify us of incidents that had occurred in the service which were reportable by law. This has meant that we have needed to tell the provider again to make improvements.