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Archived: Precise Healthcare Solutions

Overall: Inadequate read more about inspection ratings

161 High Street, Hull, North Humberside, HU1 1NQ 07983 548697

Provided and run by:
Precise Healthcare Solutions Limited

All Inspections

18 July 2018

During a routine inspection

The inspection site visit to the office took place on the 18 July 2018 and was announced by giving the provider 48 hours. Two additional days, 26 and 27 July 2018 were arranged so we could have telephone conversations with people who used the service and care staff. This was the first inspection since the service was registered with the Care Quality Commission (CQC) in December 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to younger and older adults with a range of physical or mental health needs. It also provides a service to people who may be living with dementia or who have a learning disability. At the time of the inspection, the service was providing personal care to four people who lived in North Yorkshire.

Not everyone who could use Precise Healthcare Solutions would receive 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. A registered manager is a person who has registered with 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.

Before the inspection, the local authority quality assurance and contracting team for North Yorkshire visited the service and raised concerns with CQC about how it was managed. We decided to bring forward the inspection. During the inspection, we found multiple breaches of regulations. These related to; assessment, care planning and review, risk management, limited knowledge of safeguarding procedures, a lack of understanding and implementation of the Mental Capacity Act 2005, staff recruitment, training and supervision, records, complaints management, poor quality monitoring and poor governance. During the inspection, a director of the company told us that following the visit by local authority staff, they had sought the advice and support of a consultancy agency to guide them in making the required improvements.

Because of our concerns, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. CQC is considering its regulatory response. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The registered manager and directors of the service lacked knowledge and specific skills required for their roles. There was no structured quality monitoring in place to identify shortfalls and for learning to take place. Records were not accurate and up to date; we were told by a director that some staff recruitment records had been shredded so we were unable to see them. This was not in line with the provider’s retention of records policy.

Risk management required improvement. People who used the service had risks identified in their initial assessment completed by the local authority but no risk assessment had been completed to guide staff. Some people who used the service had basic assessments for some areas of risk but these required more information to help staff minimise risk. There was limited environmental risk assessments to look at areas within people’s homes, which may be hazardous to them or staff.

There was no detailed initial assessment completed by a competent person to establish if the service could meet people’s needs. The care plans did not provide enough information to guide staff in how to support people in the way they preferred. The care plans contained inaccurate information and information belonging to other people.

The staff were recruited in London and provided with accommodation approximately an hour away from the area where people required support. They were driven to the calls by directors. As there were several calls to attend, this meant there were times when staff were late for care calls.

Staff were not recruited safely and important employment checks were missing from the staff files. The staff who carried out the initial assessments and wrote the care plans had no recruitment documents or evidence of their training.

Staff had completed a medicines management course and records stated they had also completed various on-line courses; however, there were no certificates to evidence these. An over-reliance on on-line training limited staff’s opportunity to seek clarification or discuss issues to test their comprehension.

Although there was a policy and procedure for the management of medicines, the registered manager told us staff did not administer them. We found staff did apply prescribed products, such as creams and sprays. Staff had, on at least one occasion, recorded they had given a person some pain relief medication. Staff did not have medication administration records to record when they gave people medicines or applied skin products such as creams and sprays.

Records stated staff had completed on-line training in how to safeguard people from the risk of abuse. In discussions, staff did not understand safeguarding or what constituted abuse. The registered manager was aware they would have to raise alerts with the local safeguarding team in North Yorkshire if they became aware of concerns. However, they had no contact details to hand for this. Nor was the information included in policies and procedures.

The provider had a complaints policy and procedure. There had been two complaints made to the service but these had not been documented and investigated in line with the procedure.

People were not provided with enough information about the service. We have made a recommendation about this.

People told us staff were kind and spoke with them in a nice way.

Staff told us they would contact relatives, the person’s GP or emergency services should the need arise. So far, staff had not experienced any emergency situations.

Staff told us they would support people to prepare a meal when required.