Archived: Premier Care - South Lancashire Branch

The service was last inspected on the 29 December and 2017 and 4 January 2018, when it was rated as inadequate in the area of safe and requires improvement in the areas of effective, responsive and well led. The area of caring was rated good at that time. This meant that the service was requires improvement overall. At the time of our last inspection a new provider had very recently taken over the service and the service has been renamed to Premier Care South Lancashire Branch since our last inspection.

At that inspection we found the management of medicines unsatisfactory. A basic medicine audit had been introduced, but this was ineffective, as it only focused on missing signatures on the Medication Administration Records (MAR) and therefore other shortfalls around medicines management had not been identified. This was a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment. We also identified that risks had not been managed within a risk management framework and therefore people could have potentially been at risk of harm. This was a further breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Safe care and treatment.

We also found a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Person-centered care, because people were at risk of receiving inappropriate or unsafe care and treatment. The recruitment practices adopted by the service were not sufficiently robust to ensure that all employees were fit to work with vulnerable people. Relevant checks had not been completed in a timely manner and there was no evidence to demonstrate that police checks had been conducted. This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed. Systems and processes had not been sufficiently established to ensure compliance with the requirements. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, caring and well led to at least good. Since our last inspection the new provider had taken over the service and had made a number of changes in relation to the operation, management and oversight of the service. During this inspection, we found the service was meeting the requirements of the current legislation.

Premier Care South Lancashire Branch 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, people with a physical disability and or sensory impairment. At the time of our inspection 82 people were registered with the location. However, not everyone using Premier Care South Lancashire Branch 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 people receive this element of care we also take into account any wider social care provided. The manager told us 23 people were receiving personal care support as part of their registration.

At the time of the inspection the service did not have a registered manager in post. There was a manager who had submitted a registered managers application to the Care Quality Commission. Prior to the publication of the report the manager became registered with the Care Quality Commission. 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 was run.

People told us they were happy with how their medicines were managed. Whilst improvements were noted in the way medicines were managed we saw some gaps in the medicine records. The provider took immediate action to investigate this.

People told us they felt safe receiving care from the service. Staff knew what to do if abuse was suspected and had received safeguarding training.

Safe recruitment procedures had been established and staff rotas provided clear information about the visits staff were to undertake. We received positive feedback about the knowledge and skills of the staff team. Staff told us the training provided by the service supported them in their role.

Care records we looked at had evidence of written consent. People told us their care had been discussed and agreed with them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care records contained information about health professionals involved in people’s care. People we spoke with were very happy with care they received from the service. It was clear from the comments that staff treated people with dignity and respect at all times.

Improvements had been made to the care records which demonstrated what people’s individual needs were and how these could be met. Technology was used to good effect for the benefit of the service provided to people.

Systems to deal with complaints were in place and people we spoke with told us they knew how to complain. We received very positive feedback about the improvements since the new company took over the service. Team meetings were held and we saw minutes that demonstrated the topics discussed.

Audits and quality monitoring was taking place. This demonstrated that the service was run effectively.

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 for older people, people with physical disabilities and people with a sensory impairment. At the time of our inspection there were 42 people using the services of Gentle Touch and there were 21 staff appointed. The well-equipped agency office is located close to Leyland town centre. On street car parking is permitted within parts of the surrounding area.

A short time prior to our inspection Gentle Touch had been acquired by the company Premier Care (Lancashire) Limited. The legal entity of the company ‘Gentle Touch Care service limited’ remained the same for the time being. A new manager had been brought in with the new owners and due to the short time in post had not been registered with the Care Quality Commission. 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 the previous inspection on 28 October 2016 we found that staff did not always follow policies and procedures on the administration of medicines. The provider did not have an effective system to monitor the safe documentation of medicines. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Safe Care and Treatment.

Following that inspection the provider submitted an action plan, as requested to show how they intended to improve the management of medicines.

At this inspection we found the management of medicines remained unsatisfactory. A basic medicine audit had been introduced, but this was ineffective, as it only focussed on missing signatures on the Medication Administration Records (MAR) and therefore other shortfalls around medicines management had not been identified.

This was a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Safe Care and Treatment. I would perhaps move this and previous paragraph below the next two for flow.

Information about people was gathered before a package of care was arranged. However, the care planning process was not always person centred and did not incorporate all the needs of people who used the service or how these needs were to be best met. People were therefore at risk of receiving inappropriate or unsafe care and treatment.

This was a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for person-centred care.

Some risk assessments were in place. However, other areas of identified risk had not been managed within a risk management framework and therefore people could have potentially been at risk of harm.

This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for safe care and treatment.

The recruitment practices adopted by the agency were not sufficiently robust to ensure all employees were fit to work with vulnerable people. Relevant checks had not been completed in a timely manner and there was no evidence to demonstrate that police checks had been conducted.

This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for fit and proper persons employed.

We identified a number of shortfalls during our inspection, which resulted in multiple breaches of the regulations and several recommendations; it was evident that systems and processes had not been sufficiently established to ensure compliance with the requirements.

This is a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for good governance.

New staff received an induction programme. This helped them to understand their role and to learn about their responsibilities. Staff were regularly supervised through one to one sessions, observations and spot checks. This helped to ensure they had the skills, knowledge and experience required to support people with their care and support needs. However, there was no evidence to demonstrate that annual appraisals had been conducted. We made a recommendation about this.

People’s mental capacity had been assessed where needed and the policies of the agency protected those who used the service against abusive situations. Staff had received safeguarding training and they understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. However, consent had not always been obtained in relation to care and treatment. We made a recommendation about this.

Those who used the services of Gentle Touch were treated equally without discrimination and their human rights were protected. People told us staff were kind and caring and their privacy and dignity was promoted. They were mostly supported by the same group of staff, which enabled a good relationship to develop. This ensured staff understood the support needs of people they visited and how individuals wanted their care to be delivered. However, it was reported by many of the people we spoke with that the timings of visits were inconsistent and did not always suit people’s needs. We made a recommendation about this. We established that the new provider and new manager were addressing this issue. A specialised ‘clocking in’ and ‘clocking out’ system had already been implemented, so the timing of visits could be monitored more closely.

The new management team were in the process of prioritising work needed and implementing an auditing system, in order to closely assess and monitor the quality of service provided. We made a recommendation about this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

A staff training programme was in place. However, the views of staff we spoke with varied in relation to e-learning. Some staff told us they would prefer face to face training, particularly in areas where practical support was needed, such as moving and handling and first aid. The provider had recognised the need for ‘hands on’ training and therefore this had been scheduled for some key members of staff. We were told practical training sessions would also be rolled out to all the staff team.

Staff members received training in relation to infection control and associated policies and procedures were in place. Personal Protective Equipment (PPE) was also readily available. This helped to reduce the possibility of cross infection.

Accidents and incidents were appropriately documented with records being retained in line with data protection. This helped to ensure confidentiality was promoted. Emergency plans had been embedded, which outlined any actions staff needed to take in the event of an emergency situation arising.

Comments we received demonstrated people were, in general satisfied with the service they received. A complaints procedure was available and people we spoke with said they knew how to complain. We saw examples where a complaint had been received, responded to, investigated and the outcome documented. Staff spoken with felt the management team were accessible supportive and approachable and would listen and act on concerns raised.

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

Gentle Touch Care Services Limited provides personal care to people living in their own homes. The agency provides support for older people, people with physical disabilities and people with a sensory impairment. The agency's office is located close to Leyland town centre. At the time of our inspection there were 47 people receiving a service from Gentle Touch Care Services Limited.

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.

At the last inspection on 18, 19, 22 July 2013, we found the provider was meeting the requirements of the regulations that were inspected.

At this inspection, staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. People were supported to meet their care-planned requirements in relation to medicines. However, there had been several occasions when staff had failed to sign to show prescribed medicines had been administered. The provider did not always act on information gathered in a timely manner. They had not checked that the medicines had been administered.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. You can see what action we told the provider to take at the back of the full version of the report.

Care plans were personalised, however we have made a recommendation, as care plans need dating.

The provider had regularly completed a range of audits to maintain people’s safety and welfare.

Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had procedures around recruitment and selection to minimise the risk of inappropriate employees working with vulnerable people. Required checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service. Staffing levels were determined by the number of people being supported and their individual needs.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. The provider ensured staff had the skills to fulfil all care tasks required by people being supported. For example, the registered manager had sought specialised training to ensure staff delivered effective support to one person with complex care needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA).

People told us they were mostly supported by the same group of staff. This ensured staff understood the support needs of people they visited and how individuals wanted their care to be delivered.

Comments we received demonstrated people were satisfied with the service they received. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

A complaints procedure was available and people we spoke with said they knew how to complain. We saw examples where a complaint had been received, responded to, investigated and the outcome documented. Staff spoken with felt the management team were accessible supportive and approachable and would listen and act on concerns raised.

The registered manager had sought feedback from people who received a service and staff. They had consulted with people and their relatives for input on how the service could continually improve.

People were advised what the cost of the service would be. We found that people irrespective of funding arrangements were treated equally

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People told us they were involved in planning their care and support package. They told us the care they received was good and that they had care plans which explained their needs and how their support should be provided. People considered they were treated with dignity and said their privacy was respected. They had no concerns about their care and treatment and said they said they felt safe with the staff. They commented staff always followed good hygiene principles whilst supporting them..

People told us they told us they liked the staff. They told us the staff were helpful, reliable and punctual.

People were being consulted about their experience of the service and were confident to exercise their right to make a complaint or comment.