Prime Support Service Limited

At the time of our inspection we were told 23 people were using the service, of which only six people received assistance with personal care. 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.

People’s experience of using this service:

Breaches in the regulation found at our last inspection had been met. During this inspection we found action had been taken to demonstrate clear management and oversight of the service. Further systems had also been improved with regards to medication, recruitment and financial records and emergency situations.

People told us they continued to receive care and support in a safe way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People said staff supported and encouraged them to make decisions about how their needs were to be met. Staff spoken with clearly understood the importance of respecting people's privacy, dignity and independence.

People continued to receive effective care from skilled and competent staff. Staff said the management team were approachable and responsive to requests for advice and support.

Suitable arrangements were in place to respond to any complaints and concerns. People we spoke with felt they were listened to and were confident any issues would be responded to. People, and their family members were actively encouraged to provide feedback on the service and staff worked well as a team in an open and supportive manner. Everyone spoke positively about the service and the quality of the support being provided.

The service was meeting the characteristics of 'Good' in all the key questions. Therefore, our overall rating for the service is 'Good.'

Rating at last inspection: Require Improvement – published 16 May 2018.

Following that inspection, we asked the provider to send us an action plan telling us what action they were to take to make the necessary improvements.

Why we inspected: This inspection was carried out as part of our planned schedule of inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive, and will inspect the service again, if we receive information that indicates risk.

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

At our last inspection in January 2017, we found one breach of the regulations with regards to staff training and development. A recommendation had also been made in relation to the recruitment process. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe, effective and well-led to at least good. At this inspection we found the breach in regulation had been met.

During this inspection we found five breaches of the regulations. These were in relation to the records to guide staff on the safe administration of people’s medicines, recruitment records, risk management plans in the event of an emergency arising, financial records and good governance systems.

Prime Support is a domiciliary care agency. It provides personal care and support to people living in their own homes in the community. The service operates in the Stockport and Manchester areas. Not everyone using Prime Support receives the regulated activity, personal care. CQC only inspects the service being received by people provided with ‘personal care’; for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection the service was providing personal care support to 10 people.

The registered manager had resigned from the service and therefore was not present during the inspection. One of the directors of the service said they would be registering as the 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.

Clear records were needed to guide staff on the safe administration of people’s prescribed medicines so their health and well-being was maintained.

Sufficient numbers of staff were available to support those people currently using the service. However recruitment processes were not sufficiently robust to ensure that only suitable applicants were appointed to work for the service.

Suitable arrangements were not in place to help maintain the safety and protection of people and staff in the event of an emergency arising.

Adequate governance systems were not in place to demonstrate the service was monitored and reviewed so that any identified shortfalls were acted upon.

Records were not maintained to show people’s finances were appropriately managed where staff were involved in any transactions.

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

People told us they felt safe with the staff that supported them. Staff had completed training in how to safeguard people from abuse and knew the action they should take if they had any concerns. A safe system was in place where staff had access to people’s house keys.

Potential risks to people’s health and well-being had been assessed and planned for to help protect them from potential harm or injury.

Procedures were in place with regards to the management and control of infection. Staff had received training and had access to protective clothing such as disposable gloves, when needed. This helped to the reduced the risk of cross infection.

People told us they were involved and consulted about their care and support. Staff were aware of the importance of seeking people’s permission before carrying out personal care tasks.

Staff received induction, supervision and a programme of training to help ensure they were able to deliver effective care. Staff spoken with confirmed they received regularly training and were equipped to support the needs of people they visited.

Suitable arrangements were in place to help ensure people’s health and nutritional needs were met, where needed.

People and their relatives told us they were happy with the care received and that staff supported them in a dignified and respectful manner. Staff spoken with were able to demonstrate a clear understanding and gave examples of how people’s privacy and dignity was promoted and maintained.

People’s care records were kept under review and provided good person centred information to guide staff in the safe delivery of people’s care and support based on their individual needs, wishes and preferences.

Opportunities were provided for people, their relatives and staff to comment on their experiences and the quality of service provided.

All the people we spoke with said they would speak with managers and staff if they had any complaints or concerns. Records showed people’s complaints and concerns were taken seriously and acted upon.

The provider reported any accidents, serious incidents and safeguarding allegations which should be notified to CQC. This information helps us check the service is taking action to ensure people are kept safe.

Pre-inspection information requested from the provider, which is required by law, had been provided to CQC as requested.

The CQC rating and report from the last inspection was displayed at the agency office as well as on the provider web site.

Our last inspection of Prime Support Service took place on 27 September 2016 when we found multiple breaches of seven of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service inadequate and placed it into special measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. At this inspection we identified a breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which was in relation to training. We also made two recommendations, which relate to staff recruitment procedures and systems to monitor and improve the quality and safety of the service.

Prime Support Service is registered to provide personal care to people living in their own homes. The service operates in the Stockport and Manchester areas. At the time of our inspection the service provided support to 15 people.

The service employed a registered manager. However, they were absent from the service at the time of our inspection, and the service was being managed by the two directors of the company, one of whom was the nominated individual. 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.

Following our last inspection the provider had produced a detailed action plan, and had made a range of improvements to the service. Whilst many actions had been completed, we saw others such as a review of staff training were still underway. The provider was working to the timescales identified in their action plan.

Improvements had been made to the way medicines were managed. A new format for medication administration records (MARs) had been introduced that identified the medicines the individual had been supported to take. There was evidence the provider had checked completed MARs returned to the office and had acted upon any identified errors. However, we found the provider had not sought advice from a pharmacist in relation to the requirement to crush a person’s medicines. They confirmed they would do this as soon as possible.

Staff were aware of their responsibilities in relation to safeguarding. The provider had identified and reported safeguarding concerns to the local authority and the Care Quality Commission (CQC) as required. Records showed thorough investigations of any concerns raised had been carried out, with proportionate action taken to ensure people were kept safe.

People and relatives gave us positive feedback about the kind and caring nature of staff. People said they were now supported by the same staff on a consistent basis, which allowed staff and people using the service to get to know each other. There was evidence peoples’ preferences in relation to the staff supporting them had been considered.

People told us staff were reliable and committed. No-one reported any missed calls, although we did receive feedback that there could sometimes be confusion over the rota that could lead to last minute staff changes. The provider used an electronic rota system, and was developing how they used this. Staff reported the rotas were working more ‘smoothly’ than they had previously.

Care plans had been completed that provided staff with detailed information about peoples’ health and social care support needs, as well as any preferences they had in relation to how they received their care. People had had recent reviews with the provider where they had opportunity to provide feedback in relation to their care and preferences.

The provider had improved the training given to staff, and had provided training specific to individual’s health care needs where this was required. However, there were continued gaps in the training provided to staff, and the provider acknowledged this was an area that was still under development.

Checks on staff member’s identity and background had been completed to help ensure only staff of suitable character were employed by the service. However, the provider’s decision around employment was not always clearly documented when these checks indicated potential concerns.

The provider was in the process of developing systems that would help them monitor and improve the quality and safety of the service. Was saw that simple checks and overviews were in place of areas including training, accidents, supervision and medicines.

Staff felt supported and had started to receive regular supervision, which they told us they found useful. The provider had not yet arranged any team meetings, but told us this was something they intended to do in the near future.

This was the first inspection since the service was registered in December 2013.

Prime Support Service Limited is registered to provide personal care to people living in their own homes in the Stockport and Manchester areas. The service currently provides support to 18 people.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, affecting people’s safety, well-being and the quality of service provided to service users. We did not see evidence of good leadership with robust policies, systems and record keeping which would enable the provider to assure themselves they were delivering high quality care. CQC is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action 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. We may also take other enforcement action proportionate to the seriousness of any shortfalls and breaches at any time, including within the six month timescale of a revisit.

The service had 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. We found evidence during the inspection that the manager was ineffective and not carrying out their legal obligated responsibilities.

The company had a director and a nominated individual in this service. An organisation needs to have a nominated person who acts as the main point of contact for us. They must also be employed as a director, manager or secretary of the organisation, so that they have the authority to speak on behalf of the organisation.

Risk assessments and risk management plans did not provide staff with clear guidance about how to safely manage known risks to people. They were not always up to date, which meant they did not reflect people’s current needs.

Medicines were not safely managed. The provider did not have accurate recording systems in place for medicines, which were administered to people from pre-filled ‘dosette’ boxes. This meant there was no clear record to say what medicines the person had received. In addition to this, medicines risk assessments were not completed in relation to individual’s health conditions.

Care planning documentation was varied. Some were detailed, albeit where care packages were ‘straight forward’ and people being supported did not have complex needs or serious medical conditions, which could leave them vulnerable. Other care plans were generic and task focused, and in two care plans we looked at, the information was inadequate and did not contain sufficient information to provide staff with clear guidance about the care these individuals required. Despite this lack of accurate recording, people told us they received good or satisfactory care overall from the support workers who visited them and that staff knew them well. We received varying comments about the manager and owners of the service.

People told us they felt safe overall. However, the service did not have clear systems in place to report and investigate abuse. Staff understood the types of abuse and were confident in raising concerns with the management team. However, incidents were not always referred to the appropriate agencies, in lieu of the provider carrying out their own investigations. Once investigated, action was not taken as necessary where evidence was found that staff had not carried out the correct procedure or needed to be retrained. Care calls were not always delivered by a consistent staff team, meaning people were visited by different carers. However, people received their care calls on time, or when there were delays they were alerted to this by the service.

We did not consistently see that people had signed to give their consent to care. Where people were unable to consent to care, due to their mental health difficulties or understanding, the service had not completed mental capacity assessments or recorded best interest’s decisions.

The service did not have safe and effective recruitment systems in place. Once recruited, staff completed a two day induction programme, but were not subject to a formal probationary period. The service did not provide adequate training and support to their staff team and did not carry out routine competency checks to ensure staff were delivering effective care.

The service worked with other health and social care professionals but we found that they were not always proactive in liaising with other agencies to maintain a people’s well-being.

People told us care staff were friendly and caring. Some people told us staff provided them with care which promoted their independence. The service had received a number of compliments about the care they provided for people.

The service had an up to date complaints policy and people told us they knew how to raise concerns. At the time of our visit there had been no complaints received by the service so we were unable to establish how they deal with any complaints.

Staff told us they felt supported on a day to day basis by the management team, in particular the nominated individual. Staff meetings had not been held so far this year, except management team meetings. Staff told us they viewed this as a negative, as they had little opportunity to discuss their work practices, training needs and issues affecting the people they supported in collective way.

The service did not have clear management or governance systems in place. The provider had not always made the required notifications to the CQC.

People’s feedback had been sought by the provider in 2016. However there was no analysis of the information and it was unclear if action had been taken to resolve issues or concerns highlighted by people.